37 results on '"Orford JL"'
Search Results
2. Outcome of patients undergoing balloon angioplasty in the two months prior to noncardiac surgery.
- Author
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Brilakis ES, Orford JL, Fasseas P, Wilson SH, Melby S, Lennon RJ, and Berger PB
- Published
- 2005
- Full Text
- View/download PDF
3. Clinical outcome of patients undergoing non-cardiac surgery in the two months following coronary stenting.
- Author
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Wilson SH, Fasseas P, Orford JL, Lennon RJ, Horlocker T, Charnoff NE, Melby S, Berger PB, Wilson, Stephanie H, Fasseas, Panayotis, Orford, James L, Lennon, Ryan J, Horlocker, Terese, Charnoff, Nina E, Melby, Steven, and Berger, Peter B
- Abstract
Objectives: We sought to determine the frequency and timing of complications at our institution when surgery was performed within two months of coronary stent placement.Background: The optimal delay following coronary stent placement prior to non-cardiac surgery is unknown.Methods: We analyzed the Mayo Clinic Percutaneous Coronary Intervention and Surgical databases between 1990 and 2000 and identified 207 patients who underwent surgery in the two months following successful coronary stent placement.Results: Eight patients (4.0%) died or suffered a myocardial infarction or stent thrombosis. All 8 patients were among the 168 patients (4.8%, 95% confidence interval [CI] 2.1 to 9.2) undergoing surgery six weeks after stent placement; the frequency of these events ranged from 3.8% to 7.1% per week during each of the six weeks. No events occurred in the 39 patients undergoing surgery seven to nine weeks after stent placement (0%, 95% CI 0.0 to 9.0).Conclusions: These data suggest that, whenever possible, non-cardiac surgery should be delayed six weeks after stent placement, by which time stents are generally endothelialized, and a course of antiplatelet therapy to prevent stent thrombosis has been completed. [ABSTRACT FROM AUTHOR]- Published
- 2003
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4. Two cases of pericardial tamponade due to nitinol wire fracture of a gore septal occluder.
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Kumar P, Orford JL, and Tobis JM
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- Adult, Cardiac Tamponade diagnostic imaging, Cardiac Tamponade surgery, Device Removal, Female, Foramen Ovale, Patent complications, Foramen Ovale, Patent diagnostic imaging, Heart Atria diagnostic imaging, Heart Atria surgery, Heart Injuries diagnostic imaging, Heart Injuries surgery, Humans, Middle Aged, Prosthesis Design, Treatment Outcome, Cardiac Catheterization adverse effects, Cardiac Catheterization instrumentation, Cardiac Tamponade etiology, Foramen Ovale, Patent therapy, Heart Atria injuries, Heart Injuries etiology, Prosthesis Failure, Septal Occluder Device
- Abstract
Percutaneous patent foramen ovale (PFO) closure is recommended for secondary prevention of paradoxical embolism through a PFO. In the United States, two Food and Drug Administration-approved PFO closure devices are currently available, and the choice depends on operator preference and PFO anatomy. Although these devices are easy to implant, there are several potential complications. As opposed to the Amplatzer PFO Occluder, there has been no published case of atrial erosion with Gore closure devices. This report describes two cases of pericardial tamponade due to perforation of the atrial wall induced by a wire frame fracture of the Gore Helex and Cardioform devices., (© 2019 Wiley Periodicals, Inc.)
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- 2020
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5. The initial U.S. experience with the Tempo active fixation temporary pacing lead in structural heart interventions.
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Nazif TM, Chen S, Codner P, Grossman PM, Menees DS, Sanchez CE, Yakubov SJ, White J, Kapadia S, Whisenant BK, Forrest JK, Krishnaswamy A, Arshi A, Orford JL, Leon MB, Dizon JM, Kodali SK, and Chetcuti SJ
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- Aged, Aged, 80 and over, Equipment Design, Female, Heart Rate, Humans, Male, Patient Safety, Perioperative Care adverse effects, Registries, Retrospective Studies, Risk Assessment, Risk Factors, Time Factors, Treatment Outcome, United States, Ventricular Function, Right, Cardiac Pacing, Artificial adverse effects, Cardiac Surgical Procedures adverse effects, Pacemaker, Artificial, Perioperative Care instrumentation
- Abstract
Objectives: This multicenter retrospective study of the initial U.S. experience evaluated the safety and efficacy of temporary cardiac pacing with the Tempo® Temporary Pacing Lead., Background: Despite increasing use of temporary cardiac pacing with the rapid growth of structural heart procedures, temporary pacing leads have not significantly improved. The Tempo lead is a new temporary pacing lead with a soft tip intended to minimize the risk of perforation and a novel active fixation mechanism designed to enhance lead stability., Methods: Data from 269 consecutive structural heart procedures were collected. Outcomes included device safety (absence of clinically significant cardiac perforation, new pericardial effusion, or sustained ventricular arrhythmia) and efficacy (clinically acceptable pacing thresholds with successful pace capture throughout the index procedure). Postprocedure practices and sustained lead performance were also analyzed., Results: The Tempo lead was successfully positioned in the right ventricle and achieved pacing in 264 of 269 patients (98.1%). Two patients (0.8%) experienced loss of pace capture. Procedural mean pace capture threshold (PCT) was 0.7 ± 0.8 mA. There were no clinically significant perforations, pericardial effusions, or sustained device-related arrhythmias. The Tempo lead was left in place postprocedure in 189 patients (71.6%) for mean duration of 43.3 ± 0.7 hr (range 2.5-221.3 hr) with final PCT of 0.84 ± 1.04 mA (n = 80). Of these patients, 84.1% mobilized out of bed with no lead dislodgment., Conclusion: The Tempo lead is safe and effective for temporary cardiac pacing for structural heart procedures, provides stable peri and postprocedural pacing and allows mobilization of patients who require temporary pacing leads., (© 2019 Wiley Periodicals, Inc.)
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- 2020
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6. A new ST-segment elevation myocardial infarction equivalent pattern? Prominent T wave and J-point depression in the precordial leads associated with ST-segment elevation in lead aVr.
