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Query: EC:6.2.1.1 (ACS)
 78,556 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The ACS RX flow support catheter, which functions as a temporary stent, was placed successfully during four procedures in three patients who had suboptimal results following angioplasty. This investigational device allowed prolonged perfusion and supported the vessel wall when coronary blood flow was compromised, avoiding emergent coronary artery bypass graft surgery during two procedures. In the remaining procedures the device was used as a bridge to surgery. These early applications of the flow support catheter following failed balloon angioplasty suggest a rapid, effective alternative to the autoperfusion balloon when it fails or is contraindicated because of the lesion location.
Cathet Cardiovasc Diagn 1992 Sep
PMID:ACS RX flow support catheter as a temporary stent for dissection or occlusion during balloon angioplasty: initial experience. 152 14

A patient presented with an acute inferior myocardial infarction. Coronary angiography in the acute stage revealed total occlusion of the right coronary artery. Reperfusion was obtained after intracoronary infusion of 250,000 units of streptokinase. Angioplasty was subsequently performed because of a high grade residual stenosis. An 8-French right Judkins guiding catheter with a single side hole (USCI), a 3.0 mm balloon dilatation catheter (ACS), and a 0.018 high torque floppy guide wire (ACS) were used. After successful angioplasty angiography was repeated with the guide wire in the RCA, but the balloon was withdrawn into the guiding catheter. After injection of contrast, it was impossible to withdrawn the balloon catheter out of the guiding catheter. Fluoroscopy revealed extrusion of the balloon through the side hole in the guiding catheter.
Cathet Cardiovasc Diagn 1986
PMID:Inadvertant balloon extrusion through a side hole in a guiding catheter. 395 42

Balloon inflation caused by contrast injection through the guiding catheter has been observed during several angioplasty procedures. The phenomenon is observed when employing an 8F USCI guiding catheter in combination with an ACS dilatation catheter. Two cases demonstrating the phenomenon are described in detail, together with an in vitro experiment that illustrates and quantifies the mechanism.
Cathet Cardiovasc Diagn 1984
PMID:Balloon inflation caused by contrast injection through the guiding catheter: an unusual observation during coronary angioplasty. 623 80

Coronary angioplasty (PTCA) through 6 French (F) guiding catheters is feasible, although acute or threatened closure following coronary artery dissections may occur. This report describes our experience with the treatment of suboptimal results in 13 patients from a population of 144 patients who had PTCA through 6F guiding catheters. Patients were treated with a new low profile autoperfusion catheter (ACS, Flowtrack40) or with Palmaz Schatz stents, advanced through 6F guiding catheters. PTCA was performed via the radial artery in 11 pts (85%) or via the femoral artery in two patients (15%). In two patients, (15%) PTCA was complicated by an dissection associated with complete loss of flow (TIMI 0) and a dissection was considered to lead to abrupt closure in the remaining 11 patients (85%), despite the presence of normal flow. A Flow-track40 perfusion catheter was successfully applied in three of four patients. In one patient a persisting dissection after restoration of flow by a perfusion catheter was treated with three Palmaz Schatz stents. Implantation of Palmaz Schatz stents was attempted as primary technique in nine patients. In one patient the stent could not cross a dissection in the proximal LAD via the radial artery. With an 8F system via the femoral artery, two stents could successfully be deployed with the stent delivery system. In another patient the stent could not be advanced across a subtotal residual stenosis in a tortuous left anterior descending coronary artery. Despite normal antegrade flow and emergency bypass surgery, this patient developed a non-Q-myocardial infarction. In the remaining patients, the clinical course was uncomplicated.(ABSTRACT TRUNCATED AT 250 WORDS)
Cathet Cardiovasc Diagn 1994 Aug
PMID:Bailout techniques for failed coronary angioplasty using 6 French guiding catheters. 798 20

Stent migration and embolization are well-known complications of intracoronary stenting with balloon-mounted stents. During an elective stenting procedure of a proximal right coronary artery stenosis, a 3.5 mm Wiktor stent (Medtronic Inc., Minneapolis) was displaced from its delivery balloon. The guiding catheter and the delivery system were withdrawn, leaving the stent around a 3 m 0.014 inch High Torque floppy guidewire (ACS, Santa Clara, CA) in the abdominal aorta. An 40 cm 5F Alligator Forceps catheter (Cook OB/Gyn., Spencer, IN), introduced through a cut-off 8F coronary guiding catheter, allowed improved torque control of the retrieval catheter and a safe and successful withdrawal of the stent through the arterial introducer sheet.
Cathet Cardiovasc Diagn 1993 Oct
PMID:Retrieval of a migrated coronary stent by means of an alligator forceps catheter. 822 73

