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Dangoisse V, Burzotta F, Kedev S, Bihin B. Guiding catheters for transradial approach: New designs and summary of experiences with VDL/VDR catheters. A novel score for PCI technical complexity. Cardiovasc Revasc Med 2021; 38:111-116. [PMID: 34456154 DOI: 10.1016/j.carrev.2021.08.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/13/2021] [Accepted: 08/16/2021] [Indexed: 11/24/2022]
Abstract
In one multicenter and several single-center studies involving 202 cases, new shapes of transradial access PCI guide catheters were tested following a standardized original protocol. The evaluation included a newly designed score for PCI complexity. Three operators successfully performed the 40 cases of the multicenter study, scoring intermediate to difficult 66% of the cases. New shapes were tested for left and right coronary artery and saphenous vein graft PCIs, with right or left transradial access. The new shapes performed adequately, including in 5F sizing. PCI success and fluoroscopy time were related to the score of complexity.
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Affiliation(s)
- Vincent Dangoisse
- Université catholique de Louvain, CHU UCL Namur, site Godinne, Cardiology Service, Yvoir, Belgium; CHAUR pavillon Ste Marie, Trois-Rivières, Qc, Canada.
| | - Francesco Burzotta
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Universita Cattolica del Sacro Cuore, Rome, Italy
| | - Sasko Kedev
- University Clinic of Cardiology, University St Cyril & Methodius, Skopje, Macedonia
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Schroeder E, Jamart J, Boutaghane W, Chenu P, Dangoisse V, Eucher P, Gabriel L, Guedes A, Hanet C, Lacour C, Paridaens O, Schank A, Buche M. P2694Long-term outcome after myocardial revascularisation by bilateral mammary grafting. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | | | | | - P Chenu
- CHU UCL Namur, Yvoir, Belgium
| | | | | | | | | | - C Hanet
- CHU UCL Namur, Yvoir, Belgium
| | | | | | | | - M Buche
- CHU UCL Namur, Yvoir, Belgium
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Higny J, Guédès A, Jamart J, Hanet C, Gabriel L, Dangoisse V, de Meester de Ravenstein C, Schroeder E. Early prognosis and predictor analysis for positive coronary angiography after out-of-hospital cardiac arrest (OHCA). Acta Cardiol 2018; 73:1-8. [PMID: 29336239 DOI: 10.1080/00015385.2017.1415403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 12/02/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Key predictors of survival after OHCA have been described in the literature. Current guidelines recommend emergency angiography in patients without an obvious extra-cardiac cause of arrest. However, the value of this strategy is debated. Moreover, diagnosis of acute coronary ischaemia after OHCA remains challenging, especially in patients without ST-segment elevation. OBJECTIVES The primary objective was to identify qualitative variables associated with an increased chance of 30-d survival after OHCA. The secondary objective was to identify predictors of 30-d survival among patients with ischaemic cardiomyopathy and patients without ST-segment elevation. Afterwards, we sought to identify parameters associated with acute coronary ischaemia and positive coronary angiography in patients without ST-segment elevation. METHODS Retrospective single-centre study including 123 patients resuscitated from OHCA. Baseline characteristics, resuscitation settings and angiographic findings were analysed. RESULTS The predictors of 30-d survival after OHCA included witnessed cardiac arrest, haemodynamic instability and coronary angiography. Convertible cardiac rhythm, history of coronary disease and presence of at least two cardiovascular risk factors were associated with acute coronary ischaemia. Predictors for a positive angiography in patients without ST-segment elevation included history of coronary disease, gender, diabetes, dyslipidaemia and presence of at least two cardiovascular risk factors (all p < .05). CONCLUSIONS We identified qualitative predictors of 30-day survival after OHCA. Our findings suggest that the recognition of acute coronary ischaemia after OHCA might be improved. The identification of risk criteria may help to select the best candidates for emergency angiography.