- Author
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Goebel M, Bledsoe J, Orford JL, Mattu A, and Brady WJ
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- Humans, Male, Middle Aged, Myocardial Infarction physiopathology, Electrocardiography, Myocardial Infarction diagnosis
- Abstract
Certain acute coronary syndrome electrocardiographic (ECG) patterns, which do not include ST-segment elevation, are indicative of acute coronary syndrome caused by significant arterial occlusion; these patterns are, of course, associated with significant risk to the patient and mandate a rapid response from the health care team. One such high-risk ECG pattern includes the association of the prominent T wave and J-point depression producing ST-segment depression seen in the precordial leads coupled with ST-segment elevation in lead aVr. This ECG presentation is associated with significant left anterior descending artery obstruction. We report the case of a patient with this ECG presentation who progressed over a very short time to ST-segment elevation myocardial infarction of the anterior wall.
- Published
- 2014
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7. Can N-acetylcysteine reverse the antiplatelet effects of clopidogrel? An in vivo and vitro study.
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Campbell CL, Berger PB, Nuttall GA, Orford JL, Santrach PJ, Oliver WC, Ereth MH, Thompson CM, Murphy MK, McGlassen DL, Schrader LM, and Steinhubl SR
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- Clopidogrel, Drug Interactions, Humans, Prospective Studies, Ticlopidine antagonists & inhibitors, Acetylcysteine pharmacology, Platelet Aggregation drug effects, Platelet Aggregation Inhibitors pharmacology, Ticlopidine analogs & derivatives
- Abstract
Background: The active metabolite of clopidogrel binds the P2Y12 ADP receptor on the platelet surface via a disulfide bond. N-Acetylcysteine (NAC) is able to reduce disulfide bonds. We postulated that NAC might reverse clopidogrel's effect on platelets., Methods: Two groups of patients were investigated. Group 1 included 11 patients with stable coronary disease who, after discontinuation of aspirin, received 14 days of clopidogrel, 75 mg/day. Bleeding time and whole-blood platelet aggregometry (with 5 micromol/L ADP) were compared before and after the 14 days. Patients were then treated with 6 g of NAC orally, followed by repeat measurement of bleeding time and aggregometry. In group 2, 14 patients were treated with clopidogrel (300 mg) and aspirin before a percutaneous coronary intervention. Blood was drawn 22 +/- 3 hours later and divided into 2 samples. One was sent immediately for platelet-rich plasma aggregometry (using 5 and 2 micromol/L ADP, collagen, and arachidonic acid as agonists), thromboelastography, and aggregometry using the Plateletworks assay (Helena Laboratories, Beaumont, Tex). The other sample was treated with NAC (500 mg/L), after which these same platelet function tests were performed., Results: In group 1, NAC therapy did not significantly change the bleeding time or results of aggregometry. In group 2, neither aggregometry nor the Plateletworks assay suggested reversal of inhibition by NAC., Conclusions: These studies reveal that a large dose of NAC does not reduce inhibition of platelet aggregation by clopidogrel in vitro or in vivo.
- Published
- 2005
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8. Differences in human antioxidized LDL autoantibodies in patients with stable and unstable angina.
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Fernandes JL, Orford JL, Garcia C, Coelho OR, Gidlund M, and Blotta MH
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- Adult, Aged, Angina, Unstable diagnosis, Biomarkers blood, C-Reactive Protein analysis, Female, Humans, Immunoglobulin G blood, Immunoglobulin Isotypes blood, Male, Middle Aged, Recurrence, Angina Pectoris immunology, Angina, Unstable immunology, Autoantibodies blood, Coronary Artery Disease immunology, Lipoproteins, LDL immunology
- Abstract
Background: Autoantibodies to oxidized LDL (anti-oxLDL) have been found in the serum of patients with coronary artery disease (CAD). This study was designed to compare the differences in anti-oxLDL titers and isotypes in unstable and stable angina patients and to correlate these results with known markers of active inflammation in CAD., Methods: Thirty patients from a tertiary referral general hospital with documented CAD were studied. Anti-oxLDL IgG titers and its isotypes, high sensitivity C-reactive protein (hsCRP) and serum amyloid A (SAA) were measured., Results: The anti-oxLDL IgG titer was lower (p=0.03) in the unstable angina group compared to the stable angina patients (0.084+/-0.102 OD versus 0.195+/-0.149 OD, respectively). The predominant IgG isotype in both groups was IgG2. IgG4 was significantly higher (0.270+/-0.146 OD, p=0.04) in the unstable angina group versus patients with stable angina (0.198+/-0.019 OD). There was a significant inverse correlation between anti-oxLDL and hsCRP and SAA in this sample population (R=0.37, p<0.05 and R=0.36, p<0.05, respectively)., Conclusion: Patients with unstable angina have lower levels of anti-oxLDL IgG in the acute setting of CAD. Plaque instabilization does not seem to acutely modify the isotype subsets of anti-oxLDL IgG in these patients.
- Published
- 2004
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9. Cutting balloon angioplasty vs. conventional balloon angioplasty in patients receiving intracoronary brachytherapy for the treatment of in-stent restenosis.
- Author
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Fasseas P, Orford JL, Lennon R, O'Neill J, Denktas AE, Panetta CJ, Berger PB, and Holmes DR
- Subjects
- Aged, Angioplasty, Balloon, Coronary, Case-Control Studies, Chi-Square Distribution, Combined Modality Therapy, Coronary Angiography, Coronary Restenosis etiology, Coronary Restenosis radiotherapy, Female, Humans, Male, Middle Aged, Registries, Retrospective Studies, Statistics, Nonparametric, Stents, Treatment Outcome, Angioplasty, Balloon methods, Brachytherapy, Coronary Restenosis therapy
- Abstract
The objective of this study was to evaluate the safety and efficacy of cutting balloon angioplasty (CBA) for the treatment of in-stent restenosis prior to intracoronary brachytherapy (ICB). Cutting balloon angioplasty may reduce the incidence of uncontrolled dissection requiring adjunctive stenting and may limit "melon seeding" and geographic miss in patients with in-stent restenosis who are subsequently treated with ICB. We performed a retrospective case-control analysis of 134 consecutive patients with in-stent restenosis who were treated with ICB preceded by either CBA or conventional balloon angioplasty. We identified 44 patients who underwent CBA and ICB, and 90 control patients who underwent conventional percutaneous transluminal coronary angioplasty (PTCA) and ICB for the treatment of in-stent restenosis. Adjunctive coronary stenting was performed in 13 patients (29.5%) in the CBA/ICB group and 41 patients (45.6%; P < 0.001) in the PTCA/ICB group. There was no difference in the injury length or active treatment (ICB) length. The procedural and angiographic success rates were similar in both groups. There were no statistically significant differences in the incidence of death, myocardial infarction, recurrent angina pectoris, subsequent target lumen revascularization, or the composite endpoint of all four clinical outcomes (P > 0.05). Despite sound theoretical reasons why CBA may be better than conventional balloon angioplasty for treatment of in-stent restenosis with ICB, and despite a reduction in the need for adjunctive coronary stenting, we were unable to identify differences in clinical outcome., ((c) 2004 Wiley-Liss, Inc.)
