ObjectiveTo evaluate the potential value of intravascular ultrasound (IVUS) imaging in the diagnosis of aortic intramural hematoma (AIH).MethodsFrom September 2002 to May 2005,a consecutive series of 15 patients with suspected aortic dissection (AD) underwent both IVUS imaging and spiral computed tomography (CT).Six patients diagnosed as acute type B AIH by CT or IVUS composed the present study group.ResultsThe study group consisted of five males and one female with mean age of 66 years old.All of them had chest or back pain.In one patient,CT omitted a localized AIH and an associated penetrating atherosclerotic ulcer (PAU),which were detected by IVUS.In another patient,CT mistaken a partly thrombosed false lumen as an AIH,whereas IVUS detected a subtle intimal tear and slow moving blood in the false lumen.In the four rest patients,both CT and IVUS made the diagnosis of AIH,however,IVUS detected three PAUs in three of them,only one of them was also detected by CT,and two of them escaped initial CT and were confirmed by follow up CT or magnetic resonance imaging.ConclusionsIVUS imaging is a safe examination and has high accuracy in the diagnosis of AIH,particularly for diagnosing localized AIH,distinguishing AIH with thrombosed classic AD and detecting accompanied small PAUs.

OBJECTIVETo assess the immediate and late clinical outcome of left anterior descending artery ostial lesions treated with percutaneous coronary intervention.

METHODSSeventeen patients (6 females and 11 males) treated with percutaneous coronary intervention for ostial left anterior descending artery stenoses have had clinical follow-ups over 12 months. Clinical events were defined as an occurrence of death, myocardial infarction, recurrent angina, and requiring repeat revascularization (either by angioplasty or by surgery). A matched population treated with coronary bypass surgery was selected based on the similarities in age, left ventricular ejection fraction and the number of diseased vessels. Kaplan-Meier event-free survival curves were generated and the matched comparison was done using the Chi-square test (Mc Neimar method).

RESULTSIn the catheter-based angioplasty group, the patients' mean age was 63 +/- 8 years. One patient was treated with directional atherectomy plus balloon, 6 with rotational atherectomy plus balloon, 7 with stent and 3 with rotational atherectomy plus stent. Glycoprotein IIb/IIIa antagonist was used in 4 cases. Initial procedural success without major complications was achieved in all cases. The mean reference diameter was 2.90 +/- 0.48 mm. The minimum lumen diameter increased from 1.05 +/- 0.30 mm to 2.40 +/- 0.45 mm, and the diameter stenosis decreased from 64% +/- 7% to 8% +/- 13%. During the follow-up period, adverse events requiring repeat revascularization occurred in 8 patients. The event-free probability was 0.42 +/- 0.14 in a two-year period. In a matched population treated with bypass surgery (single mammary graft), only one event occurred, and the difference in event-free survival in two-year period between the two patient groups was significant.

CONCLUSIONSPercutaneous coronary intervention for left coronary descending artery ostial lesion is technically feasible and safe, leading to an optimal early success rate, but has a higher risk of late restenosis and greater need for repeat revascularization than coronary bypass surgery.

Aged ; Angioplasty, Balloon, Coronary ; Coronary Artery Bypass ; Coronary Disease ; therapy ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged

OBJECTIVETo assess the in-hospital clinical course and the long-term evolution of acute massive pulmonary embolism after thrombolytic therapy and to identify predictors of adverse clinical outcome.

METHODSA total of 260 patients hospitalized from January 1989 to October 1998 were retrospectively reviewed and followed up for 3.9 to 8.4 years. Baseline characteristics and variables pre- and post-thrombolysis were identified. Particular attention was paid to the clinical events, including death, recurrent thromboembolism, chronic thromboembolic pulmonary hypertension, and major bleeding attributable to the use of anticoagulants. Kaplan-Meier event-free survival curves were generated. Univariate analysis by means of the log-rank test was used to test each candidate variable for association with clinical outcome. Multivariate analysis with the Cox proportional hazard model was used to determine independent predictors of the long-term outcome.

RESULTSThe in-hospital mortality rate was 8.5%, with 68.2% due to pulmonary embolism itself, and the follow-up mortality rate was 31.7%, with 29.2% due to recurrent embolism. Factors associated with an adverse outcome in univariate analysis were: (1) prior thromboembolic diseases; (2) duration of anticoagulant therapy < 6 months; (3) inferior vena caval filter placement; (4) acute right ventricular dysfunction/dilation detected echocardiographically after thrombolysis; (5) Doppler recording of pulmonary artery systolic pressure > 50 mmHg after thrombolysis; and (6) greater than 30% obstruction of pulmonary vasculature identified by pulmonary ventilation/perfusion scintigraphy before hospital discharge. Multivariate analysis identified three independent predictors of poor long-term outcome for patients with acute massive pulmonary embolism after thrombolysis; which were: (1) Doppler recording of pulmonary artery systolic pressure > 50 mmHg, with relative risk of 3.78 and a 95% confidence interval of 2.70 to 4.86; (2) echocardiographic evidence of right ventricular dysfunction/dilatation (relative risk: 2.18; 95% confidence interval: 1.48 to 2.88); and (3) greater than 30% obstruction of pulmonary vasculature documented by lung scan (relative risk: 1.99; 95% confidence interval: 1.25 to 2.70).