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Affiliation(s)
- Julien Higny
- a Service de Pathologie Cardiovasculaire , Cliniques Universitaires de Mont-Godinne , Yvoir , Belgique
| | - Antoine Guédès
- a Service de Pathologie Cardiovasculaire , Cliniques Universitaires de Mont-Godinne , Yvoir , Belgique
| | - Jacques Jamart
- b Unité de Support Scientifique , Cliniques Universitaires de Mont-Godinne , Yvoir , Belgique
| | - Claude Hanet
- a Service de Pathologie Cardiovasculaire , Cliniques Universitaires de Mont-Godinne , Yvoir , Belgique
| | - Laurence Gabriel
- a Service de Pathologie Cardiovasculaire , Cliniques Universitaires de Mont-Godinne , Yvoir , Belgique
| | - Vincent Dangoisse
- a Service de Pathologie Cardiovasculaire , Cliniques Universitaires de Mont-Godinne , Yvoir , Belgique
| | - Christophe de Meester de Ravenstein
- c Pôle de Recherche Cardiovasculaire , Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint-Luc , Bruxelles , Belgique
| | - Erwin Schroeder
- a Service de Pathologie Cardiovasculaire , Cliniques Universitaires de Mont-Godinne , Yvoir , Belgique
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Higny J, Guédès A, Gabriel L, Hanet C, Dangoisse V, Schröder E. Early prognosis and predictor analysis for positive coronary angiography after out-of-hospital cardiac arrest (OHCA). Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Dangoisse V, Guédès A, Chenu P, Hanet C, Albert C, Robin V, Tavier L, Dury C, Piraux O, Domange J, Jourdan K, Bihin B, Schroeder E. Usefulness of a Gentle and Short Hemostasis Using the Transradial Band Device after Transradial Access for Percutaneous Coronary Angiography and Interventions to Reduce the Radial Artery Occlusion Rate (from the Prospective and Randomized CRASOC I, II, and III Studies). Am J Cardiol 2017; 120:374-379. [PMID: 28577752 DOI: 10.1016/j.amjcard.2017.04.037] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2017] [Revised: 04/25/2017] [Accepted: 04/25/2017] [Indexed: 01/28/2023]
Abstract
The study sought to evaluate the benefit of the reduction in intensity and duration of the hemostasis obtained with the transradial (TR) Band compression device on the radial artery occlusion (RAO) rate. RAO is the most frequent complication of TR access for cardiac catheterization and limits future use of this safe route. Its occurrence must be minimized. Between 2009 and 2016, 3,616 TR accesses were randomized to TR Band hemostasis during 3 consecutive protocols: CRASOC I (Compression of Radial ArterieS without Occlusion): 13 versus 10 cc of air into the TR Band and for 4 hours of continuous compression; CRASOC II: 10 cc of air for 3 hours versus 2 hours of compression; and CRASOC III: 10 cc of air for 2 hours versus 1.5 hours of compression and virtual 4F introducer as default sheath (both arms). Radial artery patency was assessed by plethysmography at 24 hours, using Doppler for doubtful or negative plethysmography. The primary end point, 24 hours of RAO, was markedly reduced when hemostasis was soft (10 cc of air) and short (1.5 hours) and resulted in a 2.3% rate of RAO versus 9.4% for 13 cc, 4 hours. Hemostasis was obtained in 89% of patients with only 10 cc of air and in 97% of patients with less than the recommended 13 cc. About 8% of patients required more than the 1.5 hours of hemostasis time. In conclusion, short and soft hemostasis with the TR Band device leads to a low RAO rate.
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Affiliation(s)
- Vincent Dangoisse
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium.
