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Cardiovascular revascularization medicine : includ... 17건

  1. [해외논문]   One stroke too many…are we underutilizing embolic protection devices during catheter and surgical intervention?  

    Heuser, Richard R. (Corresponding author at: 555 N. 18<sup>th</sup>Street, Suite 300, Phoenix, AZ 85006, United States)
    Cardiovascular revascularization medicine : including molecular interventions v.19 no.5 pt.A ,pp. 475 - 476 , 2018 , 1553-8389 ,

    초록

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  2. [해외논문]   Don't Hang Up Your Lead, Yet  

    Smilowitz, Nathaniel R. (NYU Langone Health, New York, NY ) , Weisz, Giora (Montefiore Medical Center, New York, NY)
    Cardiovascular revascularization medicine : including molecular interventions v.19 no.5 pt.A ,pp. 477 - 479 , 2018 , 1553-8389 ,

    초록

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    무료다운로드 유료다운로드

    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  3. [해외논문]   Postprocedural high-sensitivity troponin T and prognosis in patients with non-ST-segment elevation myocardial infarction treated with early percutaneous coronary intervention  

    Harada, Yukinori (Deutsches Herzzentrum München, Technische Universität München, Munich, Germany ) , Koskinas, Konstantinos C. (Department of Cardiology, Bern University Hospital, Switzerland ) , Ndrepepa, Gjin (Deutsches Herzzentrum München, Technische Universität München, Munich, Germany ) , Rä (Department of Cardiology, Bern University Hospital, Switzerland ) , ber, Lorenz (Deutsches Herzzentrum München, Technische Universität München, Munich, Germany ) , Braun, Siegmund (Department of Cardiology, Bern University Hospital, Switzerland ) , Zanchin, Thomas (Deutsches Herzzentrum München, Technische Universität München, Munich, Germany ) , Kufner, Sebastian (Department of Cardiology, Bern University Hospital, Switzerland ) , Hunziker, Lukas (Deutsches Herzzentrum München, Technische Universität München, Munich, Germany ) , Byrne, Robert A. (Institute of Social and Preventive Medicine (ISPM), University of Bern, Switzerland ) , Heg, Dik (Deutsches Herzzentrum München, Technische Universität München, Munich, Germany ) , Kastrati, Adnan (Department of Cardiology, Bern University Hospital, Switzerland) , Windecker, Stephan
    Cardiovascular revascularization medicine : including molecular interventions v.19 no.5 pt.A ,pp. 480 - 486 , 2018 , 1553-8389 ,

    초록

    Abstract Background The association of postprocedural high-sensitivity troponin T (hs-TnT) with prognosis of non-ST-segment elevation myocardial infarction (NSTEMI) patients is incompletely investigated. Aim To assess the prognostic value of hs-TnT in NSTEMI patients undergoing early percutaneous coronary intervention (PCI). Methods This study included 3783 patients with NSTEMI undergoing early PCI. Preprocedural and peak postprocedural hs-TnT was measured. Patients were divided into 3 groups: a group with postprocedural hs-TnT in the 1st tertile (hs-TnT 470ng/L; n=1261). The primary outcome was 1-year all-cause mortality. Results Overall, there were 299 deaths: 59 (5.5%), 98 (8.2%) and 142 deaths (12.6%) among patients of the 1st, 2nd and 3rd postprocedural hs-TnT tertiles (unadjusted hazard ratio [HR]=1.65, 95% confidence interval [CI] 1.20 to 2.67; P=0.002 for tertile 2 vs tertile 1 and unadjusted HR=2.41 [1.79–3.25]; P Conclusions In patients with NSTEMI undergoing early PCI, postprocedural hs-TnT is independently associated with increased risk of mortality up to 1year after PCI. Highlights Post-procedural high-sensitivity cardiac troponin T (hs-TnT) was associated with 1-year mortality in patients with NSTEMI after PCI. An increase in the post-procedural hs-TnT of >70xthe 99th percentile URL correlated with the increased risk of mortality. hs-TnT improved the discriminatory power of the multivariable models regarding prediction of mortality.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  4. [해외논문]   High sensitivity troponin in the management of tachyarrhythmias  

