11 results on '"Maiello P"'
Search Results
2. Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance.
- Author
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Colombo, Antonio, Hall, Patrick, Nakamura, Shigeru, Almagor, Yaron, Maiello, Luigi, Martini, Giovanni, Gaglione, Antonio, Goldberg, Steven L, and Tobis, Jonathan M
- Subjects
Patient Safety ,Heart Disease - Coronary Heart Disease ,Biomedical Imaging ,Clinical Research ,Cardiovascular ,Assistive Technology ,Bioengineering ,Atherosclerosis ,Heart Disease ,Hematology ,Adult ,Aged ,Angioplasty ,Balloon ,Coronary ,Aspirin ,Catheterization ,Coronary Angiography ,Coronary Disease ,Coronary Thrombosis ,Coronary Vessels ,Female ,Follow-Up Studies ,Humans ,Male ,Middle Aged ,Stents ,Ticlopidine ,Ultrasonography ,STENTS ,ULTRASONICS ,BALLOON ,PLATELETS ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Public Health and Health Services ,Cardiovascular System & Hematology - Abstract
BackgroundThe placement of stents in coronary arteries has been shown to reduce restenosis in comparison to balloon angioplasty. However, clinical use of intracoronary stents is impeded by the risk of subacute stent thrombosis and complications associated with the anticoagulant regimen. To reduce these complications, the hypothesis that systemic anticoagulation is not necessary when adequate stent expansion is achieved was prospectively evaluated on a consecutive series of patients who received intracoronary stents.Methods and resultsFrom March 1993 to January 1994, 359 patients underwent Palmaz-Schatz coronary stent insertion. After an initial successful angiographic result with < 20% stenosis by visual estimation had been achieved, intravascular ultrasound imaging was performed. Further balloon dilatation of the stent was guided by observation of the intravascular ultrasound images. All patients with adequate stent expansion confirmed by ultrasound were treated only with antiplatelet therapy (either ticlopidine for 1 month with short-term aspirin for 5 days or only aspirin) after the procedure. Clinical success (procedure success without early postprocedural events) at 2 months was achieved in 338 patients (94%). With an inflation pressure of 14.9 +/- 3.0 atm and a balloon-to-vessel ratio of 1.17 +/- 0.19, optimal stent expansion was achieved in 321 of the 334 patients (96%) who underwent intravascular ultrasound evaluation, with these patients receiving only antiplatelet therapy after the procedure. Despite the absence of anticoagulation, there were only two acute stent thromboses (0.6%) and one subacute stent thrombosis (0.3%) at 2-month clinical follow-up. Follow-up angiography at 3 to 6 months documented two additional occlusions (0.6%) at the stent site. At 6-month clinical follow-up, angiographically documented stent occlusion had occurred in 5 patients (1.6%). At 6-month clinical follow-up, there was a 5.7% incidence of myocardial infarction, a 6.4% rate of coronary bypass surgery, and a 1.9% incidence of death. Emergency intervention (emergency angioplasty or bailout stent) for a stent thrombosis event was performed in 3 patients (0.8%). The overall event rate was relatively high because of intraprocedural complications that occurred in 16 patients (4.5%). Intraprocedural complications, however, decreased to 1% when angiographically appropriately sized balloons were used for final stent dilations. There was one ischemic vascular complication that occurred at the time of the procedure and one ischemic vascular complication that occurred at the time of angiographic follow-up. By 6 months, repeat angioplasty for symptomatic restenosis was performed in 47 patients (13.1%).ConclusionsThe Palmaz-Schatz stent can be safely inserted in coronary arteries without subsequent anticoagulation provided that stent expansion is adequate and there are no other flow-limiting lesions present. The use of high-pressure final balloon dilatations and confirmation of adequate stent expansion by intravascular ultrasound provide assurance that anticoagulation therapy can be safely omitted. This technique significantly reduces hospital time and vascular complications and has a low stent thrombosis rate.
- Published
- 1995
3. Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance.