- Published
- 2004
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10. Routine intravascular ultrasound scanning guidance of coronary stenting is not associated with improved clinical outcomes.
- Author
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Orford JL, Denktas AE, Williams BA, Fasseas P, Willerson JT, Berger PB, and Holmes DR Jr
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- Coronary Angiography, Coronary Disease mortality, Disease-Free Survival, Double-Blind Method, Female, Humans, Male, Middle Aged, Myocardial Infarction, Risk, Treatment Outcome, Angioplasty, Balloon, Coronary methods, Coronary Disease therapy, Stents, Ultrasonography, Interventional
- Abstract
Purpose: The purpose of the current study was to determine whether there is any incremental benefit to routine intravascular ultrasound (IVUS) guidance of percutaneous coronary intervention., Methods and Results: We compared the outcome of 796 patients who underwent an IVUS study (IVUS group) during the index stent procedure with 8274 patients who did not have an IVUS study (angiography group). The primary end point was the composite end point of death, myocardial infarction, or ischemia-driven target vessel revascularization within 9 months of the index stent procedure. There were statistically significant differences in multiple procedural characteristics. Most importantly, those patients who underwent an IVUS study had a larger postprocedural minimal lumen diameter and smaller postprocedural percent diameter stenosis. However, there was no significant difference between the IVUS group and the angiography group with respect to the primary end point (RR 1.10, 95% CI 0.91, 1.32) or any of the individual clinical end points. Adjustment for multiple clinical and procedural characteristics did not significantly alter these findings., Conclusions: These data suggest that the routine performance of IVUS during stent placement influences the performance of the procedure, as judged by differences in procedural characteristics, but does not improve clinical outcome at 9 months.
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- 2004
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11. Does clopidogrel increase the degree of platelet inhibition when a platelet glycoprotein IIb/IIIa inhibitor has been given? Insights from an optical platelet aggregometry study.
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Talreja D, Lubbe D, Orford JL, Lennon R, DiBattiste PM, and Berger PB
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- Aged, Aged, 80 and over, Angina Pectoris blood, Angina Pectoris drug therapy, Clopidogrel, Drug Combinations, Drug Interactions physiology, Female, Humans, Male, Middle Aged, Platelet Aggregation physiology, Platelet Glycoprotein GPIIb-IIIa Complex metabolism, Tirofiban, Platelet Aggregation drug effects, Platelet Aggregation Inhibitors administration & dosage, Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors, Ticlopidine administration & dosage, Ticlopidine analogs & derivatives, Tyrosine administration & dosage, Tyrosine analogs & derivatives
- Abstract
Introduction: While the CURE trial demonstrated the benefits of clopidogrel in acute coronary syndromes, patients receiving glycoprotein IIb/IIIa antagonists were excluded. Given the frequent coadministration of these two medications, we sought to examine their interaction and their combined effect on platelet inhibition., Methods: Ten patients admitted to the hospital with stable or unstable angina underwent phlebotomy prior to, three hours and six hours after administration of a standard oral loading dose of clopidogrel. The samples were then treated in vitro with incremental concentrations of tirofiban (0, 10, 20, 40, 60, and 80 ng/mL), and optical platelet aggregometry was performed utilizing ADP and TRAP as agonists. We analyzed the combined effects of these agents using a mixed effects model with time and tirofiban concentration as fixed effects, and subject and timing of phlebotomy as random effects., Results: There was no evidence of additional inhibition of platelet aggregation due to clopidogrel regardless of the concentration of tirofiban or the study agonist (ADP 20 muM or iso-TRAP). Specifically, there was no difference in the tirofiban dose-response curves with either platelet agonist for any of the three time points (before, and three and six hours after, clopidogrel administration)., Discussion: There is no evidence that the combination of clopidogrel and tirofiban achieves greater inhibition of platelet aggregation than tirofiban alone.
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- 2004
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12. Transport and centralization of acute coronary syndrome care.
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Orford JL and Berger PB
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- Angioplasty, Balloon, Coronary statistics & numerical data, Cardiac Care Facilities, Cardiac Catheterization, Humans, Myocardial Infarction physiopathology, Randomized Controlled Trials as Topic, Regional Medical Programs, Thrombolytic Therapy statistics & numerical data, Treatment Outcome, Angina, Unstable therapy, Myocardial Infarction therapy, Patient Transfer
- Abstract
Primary percutaneous coronary intervention (PCI) is the optimal treatment for patients presenting with ST-elevation myocardial infarction (STEMI). But PCI facilities are not widely available, and the majority of patients who receive reperfusion therapy are treated with thrombolytic therapy. However, with significant improvements in the procedural success of PCI, there has been a concomitant reduction in the need for emergency bypass surgery and there is evidence to support primary PCI without on-site cardiac surgical facilities. Others have proposed immediate transfer to a suitable hospital for immediate primary PCI. An alternative treatment strategy is facilitated PCI, which might combine the early benefits of thrombolysis with the higher patency rates and superior clinical outcomes of primary PCI, although this remains unproven. Finally, rescue PCI remains a reasonable treatment option for patients with failed thrombolysis, but there is insufficient evidence to support this option as a preferred treatment strategy for patients with STEMI.
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- 2004
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13. Alveolar hemorrhage associated with periprocedural eptifibatide administration.