| | - Antoine Guédès
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
| | - Patrick Chenu
- Université catholique de Louvain, Clinique St LUC UCL, Service de Cardiologie, Bruxelles, Belgium
| | - Claude Hanet
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
| | - Clara Albert
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
| | - Valérie Robin
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
| | - Laurence Tavier
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
| | - Christine Dury
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
| | - Olivier Piraux
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
| | - Juliette Domange
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
| | - Karine Jourdan
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
| | - Benoit Bihin
- Scientific Support Unit, CHU UCL Namur, Namur, Belgium
| | - Erwin Schroeder
- Université catholique de Louvain, CHU UCL Namur - Site Godinne, Cardiology Service, Yvoir, Belgium
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Orvin K, Carrie D, Richardt G, Desmet W, Assali A, Werner G, Ikari Y, Fujii K, Goicolea J, Dangoisse V, Manari A, Saito S, Wijns W, Kornowski R. Comparison of sirolimus eluting stent with bioresorbable polymer to everolimus eluting stent with permanent polymer in bifurcation lesions: Results from CENTURY II trial. Catheter Cardiovasc Interv 2015; 87:1092-100. [DOI: 10.1002/ccd.26150] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 07/21/2015] [Indexed: 11/10/2022]
Affiliation(s)
- K Orvin
- Cardiology Department; Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
| | - D. Carrie
- Department of Cardiology; University Toulouse-Rangueil Hospital; France
| | - G. Richardt
- Segeberger Kliniken GmbH; Bad Segeberg Germany
| | - W. Desmet
- Department of Cardiovascular Medicine; University Hospitals Leuven; Leuven Belgium
| | - A. Assali
- Cardiology Department; Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
| | - G. Werner
- Medizinische Klinik I; Klinikum Darmstadt GmbH; Darmstadt Germany
| | - Y. Ikari
- Department of Cardiology; Tokai University School of Medicine; Kanagawa Japan
| | - K. Fujii
- Department of Cardiology; Sakurabashi-Watanabe Hospital; Osaka Japan
| | - J. Goicolea
- Interventional Cardiology; Hospital Universitario Puerta De Hierro/Majadahonda; Madrid Spain
| | | | - A. Manari
- Department of Interventional Cardiology; Azienda Ospedaliera-IRCCS S. Maria Nuova; Viale Risorgimento Italy
| | - S. Saito
- Shonan Kamakura General Hospital; Kanagawa Japan
| | - W. Wijns
- Cardiovascular Centre Aalst; OLV Hospital; Belgium
| | - R. Kornowski
- Cardiology Department; Rabin Medical Center, Petah Tikva, Israel and Sackler Faculty of Medicine, Tel Aviv University; Tel Aviv Israel
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Slimani A, Hanet C, Jamart J, Gabriel L, Guedes A, Dangoisse V, Galanti LM, Schroeder E. Elevation of biomarkers and long-term outcome after percutaneous coronary intervention. Eur J Clin Invest 2014; 44:1116-20. [PMID: 25284363 DOI: 10.1111/eci.12347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 09/29/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES The impact of an elevation of cardiac biomarkers occurring after percutaneous coronary intervention (PCI) on long-term outcome remains controversial. Most available data are based on observational registries using multivariable analysis. In this study, a case-control approach was used to assess separately the impact of post-PCI elevation of CK-MB on the short-term in-hospital outcome and on the long-term outcome after hospital discharge. METHODS Between 1 January 1996 and 31 December 2008, a postprocedural rise of CK-MB was observed in 363 among 8346 consecutive PCI procedures (4·3%). The overall in-hospital mortality for patients with or without CK-MB elevation after PCI was 8·5% and 1·5%, respectively (P < 0·001). For 245 hospital survivors with CK-MB elevation, we found 245 control cases matched for 9 relevant clinical parameters in our PCI database during the same period. The long-term survival of these patients was assessed by KM estimates. RESULTS Despite an increased in-hospital mortality among patients with periprocedural elevation of CK-MB, the long-term outcome of patients who are discharged alive is independent of CK-MB release, curves of overall survival and of survival free of recurrence of myocardial infarction being similar up to 10 years after hospital discharge. CONCLUSIONS In our population, the elevation of CK-MB after PCI identified a high-risk subgroup for in-hospital mortality but had no impact on the long-term prognosis, once the patient is discharged alive from the hospital.
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Affiliation(s)
- Alisson Slimani
- Division of Cardiology, CHU Dinant Godinne, UCL Namur, Belgium
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Abstract
Delivery of coronary stents can be challenging, but the use of a second or ‘buddy’ wire helps the progression of equipment through tortuous and rigid vessels. We successfully positioned a coronary stent in a distal lesion, intentionally jailing the buddy wire during stent delivery. The jailed wire was then used to proceed further with proximal coronary stenting. We report 10 cases using either the jailed or the non-jailed wire for this modified ‘buddy-in-jail’ technique.