CONCLUSIONThe study showed that Doppler echocardiographic assessments after thrombolytic therapy and ventilation/perfusion scintigraphy prior to hospital discharge are valuable to establishment of new baseline characteristics, which is informative for risk stratification and prognostication of the long-term outcome for patients with acute massive pulmonary embolism.

Acute Disease ; Aged ; Echocardiography, Doppler ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Pulmonary Embolism ; drug therapy ; mortality ; physiopathology ; Retrospective Studies ; Thrombolytic Therapy

BACKGROUNDEarly local platelet activation after coronary intervention identifies patients at increased risk of acute stent thrombosis (AST). However, early changes in platelet activation in coronary circulation following drug-eluting stent (DES) implantation have never been reported.

METHODSIn a prospective study of 26 consecutive elective stable angina patients, platelet activation was analyzed by measuring soluble glycoprotein V (sGPV) and P-selectin (CD62P) before and after implantation of either DES or bare metal stent (BMS). All patients were pretreated with clopidogrel (300 mg loading dose) and aspirin (75 mg orally) the day before the procedure. Blood samples were drawn from the coronary ostium and 10 - 20 mm distal to the lesion site.

RESULTSConsistent with the lower baseline clinical risk, the levels of CD62P and sGPV were within normal reference range, both in the coronary ostium and distal to the lesion before percutaneous coronary intervention (PCI) procedure. The levels of CD62P and sGPV did not change significantly (CD62P: (31.1 +/- 9.86) ng/ml vs (29.5 +/- 9.02) ng/ml, P = 0.319 and sGPV: (52.4 +/- 13.5) ng/ml vs (51.8 +/- 11.7) ng/ml, P = 0.674, respectively) after stent implantation when compared with baseline. Changes in these platelet activation markers did not differ between stent types.

CONCLUSIONSIntracoronary local platelet activation does not occur in stable angina patients before and immediately following DES implantation when dual anti-platelet is administered.

Adult ; Aged ; Angina Pectoris ; blood ; surgery ; Biomarkers ; Drug-Eluting Stents ; Female ; Humans ; Male ; Middle Aged ; P-Selectin ; blood ; Platelet Activation ; Platelet Membrane Glycoproteins ; analysis ; Prospective Studies

BACKGROUNDThe value of intravascular ultrasound (IVUS) imaging in patients with replacement of the ascending aorta for acute type A aortic dissection (AD) is unknown. The purpose of this study was to assess the potential use of IVUS imaging in this setting.

METHODSFrom September 2002 to July 2005, IVUS imaging with a 9 MHz probe was performed in a series of 16 consecutive patients with suspected or established AD. This study focused on 5 of them with replacement of the ascending aorta for acute type A AD. Among these 5 patients, other imaging modalities including aortography, spiral computed tomography, magnetic resonance imaging and transesophageal echocardiography were performed in 5, 3, 3 and 1 patients, respectively.

RESULTSThere were no complications related to IVUS imaging. For the replaced graft, as other imaging modalities, IVUS could identify all 5 grafts, the proximal and the distal anastomoses, and the ostia of the reimplanted coronary arteries. In 2 cases, IVUS detected 2 peri-graft pseudo-aneurysms (1 per case), which were also detected by magnetic resonance imaging but omitted by aortography. For the residual dissection, IVUS had similar findings as other imaging modalities in detecting the patency (5/5), the longitudinal and the circumferential extent, the thrombus (4/5), the recurrent dissection (1/5) and an aneurysm distal to the graft (5 in 4 patients). However, it detected more intimal tears and side branch involvements than other imaging modalities (15 vs 10 and 3 vs 1, respectively).

CONCLUSIONSIn following-up patients with replacement of the ascending aorta for acute type A AD, IVUS imaging can provide complete information of the replaced graft and the residual dissection. So, IVUS imaging may be considered when the four current frequently used imaging modalities can not supply sufficient information or there are some discrepancies between them.

Acute Disease ; Aged ; Aneurysm, Dissecting ; diagnostic imaging ; surgery ; Aorta ; diagnostic imaging ; surgery ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Prospective Studies ; Ultrasonography, Interventional