    Mariathas, Mark (Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, UK ) , Gemmell, Cameron (Faculty of Medicine, University of Southampton, Southampton, UK ) , Olechowski, Bartosz (Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, UK ) , Nicholas, Zoe (Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, UK ) , Mahmoudi, Michael (Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, UK ) , Curzen, Nick (Wessex Cardiothoracic Centre, University Hospital Southampton NHS Foundation Trust, UK)
    Cardiovascular revascularization medicine : including molecular interventions v.19 no.5 pt.A ,pp. 487 - 492 , 2018 , 1553-8389 ,

    초록

    Abstract Background The introduction of the highly sensitive troponin (hs-trop) assays into clinical practice has allowed for the more rapid diagnosis or exclusion of type 1 myocardial infarctions (T1MI) by clinicians, in addition type 2 myocardial infarctions (T2MI) are now more frequently detected. Tachyarrhythmias are one of the common causes of T2MI, the medium and long term outcome for this cohort of T2MI is yet to be clarified. Methods Retrospective review of consecutive patients admitted with a diagnosis of either (a) non ST-elevation myocardial infarction (NSTEMI) or (b) tachyarrhythmia was performed. Data were collected on patient demographics and investigations. Patient mortality status was recorded through the Personal Demographics Service (PDS) via NHS Digital. Results A total of 704 patients were eligible for inclusion to the study. 264 patients were included in the study with a final discharge diagnosis of NSTEMI and 440 patients with a final discharge diagnosis of tachyarrhythmia. There was a significantly higher peak troponin in NSTEMI patients compared to the tachyarrhythmia troponin positive group (4552ng/L vs 571ng/L, p p = 0.003), furthermore, the mortality of NSTEMI and troponin positive tachyarrhythmia patients was similar (55 vs 54, 20.8% vs 26.2%, log rank p = 0.416). Only one patient (0.14%) was given a formal diagnosis of T2MI. Conclusions These data suggest that troponin positive tachyarrhythmia is not a benign diagnosis, and has a mortality rate similar to NSTEMI. Formal labeling as T2MI is rare in real life practice. More investigation into the detection and management of T2MI and troponin positive arrhythmia patients is now warranted. Highlights The optimal management strategy for T2MI is unknown. Troponin positive tachyarrhythmia is not a benign diagnosis. The mortality rate of troponin positive tachyarrhythmia is similar to NSTEMI. Formal labeling as T2MI is rare in real life practice. More investigation into the detection and management of T2MI and troponin positive arrhythmia patients is now warranted.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  5. [해외논문]   Systematic isolated post-dilatation of the side branch as part of the provisional stent technique in the percutaneous treatment of coronary bifurcations. CR12 Registry  

    Jurado-Romá (Interventional Cardiology Unit, University General Hospital of Ciudad Real, Spain ) , n, Alfonso (Interventional Cardiology Unit, University Hospital 12 de Octubre of Madrid, Spain ) , Rubio-Alonso, Belé (Interventional Cardiology Unit, University Hospital 12 de Octubre of Madrid, Spain ) , n (Interventional Cardiology Unit, University General Hospital of Ciudad Real, Spain ) , Garcí (Interventional Cardiology Unit, University General Hospital of Ciudad Real, Spain ) , a-Tejada, Julio (Interventional Cardiology Unit, University Hospital 12 de Octubre of Madrid, Spain ) , Sá (Interventional Cardiology Unit, University Hospital 12 de Octubre of Madrid, Spain ) , nchez-Pé (Interventional Cardiology Unit, University Hospital 12 de Octubre of Madrid, Spain ) , rez, Ignacio (Interventional Cardiology Unit, University Hospital 12 de Octubre of Madrid, Spain ) , Ló (Interventional Cardiology Unit, University General Hospital of Ciudad Real, Spain) , pez-Lluva, Marí , a T. , Gó , mez-Blá , zquez, Ivá , n , Velá , zquez-Martí , n, Marí , a T. , Albarrá , n-Gonzá , lez-Trevilla, Agustí , n , Herná , ndez-Herná , ndez, Felipe , Lozano-Ruí , z-Poveda, Fernando
    Cardiovascular revascularization medicine : including molecular interventions v.19 no.5 pt.A ,pp. 493 - 497 , 2018 , 1553-8389 ,