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Dangoisse V, Guédès A, Gabriel L, Jamart J, Chenu P, Marchandise B, Schroeder E. Full conversion from transfemoral to transradial approach for percutaneous coronary interventions results in a similar success rate and a rapid reduction of in-hospital cardiac and vascular major events. EUROINTERVENTION 2013; 9:345-52. [DOI: 10.4244/eijv9i3a56] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Muschart X, Slimani A, Jamart J, Chenu P, Dangoisse V, Gabriel L, Guédès A, Marchandise B, Schröder E. The different mechanisms of periprocedural myocardial infarction and their impact on in-hospital outcome. J Invasive Cardiol 2012; 24:655-660. [PMID: 23220981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND CK-MB levels exceeding 3 times the upper limit of normal (ULN) following percutaneous coronary intervention (PCI), defining periprocedural myocardial infarction (PMI), are associated with worse outcomes. This study assessed the incidence and mechanisms of PMI and their impact on in-hospital stay. METHODS AND RESULTS Over a 12-year period (1996-2007), 272 cases of PMI (overall incidence, 3.5%) were analyzed among 310 consecutive cases of periprocedural myocardial necrosis (PMN; CK-MB > ULN). Mean numbers of treated segments and stents per procedure were 1.87 ± 0.99 and 1.43 ± 1.01, respectively. Mean stent length per procedure was 29.50 ± 19.30 mm. Following analysis of angiogram, procedural data, delay between PCI and necrosis, and mechanisms of PMN were classified as follows: cryptogenic (by exclusion, 41.5%), immediate failure, side-branch occlusion (14.0% each), stent thrombosis (10.6%), prolonged ischemia (9.2%), delayed failure (8.1%), post coronary artery bypass graft (1.5%), and non-target lesion related MI (1.1%). Significantly more stents were used in stent thrombosis, prolonged ischemia during PCI, and cryptogenic cases. In-hospital mortality was 8.1% for PMN and 8.8% for periprocedural MI, decreasing from non-target lesion related MI (25.0%) to mechanisms linked to stent thrombosis (20.7%), immediate failure (17.5%), delayed failure (7.7%), cryptogenic causes (6.1%), and prolonged ischemia (3.4%). Multivariate analysis confirms that in-hospital mortality is influenced by stent thrombosis, age, ejection fraction, and extent of coronary artery disease. CONCLUSIONS The precise mechanism of PMI was determined in about 60% of our series. Stent thrombosis and immediate failure had the poorest in-hospital outcomes.
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Affiliation(s)
- Xavier Muschart
- Department of Cardiology, Université Catholique de Louvain, University Hospital of Mont-Godinne, Belgium, Av. Gaston Therasse, 15530 Yvoir, Belgium.
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Dangoisse V. TRANSRADIAL APPROACH FOR EVALUATION OF POST CORONARY ARTERY BYPASS GRAFT SURGERY PATIENTS: LEFT OR RIGHT RADIAL ARTERY WHEN BOTH MAMMARY ARTERIES ARE GRAFTED? J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60188-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dangoisse V, Guedes A, Chenu P, Jamart J, Gabriel L, Marchandise B, Albert C, Dury C, Schroeder E. RADIAL ARTERY PATENCY AFTER TRANSRADIAL ACCESS: EFFECTIVE AND EASY WAY TO REDUCE THE RADIAL ARTERY OCCLUSION RATE, RESULTS OF THE CRASOC (COMPRESSION OF RADIAL ARTERIES WITHOUT OCCLUSION) STUDY. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)60194-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gabriel L, Chenu P, Guédès A, Dangoisse V, Marchandise B, Blommaert D, Jamart J, De Roy L, Schroeder E. A possible association between Takotsubo cardiomyopathy and treatment with flecainide. Int J Cardiol 2011; 147:173-5. [DOI: 10.1016/j.ijcard.2010.12.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 12/04/2010] [Indexed: 11/26/2022]
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Guédès A, Dangoisse V, Gabriel L, Jamart J, Chenu P, Marchandise B, Schroeder E. Low rate of conversion to transfemoral approach when attempting both radial arteries for coronary angiography and percutaneous coronary intervention: a study of 1,826 consecutive procedures. J Invasive Cardiol 2010; 22:391-397. [PMID: 20814043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
AIMS Despite a proven safety profile, the transradial approach (TRA) for coronary procedures is regarded by many as complicated and the second-choice arterial access, with a high conversion rate to transfemoral access (TFA). This study reports causes of failure and the contemporary success rate of TRA when both radial arteries are attempted first before converting to TFA. METHODS This prospective, single-center study included 1,826 consecutive patients referred for cardiac catheterization, which was performed by two trained operators between January 2005 and June 2007. Procedural data were reported in a specific database. RESULTS The procedural success rate through TRA (attempting one or both radial arteries) was 98.8%. One hundred and thirty-five radial attempts failed. Inability to puncture or to wire the artery accounted for 52.6% of failures, inability to reach coronary or graft ostia accounted for 20.7% and the remaining failures were related to the inability to reach a contralateral mammary graft. By multivariate analysis, the best predictors for failures were peripheral artery disease (PAD) (odds ratio [OR] 1.8, 95% confidence interval [CI] 1.1-2.8; p = 0.016), bedside clinical assessment of either a "small radial artery" size (OR 2.6, 95% CI 1.4 to 5.0; p = 0.003) or a "difficult access" (OR 2.5, 95% CI 1.3-4.9; p = 0.006). The number of failed attempts regresses annually by about 40% (OR 0.6, 95% CI 0.4-0.8; p < 0.001), thus demonstrating a continuous learning curve. Although rare, hematoma combined with swelling (3.8%) arises more frequently in females (OR 2.4, 95% CI 1.4-3.9; p = 0.001) and elderly patients (OR 1.9, 95% CI 1.0- 3.7; p = 0.040). CONCLUSION The TRA can be safely proposed for all patients, with a low conversion rate to TFA when an attempt on both radial arteries is considered first.
