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Background: Multiple imaging modalities are currently available to confirm diagnosis of acute aortic dissection. Each modality has certain advantages and disadvantages with respect to accuracy, speed, convenience, risk and cost. Recently, studies have argued that TEE and MRI should emerge as the most expeditious (TEE) and accurate (MRI) tools for this purpose.Methods and Results: One hundred and...
ABACAS (Adjunctive Balloon Angioplasty Following Coronary Atherectomy Study) is a prospective randomized multicenter trial to study whether aggressive debulking with IVUS-guided DCA followed by adjunctive balloon dilatation reduces restenosis. Restenosis rates were 23.6% for adjunctive balloon and 19.6% for DCA alone (n.s.). To elucidate the influence of deep wall resection and adjunctive balloon...
To assess the mechanisms of late arterial response to directional atherctomy (DCA), we analyzed serial intravascular ultrasound (IVUS) measurements in the subset of Adjunctive Balloon Angioplasty Following Coronary Atherectomy Study (ABACAS).Methods: In 39 pts out of 214 pts, who were randomized to DCA alone or to DCA with adjunctive PTCA, prospective serial IVUS was performed at pre and post-procedure,...
We have already reported the efficacy of tranilast on prevention of restenosis following percutaneous translumional coronary angioplasty (PTCA) in the multicenter study (TREAT-2). In the study, we also analized the difference of the responses on de novo lesions or restenosis lesions following PTCA. Tranilast was given 600 mg per day over 8 weeks after successful PTCA and followup angiograms were...
Background: The REstenosis ReDUction by Cutting Balloon Evaluation (REDUCE) is a prospective multicenter (44 Japaneses sites) registry to assess the efficacy of Cutting Balloon (CB).Methods: Total target registry is 800 patients, who are randomly assigned to either CB or conventional balloon angioplasty (POBA). At present, preliminary acute results are available for 208 patients out of a 460 patient...
Background: The Cutting Balloon (CB) is a novel dilation device that longitudinally incises the coronary plaque during balloon dilation. This incision limits the degree of arterial trauma associated with balloon dilation, potentially reducing the late injury response compared with plain old balloon angioplasty (POBA).Methods: To evaluate the restenosis mechanism of CB in comparison with POBA, We...
Recent advances in management, especially imaging modalities and surgical techniques, have altered the care of acute aortic dissection (AoD). To assess presentation, management and outcomes of AoD in the modern era, 175 patients (pts) with AoD, (mean age 62 years, 67% male, 61% type A), were enrolled at 10 centers in 1996. By history, 83% pts had abrupt onset of pain, more often sharp than tearing...
Concern has been raised about the risk of early (=<9 mos) cardiac death (ECD) after patient (pt) discharge from hospital after percutaneous rx of unprotected left main stenoses (ULMS). To evaluate the incidence and correlates of ECD we queried a registry of 262 consecutively treated pts from 25 centers rx'd since 194. Pts with definite non-cardiac cause !of death were excluded (n = 4). 9% of...
Background: The optimal modality for stent restenosis remains unestablished. Cutting balloon angioplasty (CBA) is a strategy to reduce tissue injury and vessel stretch.Method: To clarify the efficacy and long-term outcomes of CBA for stent restenosis, we analyzed 167 lesions treated by CBA from 9 centers. Until August 1997, clinical and angiographic follow-up has completed in 80% and 72%, respectively...
Encouraging results from modest series of patients (pts) have been reported for both directional atherectomy (DCA) and stents (S) used to treat pts with unprotected left main stenoses (ULMS). To compare their relative benefit we queried a registry of 229 non acute MI consecutively treated ULMS pts from 25 centers treated since 194. Follow-up angio was 75% complete at 6 +/- 3 mos.After adjusting...
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