    초록

    Abstract Aims To analyse systematic isolated post-dilatation of the side branch as a part of provisional stent technique. Methods 1960 angioplasties performed in two centres were prospectively registered, of which 382 were coronary bifurcations with a side branch>2mm. In centre A, isolated post-dilatation of the side branch was performed regardless its impairment after main vessel stenting. In centre B, side branch post-dilatation was performed only if it was severely affected after stent implantation. Results There was no difference between the two centres in the rate of side branch affection after stent implantation (A: 44.6 vs B: 49.3%, p=0.48) nor in the procedural success rate (A: 98.6% vs B: 96.7%, p=0.45). After one-year follow-up, a reduction of cardiovascular events was observed in centre A (A: 4.4% vs B: 10.4%, p=0.043) with a trend towards lower cardiac mortality (A: 2.2% vs B: 6.5%, p=0.093) and stent thrombosis (A: 0% vs B: 2.6%, p=0.077). There were no differences in the rate of myocardial infarction related to the treated artery (A: 1.4% vs B: 3.9%, p=0.29), or target lesion revascularization (A: 1.4% vs. B: 3.2%, p=0.45). Conclusions Systematic isolated post-dilatation of the side branch in the provisional stent technique was associated with a high angiographic success rate, and a low rate of cardiovascular events during follow-up. Although the study design does not allow definitive conclusions, this strategy could be considered a valid option in some cases or even as part of the provisional stent technique. Highlights Several options exist on side branch treatment in provisional stent technique. Systematic post-dilatation of the side branch was associated with a lower MACE rate. This technique showed a trend towards lower cardiac mortality and stent thrombosis. It was not associated with greater complications or increasing fluoroscopy time. This technique could be considered as a part of the provisional stent technique.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  6. [해외논문]   Orbital atherectomy treatment of severely calcified native coronary lesions in patients with prior coronary artery bypass grafting: Acute and one-year outcomes from the ORBIT II trial  

    Lee, Michael S. (UCLA Medical Center, Los Angeles, CA, United States ) , Anose, Bynthia M. (Cardiovascular Systems, Inc. (CSI), Saint Paul, MN, United States ) , Martinsen, Brad J. (Cardiovascular Systems, Inc. (CSI), Saint Paul, MN, United States ) , Lee, Arthur C. (The Cardiac and Vascular Institute, Gainesville, FL, United States ) , Shlofmitz, Richard A. (St. Francis Hospital–The Heart Center, Roslyn, NY, United States ) , Chambers, Jeffrey W. (Metropolitan Heart and Vascular Institute, Mercy Hospital, Minneapolis, MN, United States)
    Cardiovascular revascularization medicine : including molecular interventions v.19 no.5 pt.A ,pp. 498 - 502 , 2018 , 1553-8389 ,