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Orford JL, Fasseas P, Holmes DR, and Berger PB
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- Aged, Eptifibatide, Female, Humans, Peptides administration & dosage, Platelet Aggregation Inhibitors administration & dosage, Pulmonary Alveoli, Stents, Angioplasty, Balloon, Coronary, Hemorrhage chemically induced, Lung Diseases chemically induced, Peptides adverse effects, Platelet Aggregation Inhibitors adverse effects
- Published
- 2004
14. Increased Th1 activity in patients with coronary artery disease.
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Fernandes JL, Mamoni RL, Orford JL, Garcia C, Selwyn AP, Coelho OR, and Blotta MH
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- Adult, Aged, Aged, 80 and over, Angina Pectoris metabolism, Female, Humans, In Vitro Techniques, Interferon-gamma blood, Interleukin-12 blood, Male, Middle Aged, Receptors, CXCR3, Receptors, Chemokine metabolism, Coronary Artery Disease immunology, Th1 Cells immunology
- Abstract
Background: Atherosclerotic lesions are mainly composed of macrophages and T lymphocytes. Specific T helper type 1 (Th1) cytokines and interferon gamma (IFN-gamma) inducible chemokines have been shown to be present in these lesions, modulating the local immunologic response. To explore whether this increase in Th1 activity could also be detected in circulating cells indicating a systemic activation, we studied the peripheral expression of Th1 cytokines and chemokines in patients with coronary artery disease and controls., Methods and Results: Fifty patients with coronary artery disease (25 with unstable angina and 25 with stable angina) and 10 controls were studied. Serum interleukin (IL)-12 and IFN-gamma and the expression of IFN-gamma inducible chemokines IP-10, Mig and their receptor CXCR3 in peripheral cells were analyzed. Serum IL-12 and intracellular expression of IFN-gamma were significantly elevated in patients with unstable angina. An enhanced expression of IFN-gamma chemokines IP-10, Mig and CXCR3 in patients with stable angina was also observed., Conclusions: This study demonstrates an increased systemic inflammatory activity in patients with coronary heart disease with a predominant Th1 response, particularly in patients with unstable angina, suggesting an important role played by this polarization in plaque formation and rupture., (Copyright 2004 Elsevier Ltd.)
- Published
- 2004
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15. Routine intravascular ultrasound guidance of percutaneous coronary intervention: a critical reappraisal.
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Orford JL, Lerman A, and Holmes DR
- Subjects
- Blood Vessel Prosthesis Implantation methods, Coronary Artery Disease diagnostic imaging, Humans, Randomized Controlled Trials as Topic, Angioplasty, Balloon, Coronary methods, Coronary Artery Disease therapy, Stents, Ultrasonography, Interventional
- Abstract
Intravascular ultrasound (IVUS) has played an integral role in the evolution of interventional cardiology. However, routine IVUS guidance of coronary stent implantation is not supported by a critical reappraisal of the available evidence. Although there is a trend toward a benefit with respect to target lumen revascularization favoring IVUS-guided coronary stent implantation, it is likely that this effect is driven by improved outcomes in small vessels, long coronary stenoses, and possibly saphenous vein graft interventions. No consistent trend in the incidence of death or myocardial infarction is apparent. Furthermore, the safety, efficacy, and effectiveness of IVUS should be taken into account when considering the goals, risks, benefits, and alternatives to such a treatment strategy.
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- 2004
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16. Safety and efficacy of aspirin, clopidogrel, and warfarin after coronary stent placement in patients with an indication for anticoagulation.
- Author
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Orford JL, Fasseas P, Melby S, Burger K, Steinhubl SR, Holmes DR, and Berger PB
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- Aged, Aged, 80 and over, Angina, Unstable therapy, Angioplasty, Balloon, Coronary, Anticoagulants adverse effects, Aspirin adverse effects, Clopidogrel, Coronary Disease therapy, Drug Therapy, Combination, Female, Hemorrhage chemically induced, Humans, Male, Middle Aged, Myocardial Infarction therapy, Platelet Aggregation Inhibitors adverse effects, Retrospective Studies, Ticlopidine adverse effects, Warfarin adverse effects, Anticoagulants therapeutic use, Aspirin therapeutic use, Coronary Disease drug therapy, Platelet Aggregation Inhibitors therapeutic use, Stents, Ticlopidine analogs & derivatives, Ticlopidine therapeutic use, Warfarin therapeutic use
- Abstract
Background: Dual antiplatelet therapy with aspirin and clopidogrel has replaced aspirin and systemic anticoagulation with warfarin as the preferred antithrombotic therapy after percutaneous coronary intervention (PCI) with stent placement. However, a number of patients have indications for all 3 drugs. We sought to determine the frequency and type of hemorrhagic complications in patients who undergo systemic anticoagulation with warfarin while receiving aspirin and clopidogrel after a PCI with stent placement., Methods: We performed a retrospective analysis of the Mayo Clinic PCI database and identified 66 consecutive patients who were discharged from hospital after PCI between January 2000 and August 2002 (inclusive) receiving a combination of dual antiplatelet therapy (aspirin and clopidogrel) and systemic anticoagulation (warfarin) to determine the incidence of bleeding and other clinical events during the treatment period., Results: Six patients (9.2%; 95% CI, 3.5-19.0) reported a bleeding event; 2 patients required a blood transfusion. No patient died or sustained a myocardial infarction or stent thrombosis., Conclusions: The risk of bleeding may be increased in patients treated with aspirin, a thienopyridine, and warfarin early after PCI with stent placement.
- Published
- 2004
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17. Modulating thrombotic potential in catheter-based percutaneous coronary and peripheral vascular interventions.
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Orford JL and Berger PB
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- Humans, Severity of Illness Index, Thrombosis epidemiology, Thrombosis prevention & control, Vascular Diseases drug therapy, Vascular Diseases physiopathology, Vascular Diseases surgery, Angioplasty, Balloon adverse effects, Angioplasty, Balloon, Coronary adverse effects, Thrombosis drug therapy, Thrombosis physiopathology
- Abstract
Thrombosis is an obligatory consequence of all percutaneous vascular interventions. Balloon angioplasty, intravascular stents and other devices routinely used to facilitate dilatation of critical vascular stenoses result in fracture of the intima and exposure of the thrombogenic subendothelium with initiation and perpetuation of platelet activation and aggregation. This not uncommonly results in thrombus formation that may lead to abrupt vessel closure, distal ischemia and tissue infarction, and target organ dysfunction. Fortunately, advances in our understanding of the mechanisms that underlie vascular thrombosis have led to advances in the use of adjunctive pharmacological agents that modulate this pathophysiological response and have led to important reductions in the incidence and severity of thrombotic complications of percutaneous transluminal interventions.