- Author
-
Colombo, A, Hall, P, Nakamura, S, Almagor, Y, Maiello, L, Martini, G, Gaglione, A, Goldberg, SL, and Tobis, JM
- Subjects
Coronary Vessels ,Humans ,Coronary Disease ,Coronary Thrombosis ,Aspirin ,Ticlopidine ,Coronary Angiography ,Ultrasonography ,Catheterization ,Follow-Up Studies ,Stents ,Adult ,Aged ,Middle Aged ,Female ,Male ,Angioplasty ,Balloon ,Coronary ,STENTS ,ULTRASONICS ,BALLOON ,PLATELETS ,Angioplasty ,Balloon ,Coronary ,Cardiovascular System & Hematology ,Clinical Sciences ,Cardiorespiratory Medicine and Haematology ,Public Health and Health Services - Abstract
BackgroundThe placement of stents in coronary arteries has been shown to reduce restenosis in comparison to balloon angioplasty. However, clinical use of intracoronary stents is impeded by the risk of subacute stent thrombosis and complications associated with the anticoagulant regimen. To reduce these complications, the hypothesis that systemic anticoagulation is not necessary when adequate stent expansion is achieved was prospectively evaluated on a consecutive series of patients who received intracoronary stents.Methods and resultsFrom March 1993 to January 1994, 359 patients underwent Palmaz-Schatz coronary stent insertion. After an initial successful angiographic result with < 20% stenosis by visual estimation had been achieved, intravascular ultrasound imaging was performed. Further balloon dilatation of the stent was guided by observation of the intravascular ultrasound images. All patients with adequate stent expansion confirmed by ultrasound were treated only with antiplatelet therapy (either ticlopidine for 1 month with short-term aspirin for 5 days or only aspirin) after the procedure. Clinical success (procedure success without early postprocedural events) at 2 months was achieved in 338 patients (94%). With an inflation pressure of 14.9 +/- 3.0 atm and a balloon-to-vessel ratio of 1.17 +/- 0.19, optimal stent expansion was achieved in 321 of the 334 patients (96%) who underwent intravascular ultrasound evaluation, with these patients receiving only antiplatelet therapy after the procedure. Despite the absence of anticoagulation, there were only two acute stent thromboses (0.6%) and one subacute stent thrombosis (0.3%) at 2-month clinical follow-up. Follow-up angiography at 3 to 6 months documented two additional occlusions (0.6%) at the stent site. At 6-month clinical follow-up, angiographically documented stent occlusion had occurred in 5 patients (1.6%). At 6-month clinical follow-up, there was a 5.7% incidence of myocardial infarction, a 6.4% rate of coronary bypass surgery, and a 1.9% incidence of death. Emergency intervention (emergency angioplasty or bailout stent) for a stent thrombosis event was performed in 3 patients (0.8%). The overall event rate was relatively high because of intraprocedural complications that occurred in 16 patients (4.5%). Intraprocedural complications, however, decreased to 1% when angiographically appropriately sized balloons were used for final stent dilations. There was one ischemic vascular complication that occurred at the time of the procedure and one ischemic vascular complication that occurred at the time of angiographic follow-up. By 6 months, repeat angioplasty for symptomatic restenosis was performed in 47 patients (13.1%).ConclusionsThe Palmaz-Schatz stent can be safely inserted in coronary arteries without subsequent anticoagulation provided that stent expansion is adequate and there are no other flow-limiting lesions present. The use of high-pressure final balloon dilatations and confirmation of adequate stent expansion by intravascular ultrasound provide assurance that anticoagulation therapy can be safely omitted. This technique significantly reduces hospital time and vascular complications and has a low stent thrombosis rate.
