Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
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Catheter Cardiovasc Interv · Feb 2008
Comparative StudyThe prognostic value of combined intracoronary pressure and blood flow velocity measurements after deferral of percutaneous coronary intervention.
We evaluated deferral of PCI of intermediate coronary lesions (IL) using fractional (FFR) and coronary flow reserve (CFR) hyperemic stenosis resistance index (HSR) in patients with a negative or nondiagnostic and noninvasive stress tests. ⋯ Abnormal FFR or abnormal CFR was documented in 31% of intermediate coronary lesions. Deferral of PCI in this group was associated with a high MACE rate, which underscores the rationale of combined pressure and flow measurements providing a stenosis resistance index that is better suited for clinical decision making in these lesions.
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Catheter Cardiovasc Interv · Feb 2008
Case ReportsBidirectional manipulation facilitating percutaneous retrieval of Swan-Ganz catheter entrapped in tricuspid valve apparatus.
We present a case of a 69-year-old male patient who, after uneventful coronary artery bypass grafting, had a Swan-Ganz catheter entrapped in the tricuspid apparatus. An original technique to remove the catheter percutaneously was used after unsuccessful attempts using a conventional lasso technique.
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Catheter Cardiovasc Interv · Feb 2008
An analysis of door-to-balloon time in a single center to determine causes of delay and possibilities for improvement.
We analyzed door-to-balloon times in our institution to identify those factors which significantly prolong time to treatment in ST elevation myocardial infarction (STEMI). ⋯ In our center, transport time and on-call hour delays account for the majority of reperfusion delay. Other factors that influenced delay were atypical presentation without chest pain, borderline ST changes, or delayed presentation. Thus, transfer from an outside facility, presentation after working hours, and having a difficult diagnosis all influence the rapidity of treatment. The implementation of an in-house STEMI response team may reduce the process induced delays and improve door-to-balloon times.
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Catheter Cardiovasc Interv · Feb 2008
Cutting balloon angioplasty for resistant venous stenoses of dialysis access: immediate and patency results.
To evaluate the technical success, safety and patency of cutting balloon angioplasty for the treatment of resistant dialysis access stenoses. ⋯ For resistant venous stenoses of dialysis access, cutting balloon PTA is effective, safe, and seems to provide comparative primary patency as suggested by guidelines.
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Catheter Cardiovasc Interv · Jan 2008
ReviewUse of multislice CT for the evaluation of emergency room patients with chest pain: the so-called "triple rule-out".
Recent advances in computed tomography (CT) technology have made high resolution noninvasive coronary angiograms possible. Multiple studies involving over 2,000 patients have established that coronary CT angiography (CCTA) is highly accurate for delineation of the presence and severity of coronary atherosclerosis. The high negative predictive value (>95%) found in these studies suggests that CCTA is an attractive option for exclusion of coronary artery disease in properly selected emergency department patients with acute chest pain. ⋯ Recent technical developments now permit acquisition of well-opacified images of the coronary arteries, thoracic aorta and pulmonary arteries from a single CT scan. While this so called "triple-rule out" scan protocol can potentially exclude fatal causes of chest pain in all three vascular beds, the attendant higher radiation dose of this method precludes its routine use except when there is sufficient support for the diagnosis of either aortic dissection or pulmonary embolism. This article provides an overview of CCTA, and reviews the clinical evidence supporting the use of this technique for triage of patients with acute chest pain.