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Affiliation(s)
- Antoine Guédès
- University of Louvain, Division of Cardiovascular Medicine, Cliniques Universitaires de Mont-Godinne, Yvoir, Belgium.
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Dangoisse V. Gentleman, rebel and believer: the radial way. Indian Heart J 2010; 62:202-205. [PMID: 21275292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
The manuscript highlights some historic milestones of the universal trans-radial approach (TRA) and describes some characteristics that "radialists" share (at least in the author's opinion). The author argues against common misconceptions about the TRA, like the use of more iodine contrast, more X-ray exposition, a lower rate of successful angioplasty. Data illustrating the conversion from a trans-femoral approach catheterization laboratory to a complete TRA laboratory are presented, showing the speed of the switch and the rapid clinical benefit observed. The author concludes with possible future directions for TRA supporters, on how to optimize the material for the puncture step, how to reduce the radial occlusion rate and how to promote the TRA as the first access for acute coronary syndromes managed invasively.
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Affiliation(s)
- Vincent Dangoisse
- Departement Cardiovasculaire Cliniques Universitaires U.C.L. de Mont-Godinne, Yvoir, Belgium.
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Schroeder E, Faes D, Jamart J, Chenu P, Dangoisse V, Evrard P, Gabriel L, Guedes A, Marchandise B, Morandini E, Muller A, Paquay JL, Perot G. THE IMPACT OF VASCULAR ACCESS SITE COMPLICATIONS ON ONE-YEAR OUTCOME IN THE SETTING OF PCI : A REAPPRAISAL. J Am Coll Cardiol 2010. [DOI: 10.1016/s0735-1097(10)61257-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
The susceptibility to oxidation of freshly isolated LDL from healthy normolipidemic individuals in three age groups was estimated by exposure of LDL to ionizing radiation followed by analyses of vitamin E, TBARS, conjugated dienes, and fluorescent products. The results clearly showed that LDL from elderly subjects was the most susceptible to oxidative damage in vitro. In particular, the greater susceptibility of LDL from elderly subjects in comparison to that from young subjects may be attributed to the much lower (4-fold) concentration of LDL vitamin E in the elderly subjects. The present study reinforces the notion that the susceptibility of LDL to oxidation increases with age.