- Published
- 2004
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18. Incidence, correlates, management, and clinical outcome of coronary perforation: analysis of 16,298 procedures.
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Fasseas P, Orford JL, Panetta CJ, Bell MR, Denktas AE, Lennon RJ, Holmes DR, and Berger PB
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- Aged, Angioplasty, Balloon, Coronary, Atherectomy, Coronary adverse effects, Constriction, Databases, Factual, Female, Humans, Incidence, Male, Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors, Prospective Studies, Protamines therapeutic use, Regression Analysis, Stents adverse effects, Wounds, Penetrating etiology, Wounds, Penetrating therapy, Coronary Artery Disease therapy, Coronary Vessels injuries, Wounds, Penetrating epidemiology
- Abstract
Background: Coronary perforation is a serious but uncommon complication of percutaneous coronary intervention (PCI) and is associated with significant morbidity and mortality., Methods: We performed an analysis of the Mayo Clinic PCI database. Clinical records, procedural reports, and angiographic studies were reviewed. Multiple logistic regression analysis was performed to identify clinical, procedural, anatomic, and angiographic correlates of coronary perforation., Results: A total of 16,298 PCI procedures were performed between January 1990 and December 2001. We identified 95 coronary perforations (0.58%; 95% CI, 0.47-0.71). The incidence of coronary perforation varied with time. Correlates of coronary perforation included the use of an atheroablative device and female sex. Twelve patients (12.6%) sustained an acute myocardial infarction, and cardiac tamponade developed in 11 patients (11.6%). Management strategies included reversal of heparin, pericardiocentesis, placement of a covered stent, and surgical repair. Seven patients died (7.4%)., Conclusions: Coronary perforation during PCI is rare, but is associated with significant morbidity and mortality. The variable frequency of perforation may be explained by temporal variations in the use of atheroablative devices.
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- 2004
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19. Diabetes mellitus and preferred method of coronary revascularization--the debate continues.
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Orford JL and Berger PB
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- Clinical Trials as Topic, Coronary Disease complications, Humans, Coronary Disease therapy, Diabetes Complications, Myocardial Revascularization methods
- Published
- 2003
20. Safety and efficacy of cutting balloon angioplasty: the Mayo Clinic experience.
- Author
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Orford JL, Fasseas P, Denktas AE, Hammes L, Garratt KN, Berger PB, Holmes DR, and Barsness GW
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- Academic Medical Centers, Aged, Angina, Unstable diagnostic imaging, Angioplasty, Balloon methods, Coronary Angiography, Equipment Design, Equipment Safety, Female, Follow-Up Studies, Humans, Male, Middle Aged, Minnesota, Myocardial Infarction diagnostic imaging, Prognosis, Registries, Retrospective Studies, Risk Assessment, Severity of Illness Index, Treatment Outcome, Angina, Unstable therapy, Angioplasty, Balloon instrumentation, Myocardial Infarction therapy, Stents
- Abstract
Unlabelled: A number of evolving clinical indications for cutting balloon angioplasty (CBA) have been described in the clinical literature, including angioplasty-resistant stenoses, in-stent restenosis, ostial lesions and small vessel disease., Methods: We analyzed the Mayo Clinic PTCA registry and report procedural and in-hospital clinical outcomes in 100 patients (103 procedures, 114 lesions) undergoing CBA., Results: CBA was successfully completed in 109 lesions (96%). The majority of lesions (73%) required additional treatment with either balloon angioplasty (39%) or stent implantation (34%). Severe intimal dissection resulting in at least 50% luminal obstruction occurred in 13 lesions (11%). A single incident of branch occlusion was documented, resulting in ST elevation myocardial infarction. There were no incidents of vessel perforation, urgent percutaneous or surgical target vessel revascularization, or in-hospital death., Conclusion: CBA is feasible and safe, with a low incidence of procedural complications and in-hospital adverse cardiac events when used primarily for in-stent restenosis.
- Published
- 2002
21. Frequency and correlates of coronary stent thrombosis in the modern era: analysis of a single center registry.
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Orford JL, Lennon R, Melby S, Fasseas P, Bell MR, Rihal CS, Holmes DR, and Berger PB
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- Aged, Aged, 80 and over, Angina, Unstable therapy, Aspirin administration & dosage, Clopidogrel, Coronary Angiography, Coronary Thrombosis etiology, Coronary Thrombosis prevention & control, Drug Therapy, Combination, Female, Humans, Male, Middle Aged, Multivariate Analysis, Platelet Aggregation Inhibitors administration & dosage, Registries, Retrospective Studies, Risk Factors, Ticlopidine administration & dosage, Treatment Outcome, Angioplasty, Balloon, Coronary adverse effects, Coronary Thrombosis epidemiology, Platelet Aggregation Inhibitors therapeutic use, Stents adverse effects, Ticlopidine analogs & derivatives
- Abstract
Objectives: The study examined the frequency, correlates, and outcome of patients with stent thrombosis within 30 days of stent placement., Background: Patients in trials evaluating stents or dual antiplatelet therapy to prevent coronary stent thrombosis have generally had narrow inclusion criteria; the extent to which stent thrombosis rates in such trials represent current practice, particularly with the availability of newer stents, is unclear., Methods: We performed a retrospective analysis of the Mayo Clinic Percutaneous Coronary Intervention database and identified all patients who received at least one coronary stent and dual antiplatelet therapy (aspirin and ticlopidine or clopidogrel for two to four weeks)., Results: Four thousand five hundred nine patients underwent successful coronary stent implantation and were treated with dual antiplatelet therapy between July 1, 1994, and April 30, 2000. Stent thrombosis occurred in 23 patients (0.51%; 95% confidence interval 0.32%, 0.76%) within 30 days of stent placement. Multivariate analysis using bootstrap model selection to avoid over-fitting the model indicated that only the number of stents placed was an independent correlate of stent thrombosis (odds ratio 1.80, p < 0.001). The frequency of death and frequency of nonfatal myocardial infarction (MI) among the 23 patients with stent thrombosis were 48% and 39%, respectively., Conclusions: Stent thrombosis is even more rare in the current era than in earlier trials. Number of stents placed was an independent correlate of stent thrombosis. Most patients who suffer stent thrombosis either die or suffer MI.