    초록

    Abstract Aims Patients undergoing percutaneous coronary intervention (PCI), with a history of coronary artery bypass grafting (CABG), may be at increased risk for mortality and repeat revascularization, compared with patients without prior CABG. In this post-hoc analysis of the ORBIT II trial, safety and efficacy of coronary orbital atherectomy (OA) to modify severe coronary artery calcium, prior to stent placement, was evaluated in subjects based on history of CABG. Methods and results Comorbidities: diabetes, dyslipidemia, hypertension, and history of myocardial infarction (MI) were more prevalent in the CABG group. The in-hospital major adverse cardiac event (MACE) rate, defined as a composite of cardiac death, MI (CK-MB>3× ULN), and target vessel revascularization (TVR), was higher in the CABG group (16.9% vs. 8.5%, p=0.04), driven primarily by a higher incidence of MI (16.9% vs. 8.0%, p=0.03); however, Q-wave rates were low at 1.5% vs 0.5%, (p=0.38). There was no significant difference in rates of cardiac death (6.2% vs. 2.7%, p=0.17) and TVR (7.9% vs. 5.5%, p=0.47). Conclusions Low rates of TVR, cardiac death, and Q-wave MI, suggest OA treatment to facilitate stent delivery is successful and provides durable outcomes in subjects with and without prior CABG. Condensed abstract Patients with history of CABG have extensive coronary artery disease. Those who undergo PCI may be at increased risk for mortality and repeat revascularization, compared with patients without prior CABG. This post-hoc analysis of ORBIT II trial evaluated safety and efficacy of coronary OA to modify severe coronary artery calcium, prior to stent placement, based on subject history of CABG. The MACE rate was higher in the CABG group, driven by higher incidence of MI; however, Q-wave rates were low. OA treatment to facilitate stent delivery is successful, but higher incidence of non-Q-wave MI in CABG patients warrants further study.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  7. [해외논문]   Acute procedural outcomes of orbital atherectomy for the treatment of iliac artery disease: Sub-analysis of the CONFIRM registries  

    Lee, Michael S. (UCLA Medical Center, Los Angeles, CA, United States ) , Martinsen, Brad J. (Cardiovascular Systems, Inc., St. Paul, MN, United States ) , Hollowed, John (UCLA Medical Center, Los Angeles, CA, United States ) , Heikali, Daniel (UCLA Medical Center, Los Angeles, CA, United States ) , Mustapha, Jihad (Metro Health Hospital, Wyoming, MI, United States ) , Adams, George (Rex Healthcare, Raleigh, NC, United States ) , Mahmud, Ehtisham (UC San Diego Medical Center, La Jolla, CA, United States)
    Cardiovascular revascularization medicine : including molecular interventions v.19 no.5 pt.A ,pp. 503 - 505 , 2018 , 1553-8389 ,

    초록

    Abstract Endovascular intervention is an appealing revascularization strategy for iliac artery disease. Atherectomy of the iliac artery is uncommon due to the risk of life-threatening perforation but may be necessary if the iliac lesion is heavily calcified, preventing stent delivery or optimal expansion. We assessed the feasibility and safety of orbital atherectomy for the treatment of iliac artery disease. Demographic data, lesion characteristics, and procedure outcomes for the CONFIRM patients with at least one iliac artery lesion treated with orbital atherectomy ( n = 62 patients; n = 68 lesions) were compared to patients with at least one superficial femoral artery (SFA) lesion treated with orbital atherectomy ( n = 1570 patients; n = 1809 lesions). The procedural complication rate, defined as the composite of flow limiting dissection, perforation, slow flow, vessel closure, spasm, embolism, or thrombosis, was compared in iliac lesions versus SFA lesions. The iliac artery group had more patients with diabetes, shorter lesions, and more severely calcified lesions. The orbital atherectomy run time was significantly shorter in the iliac artery group. Additionally, in the iliac group there was one reported perforation and one reported vessel closure; the rates of slow flow, spasm, embolism, thrombus, and flow limiting dissection were 0%. The overall procedural complication rate was significantly lower in the iliac group (2.9% vs. 11.2%, p = 0.03). Orbital atherectomy of the iliac artery is feasible with few reported angiographic complications and compared favorably with the SFA group. Orbital atherectomy may be considered to facilitate the delivery and expansion of a balloon or stent if the iliac artery is calcified.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  8. [해외논문]   Jetstream Atherectomy System treatment of femoropopliteal arteries: Results of the post-market JET Registry  