- Published
- 1995
4. Clinical Feasibility of an 0.018" lntravascular Ultrasound Imaging Device
- Author
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Tobis, Jonathan, Hall, Patrick, Maiello, Luigi, ltoh, Akira, Jang, Yue-Teh, Salmon, Steve, and Colombo, Antonio
- Subjects
Ultrasound ,Cardiovascular ,Stent ,Imaging ,Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Sports science and exercise - Abstract
lntravascular ultrasound imaging (IVUS) is limited by the size of the imaging catheter. To facilitate imaging prior to and during interventions, a 30 MHz ultrasonic imaging device was developed that is the same dimension as an 0.018" guidewire. This imaging core was tested in 8 patients with the use of a monorail guiding sheath that was advanced through a 7Fr catheter. In addition, the standard guidewire was removed and the imaging core was placed inside a compatible balloon and imaging was performed following 6 coronary interventions. The mean lumen CSA was 6.8 ± 3.2 mm2. The lumenplaque interface and the media-plaque interface were clearly visualized in all patients. In 4 patients, imaging was also performed with a standard 2.9 Fr IVUS catheter. There was no detectable loss in image quality between the new imaging device and the larger IVUS catheter, and measurements of lumen CSA were not statistically different.Conclusions: Improvements in manufacturing technology have permited the development of a mechanically rotating ultrasound imaging core which is 0.018" in diameter. It is compatible with current balloon catheters without degradation of image quality.
- Published
- 1995
5. IN-VIVO EVIDENCE THAT PALMAZ-SCHATZ STENTS DO NOT RECOIL IMMEDIATELY FOLLOWING DEPLOYMENT
- Author
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HALL, P, MAIELLO, L, COLOMBO, A, ITOH, A, JANG, YT, SALMON, S, and TOBIS, J
- Subjects
Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Sports science and exercise - Published
- 1995
6. CLINICAL FEASIBILITY OF AN 0.018-INCH INTRAVASCULAR ULTRASOUND IMAGING DEVICE
- Author
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TOBIS, J, HALL, P, MAIELLO, L, ITOH, A, JANG, YT, SALMON, S, and COLOMBO, A
- Subjects
Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Public Health and Health Services ,Cardiovascular System & Hematology - Published
- 1995
7. Intracoronary ultrasound observations during stent implantation.
- Author
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Nakamura, S, Colombo, A, Gaglione, A, Almagor, Y, Goldberg, SL, Maiello, L, Finci, L, and Tobis, JM
- Subjects
Coronary Vessels ,Humans ,Coronary Disease ,Coronary Angiography ,Ultrasonography ,Interventional ,Equipment Design ,Stents ,Image Processing ,Computer-Assisted ,Middle Aged ,Female ,Male ,Angioplasty ,Balloon ,Coronary ,Cardiovascular System & Hematology ,Clinical Sciences ,Cardiorespiratory Medicine and Haematology ,Public Health and Health Services - Published
- 1994
8. HAS THE INTRODUCTION OF INTRAVASCULAR ULTRASOUND GUIDANCE LED TO DIFFERENT CLINICAL-RESULTS IN THE DEPLOYMENT OF INTRACORONARY STENTS
- Author
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GOLDBERG, SL, COLOMBO, A, ALMAGOR, Y, HALL, P, MAIELLO, L, NAKAMURA, S, and TOBIS, JM
- Subjects
Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Sports science and exercise - Published
- 1994
9. INTRAVASCULAR ULTRASOUND CRITERIA FOR SUCCESSFUL STENT DEPLOYMENT
- Author
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NAKAMURA, S, COLOMBO, A, GAGLIONE, A, GOLDBERG, SL, ALMAGOR, Y, MAIELLO, L, BARRIONE, M, FINCI, L, and TOBIS, JM
- Subjects
Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Sports science and exercise - Published
- 1993
10. CAN INTRAVASCULAR ULTRASOUND IMPROVE CORONARY STENT DEPLOYMENT
- Author
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GOLDBERG, SL, COLOMBO, A, ALMAGOR, Y, MAIELLO, L, GAGLIONE, A, NAKAMURA, S, and TOBIS, JM
- Subjects
Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Sports science and exercise - Published
- 1993
11. CORONARY STENTING GUIDED BY INTRAVASCULAR ULTRASOUND
- Author
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NAKAMURA, S, COLOMBO, A, GAGLIONE, A, ALMAGOR, Y, GOLDBERG, SL, MAIELLO, L, FINCI, L, RIZZON, P, and TOBIS, JM
- Subjects
Cardiorespiratory Medicine and Haematology ,Clinical Sciences ,Public Health and Health Services ,Cardiovascular System & Hematology ,Cardiovascular medicine and haematology ,Clinical sciences ,Sports science and exercise - Published
- 1993
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