- Published
- 2002
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22. Impact of intra-aortic balloon counterpulsation with different balloon volumes on cardiac performance in humans.
- Author
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Cohen M, Fasseas P, Singh VP, McBride R, Orford JL, and Kussmaul WG 3rd
- Subjects
- Aged, Angina Pectoris physiopathology, Female, Hemodynamics, Humans, Male, Middle Aged, Prospective Studies, Shock, Cardiogenic physiopathology, Angina Pectoris therapy, Cardiac Output, Counterpulsation methods, Shock, Cardiogenic therapy
- Abstract
Intra-aortic balloon (IAB) counterpulsation can augment the cardiac output. However, the effect of different IAB volumes on cardiac performance has not been adequately evaluated in humans. Eighty-two patients (52 males [63%]; mean age, 65 +/- 12 years; mean body surface area [BSA], 1.8 +/- 0.2 m(2)) had IAB counterpulsation for cardiogenic shock, refractory angina, and preoperatively for high-risk cardiac surgery. Cardiac hemodynamics were prospectively studied during IAB with inflation volumes of 32 vs. 40 cc. Hemodynamic data collected included aortic pressure, pulmonary artery pressure, systemic and mixed venous oxygen saturations, and cardiac output (by Fick). Transthoracic echocardiography (TTE) was used to obtain both velocity time integrals (VTIs) and the area of the left ventricular outflow tract (LVOT). Left ventricular stroke volume was then calculated as LVOT area x VTI. Cardiac output (CO) determined by the Fick method and VTI did not differ significantly (P = NS) between the two inflation volumes (y = 0.002 + 0.97x). In a subgroup of 33 patients with BSA
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- 2002
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23. Anterior ischemia secondary to embolization of the posterior descending artery in a patient with a chronic total occlusion of the left anterior descending artery.
- Author
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Orford JL, Fasseas P, Denktas AE, and Garratt KN
- Subjects
- Chronic Disease, Humans, Male, Middle Aged, Treatment Failure, Coronary Stenosis complications, Coronary Stenosis therapy, Embolization, Therapeutic adverse effects, Myocardial Ischemia etiology
- Published
- 2002
24. A comparison of the Framingham and European Society of Cardiology coronary heart disease risk prediction models in the normative aging study.
- Author
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Orford JL, Sesso HD, Stedman M, Gagnon D, Vokonas P, and Gaziano JM
- Subjects
- Adult, Aged, Cohort Studies, Coronary Disease epidemiology, Europe epidemiology, Female, Humans, Incidence, Male, Massachusetts epidemiology, Middle Aged, Risk Assessment, Algorithms, Coronary Disease complications
- Abstract
Background: A number of prediction models have been developed in an attempt to accurately identify patients at increased risk of a first coronary heart disease event. We sought to determine the ten-year incidence of coronary heart disease events in a healthy cohort with measurable risk factors, and to compare these results with the predicted number of events by use of both the Framingham and European Society of Cardiology risk prediction models., Methods: We compared the predicted and observed number of events in 5 risk categories in 1393 subjects aged 30 to 74 years who were enrolled in the Normative Aging Study., Results: The risk prediction models reliably stratify populations with regards to relative risk of coronary heart disease events and there is reasonable agreement between the 2 models (weighted kappa = 0.46, P <.01). The Framingham model underestimated the absolute risk of coronary heart disease events in the low-risk group, and both risk prediction models overestimated the absolute risk of events in the high- or very-high-risk groups (Framingham c-statistic = 0.60, European Society of Cardiology c-statistic = 0.58)., Conclusions: Despite simplification, the accuracy of the European model was not significantly different from the Framingham model. But the accuracy of absolute risk prediction, particularly at the extremes of risk, is imperfect. Refinement and validation of these risk prediction models is important because they affect the management of individual patients and the allocation of community resources.
- Published
- 2002
- Full Text
- View/download PDF
25. GUSTO V: should it affect clinical practice? Global Use of Strategies to Open Occluded Coronary Arteries.
- Author
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Orford JL and Berger PB
- Subjects
- Abciximab, Aged, Angioplasty methods, Antibodies, Monoclonal adverse effects, Drug Therapy, Combination, Fibrinolytic Agents adverse effects, Hemorrhage chemically induced, Humans, Immunoglobulin Fab Fragments adverse effects, Platelet Aggregation Inhibitors adverse effects, Recombinant Proteins adverse effects, Tissue Plasminogen Activator adverse effects, Antibodies, Monoclonal therapeutic use, Coronary Disease drug therapy, Fibrinolytic Agents therapeutic use, Immunoglobulin Fab Fragments therapeutic use, Platelet Aggregation Inhibitors therapeutic use, Recombinant Proteins therapeutic use, Tissue Plasminogen Activator therapeutic use
- Published
- 2002
- Full Text
- View/download PDF
26. Rescue percutaneous coronary intervention following coronary artery bypass graft--a descriptive analysis of the changing interface between interventional cardiologist and cardiac surgeon.
- Author
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Adams MR, Orford JL, Blake GJ, Wainstein MV, Byrne JG, and Selwyn AP
- Subjects
- Aged, Aged, 80 and over, Coronary Artery Disease epidemiology, Coronary Artery Disease therapy, Female, Follow-Up Studies, Hospital Mortality, Humans, Incidence, Male, Massachusetts, Middle Aged, Multivariate Analysis, Predictive Value of Tests, Reoperation, Severity of Illness Index, Time Factors, Treatment Outcome, Angioplasty, Balloon, Coronary, Cardiology, Coronary Artery Bypass, Thoracic Surgery
- Abstract
Background: Despite decreasing rates of acute and subacute complications of percutaneous coronary intervention (PCI), these procedures are generally only performed in centers where it is possible for failed PCI to be treated by rescue coronary artery bypass graft (CABG). Case reports and case series have documented successful PCI following failed CABG. We sought to confirm this decrease in the need for rescue CABG following failed PCI and to examine trends in the utilization of rescue PCI following failed CABG., Hypothesis: The interface between interventional cardiologist and cardiac surgeon is characterized by changing practice patterns and resource utilization., Methods: We examined the medical records of all patients admitted to the Brigham and Women's Hospital over a 7-year period and identified 169 patients who required both PCI and CABG during the same hospital admission. We describe and compare three predetermined groups of patients defined by the sequence of, and indication for, the relevant myocardial revascularization procedures., Results: In all, 100 patients required CABG for failed PCI, 46 patients had planned hybrid procedures involving both CABG and PCI, and 23 patients required PCI following failed CABG. There was a decrease in the need for rescue CABG following failed PCI, both in total numbers and as a percentage of total cases (2.5% in 1994 and 0.22% in 1999). There was a simultaneous increase in the utilization of rescue PCI following failed CABG (0% in 1994 and 1.6% in 2000). Hybrid procedures were identified as a source of innovative solutions to a variety of challenging clinical problems., Conclusions: Changing patterns of resource utilization should be considered when planning hospital facilities and patient triage, and these patients undergoing percutaneous or surgical revascularization may benefit from close cooperation between the cardiac surgeon and the interventional cardiologist.