    Gray, William A. (Department of Cardiology, Columbia University Medical Center, New York, NY, USA ) , Garcia, Lawrence A. (St. Elizabeth's Medical Center, Tufts University School of Medicine, Boston, MA, USA ) , Amin, Ali (Reading Hospital & Medical Center, West Reading, PA, USA ) , Shammas, Nicolas W. (Midwest Cardiovascular Research Foundation, Davenport, IA, USA)
    Cardiovascular revascularization medicine : including molecular interventions v.19 no.5 pt.A ,pp. 506 - 511 , 2018 , 1553-8389 ,

    초록

    Abstract Objectives To report on procedural, safety, and effectiveness outcomes of real-world practice with the Jetstream rotational atherectomy system for treatment of femoropopliteal artery lesions. Background Safety and effectiveness of treatment with the Jetstream device has been demonstrated in clinical trials, but outcomes during real-world clinical practice have yet to be examined. Methods 241 patients (66% male, mean age 67years, 41% diabetes; Rutherford 1–3) with de novo or restenotic (non-stent) femoropopliteal lesions ≥4cm in length were recruited. Major adverse events (MAE), defined as amputation, death, target lesion/vessel revascularization (TLR/TVR), myocardial infarction, or angiographic distal embolization that required a separate intervention; and binary restenosis were assessed at 30days and 12months. Results The mean (±SD) lesion length was 16.4±13.6cm; 35% of patients received adjunctive stents. Procedural success was achieved for 98.3% of lesions. The 30-day MAE rate was 2% (5/219; 2 TLR/TVR and 3 distal embolization); there were no deaths, index limb amputations, or myocardial infarctions. At 12months, the overall estimated freedom from TLR/TVR was 81.7% and 77.2% (44/57) of patients were free from duplex ultrasound-assessed restenosis. Efficacy and patency in a diabetic subset were similar to those of the overall cohort, while maintaining a similar safety profile. Conclusion In a cohort reflecting real-world practice, the Jetstream Atherectomy System demonstrated a high procedural success rate with a low rate of complications and reinterventions, especially given the relatively long lesions studied. Highlights The JET registry was initiated to observe Jetstream Atherectomy System performance during standard clinical practice. Mean lesion length was 16.4 cm and 35% of patients received an adjunctive stent. MAEs were rare.

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    회원님의 원문열람 권한에 따라 열람이 불가능 할 수 있으며 권한이 없는 경우 해당 사이트의 정책에 따라 회원가입 및 유료구매가 필요할 수 있습니다.이동하는 사이트에서의 모든 정보이용은 NDSL과 무관합니다.

    NDSL에서는 해당 원문을 복사서비스하고 있습니다. 아래의 원문복사신청 또는 장바구니담기를 통하여 원문복사서비스 이용이 가능합니다.

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  9. [해외논문]   S UPERA stent outcomes in A bove-The- K nee Interv E ntions: Effects of COMP ression and EL ongation (SAKE-COMPEL) Sub-study  

    Bhatt, Hemal (Division of Cardiovascular Disease, Einstein Medical Center, Philadelphia, PA 19141, United States ) , Kovach, Richard (Division of Interventional Cardiology and Endovascular Medicine, Deborah Heart and Lung Center, Browns Mills, NJ 08015, United States ) , Janzer, Sean (Division of Cardiovascular Disease, Einstein Medical Center, Philadelphia, PA 19141, United States ) , George, Jon C. (Division of Cardiovascular Disease, Einstein Medical Center, Philadelphia, PA 19141, United States)
    Cardiovascular revascularization medicine : including molecular interventions v.19 no.5 pt.A ,pp. 512 - 515 , 2018 , 1553-8389 ,