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Affiliation(s)
- A Khalil
- Department of Internal Medicine, Faculté de Médecine, Institut Universitaire de Gériatrie, Sherbrooke, Qué, Canada
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Dangoisse V. Optimizing the treatment of acute myocardial infarction. J Thromb Thrombolysis 1995. [DOI: 10.1007/bf01063160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Anderson JL, Sorensen SG, Moreno FL, Hackworthy RA, Browne KF, Dale HT, Leya F, Dangoisse V, Eckerson HW, Marder VJ. Multicenter patency trial of intravenous anistreplase compared with streptokinase in acute myocardial infarction. The TEAM-2 Study Investigators. Circulation 1991; 83:126-40. [PMID: 1984877 DOI: 10.1161/01.cir.83.1.126] [Citation(s) in RCA: 59] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Thrombolytic therapy has been shown to improve clinical outcome when administered early after the onset of symptoms of acute myocardial infarction; the mechanism of benefit is believed to be reestablishment and maintenance of coronary artery patency. Anistreplase is a second generation thrombolytic agent that is easily administered and has a long duration of action. To compare anistreplase (30 units/2-5 min) and therapy with the Food and Drug Administration-approved regimen of intravenous streptokinase (1.5 million units/60 min), a randomized, double-blind, multicenter patency trial was undertaken in 370 patients less than 76 years of age with electrocardiographic ST segment elevation who could be treated within 4 hours of symptom onset. Coronary patency was determined by reading, in a blinded fashion, angiograms obtained early (90-240 minutes; mean, 140 minutes) and later (18-48 hours; mean, 28 hours) after beginning therapy. Early total patency (defined as Thrombolysis in Myocardial Infarction grade 2 or 3 perfusion) was high after both anistreplase (132/183 = 72%) and streptokinase (129/176 = 73%) therapy, and overall patency patterns were similar, although patent arteries showed "complete" (grade 3) perfusion more often after anistreplase (83%) than streptokinase (72%) (p = 0.03). Similarly, residual coronary stenosis, determined quantitatively by a validated computer-assisted method, was slightly less in patent arteries early after anistreplase (mean stenosis diameter, 74.0%) than streptokinase (77.2%, p = 0.02). In patients with patent arteries without other early interventions, reocclusion risk within 1-2 days was defined angiographically and found to be very low (anistreplase = 1/96, streptokinase = 2/94). Average coronary perfusion grade was greater, and percent residual stenosis was less, at follow-up than on initial evaluation and did not differ between treatment groups. Enzymatic and electrocardiographic evolution was not significantly different in the two groups. Despite rapid injection, anistreplase was associated with only a small (4-5 mm Hg), transient (at 5-10 minutes) mean differential fall in blood pressure. In-hospital mortality rates were comparable for anistreplase and streptokinase (5.9%, 7.1%). Stroke occurred in one (0.5%) and three (1.6%) patients, respectively; one stroke was hemorrhagic. Other serious bleeding events and adverse experiences occurred uncommonly and with similar frequency in the two groups. Thus, for the end points of our study (patency, safety), anistreplase and streptokinase showed overall favorable and relatively comparable outcomes, with a few differences.(ABSTRACT TRUNCATED AT 400 WORDS)
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Affiliation(s)
- J L Anderson
- Department of Medicine, University of Utah, Salt Lake City
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Affiliation(s)
- V Dangoisse
- Department of Medicine, Centre Hospitalier Universitaire, Sherbrooke, Quebec, Canada
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Corcos T, David PR, Val PG, Renkin J, Dangoisse V, Rapold HG, Bourassa MG. Failure of diltiazem to prevent restenosis after percutaneous transluminal coronary angioplasty. Am Heart J 1985; 109:926-31. [PMID: 3158187 DOI: 10.1016/0002-8703(85)90231-5] [Citation(s) in RCA: 196] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
This prospective randomized trial was carried out in 92 patients who underwent a successful percutaneous transluminal coronary angioplasty (PTCA) and had no evidence of coronary spasm before PTCA. All patients were premedicated with calcium antagonists and platelet inhibitors and received platelet inhibitors (aspirin and dipyridamole) for 6 months after PTCA. The diltiazem group (46 patients with 50 stenoses successfully dilated) received diltiazem, 90 mg three times a day by mouth for 3 months after PTCA; in the control group (46 patients, 53 stenoses), calcium antagonists were discontinued immediately after PTCA. All patients underwent a control angiogram 5 to 10 months after PTCA unless recurrence of angina dictated its need earlier. Baseline characteristics were similar in both groups, except for the number of diseased vessels greater than or equal to 70%, which was higher in the control group (1.2 +/- 0.55 vs 0.9 +/- 0.39 for the diltiazem group, p less than 0.05). In the diltiazem group, the degree of stenosis increased from 38 +/- 15% immediately after PTCA to 42 +/- 23% at repeat angiography 8.24 +/- 4.79 months after PTCA and there were seven restenoses. In the control group, the degree of stenosis increased from 37 +/- 12% to 44 +/- 23% at repeat angiography 8.26 +/- 4.91 months after PTCA and there were 10 restenoses (NS vs the diltiazem group). In conclusion, in patients without variant angina before PTCA, adjunction of diltiazem to platelet inhibitors does not decrease the incidence of restenosis. These data suggest that coronary spasm is not the major mechanism of restenosis.
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Abstract
Four years after mediastinal radiation for Hodgkin's lymphoma, a 32-year-old man developed angina at rest and with varying levels of physical activity. At coronary arteriography, 40 percent to 50 percent stenoses were seen in the left coronary artery; ergonovine induced severe coronary spasm. Treatment with diltiazem eliminated all anginal attacks.
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