- Published
- 2002
- Full Text
- View/download PDF
27. Clopidogrel inhibits shear-induced platelet function.
- Author
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Orford JL, Kinlay S, Adams MR, Simon DI, and Selwyn AP
- Subjects
- Adult, Blood Platelets drug effects, Clopidogrel, Drug Evaluation, Female, Humans, Male, Perfusion, Platelet Function Tests, Stress, Mechanical, Ticlopidine administration & dosage, Ticlopidine analogs & derivatives, Platelet Activation drug effects, Ticlopidine pharmacology
- Abstract
We enrolled 17 healthy adult volunteers and measured platelet hemostasis time (PHT) and collagen-induced thrombus formation (CITF) before and after the oral administration of 300 mg of clopidogrel utilizing the Xylum Clot Signature Analyzer. We documented a statistically significant 30% prolongation of the PHT from 291+/-13 (SE) seconds to 376+/-31 (SE) s (P=0.037). There was a 7% prolongation of the CITF from 347+/-10 to 371+/-17 (SE) s (P=0.245). This study suggests that the Xylum Clot Signature Analyzer can measure changes in platelet function in response to a modest platelet inhibitor, and may be a useful clinical tool for the monitoring of antiplatelet therapies in patients.
- Published
- 2002
- Full Text
- View/download PDF
28. Abciximab readministration.
- Author
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Orford JL and Holmes DR Jr
- Subjects
- Abciximab, Angioplasty, Balloon, Coronary, Antibodies, Monoclonal administration & dosage, Clinical Trials, Phase IV as Topic, Coronary Disease therapy, Humans, Immunoglobulin Fab Fragments administration & dosage, Platelet Aggregation Inhibitors administration & dosage, Treatment Outcome, Antibodies, Monoclonal adverse effects, Coronary Disease drug therapy, Immunoglobulin Fab Fragments adverse effects, Platelet Aggregation Inhibitors adverse effects, Platelet Glycoprotein GPIIb-IIIa Complex antagonists & inhibitors, Thrombocytopenia chemically induced
- Abstract
The IIb/IIIa receptor inhibitors have been shown to improve outcomes following percutaneous coronary intervention (PCI), particularly by decreasing periprocedural myocardial necrosis. Abciximab has been subject to multiple studies, demonstrating consistent improved early and late outcomes in multiple patient populations, including a mortality advantage in diabetics, but there has been concern about the possibility of anaphylaxis, thrombocytopenia, and reduced clinical efficacy with repeat administration of abciximab. Results of the ReoPro Readministration Registry, a prospective, phase IV, multicenter registry of 500 patients undergoing PCI who were treated with abciximab at least 7 days after a previous treatment with this same drug, support the contention that abciximab readministration is both safe and clinically efficacious and that there is no significant increase in the incidence of thrombocytopenia as compared with historical controls of trials of first abciximab administration. However, profound thrombocytopenia did occur with increased frequency as compared with historical controls, suggesting a shift from mild to profound thrombocytopenia with abciximab readministration.
- Published
- 2002
29. Clopidogrel.
- Author
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Orford JL, Fasseas P, Brosh D, and Berger PB
- Subjects
- Cardiac Catheterization, Cardiovascular Diseases prevention & control, Clopidogrel, Humans, Thrombosis prevention & control, Cardiovascular Diseases drug therapy, Platelet Aggregation Inhibitors pharmacology, Platelet Aggregation Inhibitors therapeutic use, Ticlopidine analogs & derivatives, Ticlopidine pharmacology, Ticlopidine therapeutic use
- Published
- 2001
30. Refractory angina and anterior ischemia in a patient with a patent left internal mammary artery bypass graft.
- Author
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Orford JL, Fasseas P, Denktas AE, Bybee KA, Rihal CS, and Holmes DR
- Subjects
- Humans, Male, Middle Aged, Recurrence, Angina Pectoris complications, Angina Pectoris surgery, Coronary Artery Bypass, Mammary Arteries surgery, Myocardial Ischemia complications, Myocardial Ischemia surgery
- Published
- 2001
31. Manipulating the vascular biology of coronary atherosclerosis in diabetes: new opportunities.
- Author
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Orford JL, Kinlay S, Fernandes J, Behrendt D, Ganz P, and Selwyn AP
- Subjects
- Angiotensin-Converting Enzyme Inhibitors therapeutic use, Coronary Disease prevention & control, Diabetic Angiopathies prevention & control, Endothelium, Vascular physiopathology, Humans, Hyperglycemia complications, Hyperinsulinism complications, Hyperlipidemias complications, Hyperlipidemias drug therapy, Hypoglycemic Agents therapeutic use, Inflammation complications, Insulin Resistance, Risk Factors, Coronary Disease etiology, Diabetes Complications, Diabetic Angiopathies etiology
- Published
- 2001
- Full Text
- View/download PDF
32. Distal protection devices during percutaneous coronary and carotid interventions.
- Author
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Fasseas P, Orford JL, Denktas AE, and Berger PB
- Abstract
Distal embolization of particulate matter complicates percutaneous coronary and peripheral interventions more often than had been recognized until recently. A number of distal protection devices are under development. The PercuSurge GuardWiretrade mark is a balloon occlusion thrombectomy device approved by the United States Food and Drug Administration for saphenous vein graft intervention. A number of filter devices utilize an expandable filter mounted on the angioplasty guidewire to facilitate entrapment of particles and safe removal. The Parodi Anti-Emboli Systemtrade mark is an example of a catheter occlusion device that establishes protection by reversing blood flow in the target vessel.