    초록

    Abstract Introduction The interwoven nitinol design of the Supera stent has been shown to have superior radial strength and fracture resistance resulting in higher patency rates at 6 and 12months. A detailed sub-analysis of SUPERB trial showed differences in patency based on stent conformation post deployment. We evaluated the patency of the stent within the SAKE study cohort based on stent deployment conformation. Methods We retrospectively evaluated the medical records of 63 patients (77 limbs) with Rutherford class 2-5 symptoms who received Supera stents in the femoro-popliteal artery from March 2010 through May 2011 as part of the SAKE study. These patients were followed for patency and the need for re-intervention over a mean follow up of 15months. Compression or Elongation was defined as follows based on previous sub-analyses: Moderate Compression (−40 to −21%); Minimal Compression (−20 to −11%); Nominal (−10 to 10%); Minimal Elongation (11 to 20%); Moderate Elongation (21 to 40%); and Severe Elongation (>40%). Significance was determined using Chi X 2 test. Results The best patency rates (85.2% primary patency and 92.6% assisted primary patency) and lowest re-intervention rates (14.8%) were achieved with stent compression, followed by nominal deployment or minimal elongation, and worst outcomes (64.7% primary patency; 82.3% assisted primary patency; and 35.3% re-intervention) with stent elongation to moderate or severe degree. Conclusions Patency rates and re-intervention rates are variable based on deployment characteristics of the Supera stent. Best outcomes are achieved with compression of the stent during deployment. Highlights Supera stent has different patency outcomes based on stent deployment characteristics. Supera stent compression leads to better patency outcomes than stent elongation. Supera stent outcomes in the real world population differs from that in trial population.

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  10. [해외논문]   Prevalence of high on-treatment (aspirin and clopidogrel) platelet reactivity in patients with critical limb ischemia  

    Clavijo, Leonardo C. (Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States ) , Al-Asady, Noor (Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States ) , Dhillon, Ashwat (Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States ) , Matthews, Ray V. (Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States ) , Caro, Jorge (Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States ) , Tun, Han (Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States ) , Rowe, Vincent (Division of Vascular Surgery, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States ) , Shavelle, David M. (Division of Cardiovascular Medicine, Keck School of Medicine, University of Southern California,)
    Cardiovascular revascularization medicine : including molecular interventions v.19 no.5 pt.A ,pp. 516 - 520 , 2018 , 1553-8389 ,

    초록

    Abstract Objectives The goal of this study is to establish the prevalence of high on-treatment platelet reactivity to aspirin (HPRA) and clopidogrel (HPRC) in patients with critical limb ischemia (CLI). Background CLI is associated with an increased risk of death and cardiovascular events. Unlike other patient populations with atherosclerotic cardiovascular disease, previous studies failed to demonstrate a benefit of antiplatelet therapy in patients with CLI. Methods From June 2014 to November 2016, we performed platelet reactivity studies for P2Y12 and thromboxane A2 (TXA2) inhibition in 100 CLI patients receiving daily treatment with aspirin and clopidogrel. P2Y12 inhibition was measured by two assays: vasodilator-stimulated phosphoprotein (VASP) and VerifyNow P2Y12 assays. HPRC was defined as VerifyNow P2Y12 reactive units (PRU) >208 and VASP-platelet reactivity index (VASP-PRI) >50%. TXA2 inhibition was measured with the VerifyNow aspirin test and HPRA was defined as aspirin reaction units (ARU) >550. Results Mean age was 67±11 years, 50% were male, 80% had diabetes mellitus, and 26% had chronic renal insufficiency. Thirty-three percent of patients had a PRU >208 and 46% a VASP-PRI >50%. HPRC was present in 26% of patients based on the criteria of both a PRU >208 and VASP-PRI >50%. HPRA was present in 25% of patients. The overall prevalence of HPR to ASA or clopidogrel was 35% and HPR to both drugs was present in 8% of patients. Clinical characteristics were similar between groups. Conclusions HPR to aspirin or clopidogrel is highly prevalent in patients with CLI. Nearly one in ten patients with CLI is a hyporesponder to both aspirin and clopidogrel. Graphical abstract [DISPLAY OMISSION]

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