- Published
- 2001
- Full Text
- View/download PDF
33. Sphincter of Oddi dysfunction: two case reports and a review of the literature.
- Author
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Orford JL, Dibos PE, and Soudry G
- Subjects
- Adult, Cholangiopancreatography, Endoscopic Retrograde, Cholecystokinin pharmacokinetics, Common Bile Duct Diseases surgery, Female, Humans, Middle Aged, Radionuclide Imaging, Radiopharmaceuticals, Sphincter of Oddi surgery, Sphincterotomy, Transduodenal, Technetium Tc 99m Diethyl-iminodiacetic Acid, Common Bile Duct Diseases diagnostic imaging, Sphincter of Oddi diagnostic imaging
- Abstract
Sphincter of Oddi dysfunction is an underdiagnosed but important clinical condition. It should be considered in the differential diagnosis of biliary pain when the gallbladder sonogram shows no evidence of gallbladder disease. Hepatobiliary scanning (Tc-99m dimethyl iminodiacetic acid) may provide valuable information in the evaluation of these patients and may be helpful in monitoring response to treatment.
- Published
- 2000
- Full Text
- View/download PDF
34. The comparative pathobiology of atherosclerosis and restenosis.
- Author
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Orford JL, Selwyn AP, Ganz P, Popma JJ, and Rogers C
- Subjects
- Animals, Coronary Artery Disease physiopathology, Endothelium, Vascular pathology, Endothelium, Vascular physiopathology, Humans, Inflammation pathology, Inflammation physiopathology, Recurrence, Stents, Tunica Intima pathology, Coronary Artery Disease pathology
- Abstract
Percutaneous coronary interventions (PCIs) play an increasingly important role in the management of patients with coronary artery disease. However, these important procedures are complicated by restenosis in a sizeable number of patients. The pathobiology of atherosclerosis comprises a complex interaction among lipids, the endothelium, circulating and tissue inflammatory cells, platelets, and vascular smooth muscle cells. The superimposition of the mechanical and cellular consequences of PCIs on the abnormal substrate of atherosclerosis leads to a characteristic and distinct pathobiology that initiates and perpetuates restenosis. A clear understanding of the significant differences between atherosclerosis and restenosis will provide a rational basis for developing treatment plans that always address both problems. This article reviews and contrasts the pathobiology of atherosclerosis and restenosis and compares the mechanisms and time-course of these distinct entities.
- Published
- 2000
- Full Text
- View/download PDF
35. Treating ambulatory ischemia in coronary disease by manipulating the cell biology of atherosclerosis.
- Author
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Orford JL, Kinlay S, Ganz P, and Selwyn AP
- Subjects
- Cholesterol, LDL blood, Coronary Artery Disease complications, Electrocardiography, Ambulatory, Endothelium, Vascular physiopathology, Humans, Lovastatin therapeutic use, Male, Myocardial Ischemia diagnosis, Myocardial Ischemia etiology, Risk Factors, Anticholesteremic Agents therapeutic use, Coronary Artery Disease physiopathology, Myocardial Ischemia therapy
- Abstract
Obstructive coronary artery disease is the most common cause of morbidity and mortality in the developed world. Our understanding of the pathobiology of coronary atherosclerosis provides us with new opportunities to reduce myocardial ischemia by interventions that address these mechanisms directly. These interventions include lipid-lowering therapies that improve local coronary vasomotion, inflammation, and the procoagulant state. These interventions have also been shown to result in important reductions in clinical events, including angina pectoris, myocardial ischemia and infarction, and death. Ambulatory electrocardiography provides a versatile and quantifiable measure of regional myocardial ischemia. Reductions in ischemia, as quantified by this diagnostic modality, are associated with improved clinical outcomes that may reflect improvements in the cellular pathophysiology of coronary atherosclerosis. This review discusses new information regarding the interactions between low-density lipoprotein cholesterol, the cell biology of atherosclerosis, and the activity of ischemia in patients with coronary artery disease.
- Published
- 2000
- Full Text
- View/download PDF
36. Pathophysiology of atherosclerosis: development, regression, restenosis.
- Author
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Adams MR, Kinlay S, Blake GJ, Orford JL, Ganz P, and Selwyn AP
- Subjects
- Arteriosclerosis pathology, Arteriosclerosis therapy, Constriction, Pathologic pathology, Constriction, Pathologic physiopathology, Constriction, Pathologic therapy, Humans, Recurrence, Arteriosclerosis physiopathology
- Abstract
There is now a very large number of patients with coronary artery disease who have also undergone percutaneous interventions such as coronary angioplasty. Atherosclerosis and restenosis are two distinct pathologic processes with different underlying pathophysiologic mechanisms, different natural histories, different clinical presentations, and treatment strategies. Management strategies to target both processes are currently poorly applied in clinical practice. The development of integrated management strategies to target atherosclerosis, as well as restenosis in the postprocedural period remains a priority.
- Published
- 2000
- Full Text
- View/download PDF
37. Atherogenic lipids and endothelial dysfunction: mechanisms in the genesis of ischemic syndromes.
- Author
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Adams MR, Kinlay S, Blake GJ, Orford JL, Ganz P, and Selwyn AP
- Subjects
- Arteriosclerosis physiopathology, Cell Division, Endothelium, Vascular pathology, Humans, Lipoprotein(a) physiology, Triglycerides physiology, Vasomotor System physiopathology, Arteriosclerosis complications, Endothelium, Vascular physiopathology, Ischemia etiology, Lipoproteins, LDL physiology, Nitric Oxide physiology
- Abstract
Atherogenic lipids, particularly oxidized low-density lipoprotein, are responsible for a wide range of cellular dysfunctions within the vessel wall. The effects on endothelial cells disrupt normal control of vasomotion, with a reduction of effective nitric oxide activity, the development of a procoagulant surface, chronic low-grade inflammation, and abnormal cell growth. These changes are central not only in the development of atherosclerosis but also in the evolution of both stable and unstable ischemic syndromes. There is growing evidence that these abnormal changes in cell function respond rapidly to changes in the atherogenic lipids. Certain cell functions can improve within hours or days of cholesterol lowering.
- Published
- 2000
- Full Text
- View/download PDF
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