The effective flow rates with human blood through an autoperfusion catheter cannot be monitored in vivo and have not been experimentally determined in vitro. The manufacturers (Advanced Cardiovascular Systems [ACS], Temecula, CA) have suggested that "the flow rate" through the Stack over the wire and the RX-60 monorail catheter is 60 ml/min with a pressure gradient of 80 mmHg. We measured human blood flow rates in vitro through these catheters under different continuous pressure regimens (between 40 and 120 mmHg), with varying hematocrit levels (between 25% and 62%). Measured blood flows at a gradient of 80 mmHg were found to vary from 32 to 65 cc/min, with hematocrit levels of 62-25%. Minor variations in the circuitry, besides the viscosity of the medium, cause significant changes in observed flow rates (such as kinking of the catheter and blood sedimentation). In vitro determinations of blood flows cannot automatically be transferred to the in vivo condition, primarily because in vitro determinations do not account for the systolic intramural pressure increase (which may overcome the aortic pressure). If such a phenomenon is also considered, then the in vitro flow rates reported here should be multiplied by a factor of 0.40-0.60 to determine effective in vivo flow rates. Such information is relevant for the clinical operator of angioplasty, especially in the treatment of patients at high risk for undergoing percutaneous transluminal coronary angioplasty.
Cathet Cardiovasc Diagn 1993 Sep
PMID:In vitro evaluation of blood flow through autoperfusion balloon catheters. 840 68

Perfusion balloon catheters are designed to provide continuous transcatheter blood flow and thereby reduce myocardial ischemia during coronary angioplasty. To compare the transcatheter flow rates of active and passive (auto-) perfusion catheters, a well-controlled experimental study was performed in a circulation model that duplicates the phasic, predominantly diastolic flow pattern of the left coronary artery. Mean diastolic coronary driving pressure varied between 20 and 100 mm Hg. For the autoperfusion catheters, a strong relationship between transcatheter flow and diastolic coronary driving pressure was found. For example, a coronary driving pressure of 80 mm Hg provided a coronary flow of 30 ml/min (RX-Perfusion [RP], ACS), 28 ml/min (Speedflow [SF], Schneider), 20 ml/min (Lifestream [LS], ACS), and 19 ml/min (Flowtrack [FT], ACS). Reduction of driving pressure to 40 mm Hg decreased the absolute transcatheter flow, which was now 16 ml/min (RP), 13 ml/min (SF), and 10 ml/min (LS and FT). The relative catheter flow (the ratio of absolute flow to baseline coronary flow rate without a catheter in place), was independent of actual coronary driving pressure and ranged between 21% +/- 1% (RP) and 14% +/- 1% (FT and LS). For the active perfusion system (Coreflo, Leocor, a maximal transcatheter flow of 82 ml/min was found. Using this active perfusion system, the relative catheter flow increased with decreasing coronary driving pressure:80 --> 40 mm Hg: 56% --> 107%. For all catheters, the distal perfusion decreased between 30% (3.0 mm RP) and 50% (3.0 mm LS) by a 0.014-inch guidewire placed through the inner channel of the catheter. Because of the strong relationship between coronary driving pressure and transcatheter flow, the residual flow through all autoperfusion catheters becomes critical (<20 ml/min), when the coronary driving pressure drops below 50 mm Hg. By contrast, active perfusion systems are independent of the actual coronary driving pressure and are therefore advantageous for prolonged dilation in patients with low aortic pressure.
Cathet Cardiovasc Diagn 1996 Aug
PMID:Comparison of passive and active perfusion catheters: an in vitro study in a pulsatile coronary flow model. 885 58

Extending a guidewire (ACS) with a "Doc" device not infrequently results in kinking of the proximal end of the guidewire, due to the fragile nature of the tapered proximal tip. Straightening the bent guidewire is accomplished easily with the use of two guidewire torque devices attached to both ends of the kinked connection.
Cathet Cardiovasc Diagn 1996 Nov
PMID:Straightening a kinked guidewire extension. 893 78

Currently, the recommended strategy for Palmaz-Schatz intracoronary stent implantation is to use two balloons: an undersized balloon for predilation to facilitate a channel for the stent and a high pressure balloon for postdilation to obtain good apposition of the struts into the vessel wall. We reported our experience using the perfusion balloon as the initial balloon to dilate intracoronary lesions and demonstrated a reduction in the total number of balloons used per angioplasty procedure. The objective of this study was to examine whether a single balloon could effectively be used for stent implantation. The study population included 95 patients who underwent elective intracoronary stent placement to 100 lesions using 110 Palmaz-Schatz stents by nine individual operators. Lesions were predilated with an ACS RX LIFESTREAM balloon at a low pressure of 4-6 atm (mean 5.7 +/- 2.6). After stent deployment, the same balloon was used at a high pressure (mean 16.2 +/- 1.2). Mean balloon size, which was chosen as the stent size, was 3.4 +/- 0.4 mm. Comparison of this strategy with the recommended strategy of 68 consecutive elective stent deployments at a single center during the same time was performed. Stent implantation using a single balloon strategy was angiographically successful in 99 of 100 (99.0%) lesions. The single balloon strategy was associated with a balloon burst rate of 9.1%. The number of balloons used per stent deployment was 1.2 vs. 2.4 using the recommended strategy (P < 0.0001). There was no evidence of stent thrombosis, any MI, or target lesion revascularization during the procedure and hospitalization. One in-hospital death as a result of nonhemorrhagic stroke was documented in the treated group. We concluded that using a single high pressure perfusion balloon for pre and postdilation in patients undergoing elective stent placement is safe and reduces the number of balloons used per procedure.
Cathet Cardiovasc Diagn 1997 Feb
PMID:Intracoronary stent implantation using a single high-pressure perfusion balloon catheter. 904 51

We report on a case of coronary embolization of an elastic membrane fixing the ACS RX Multilink stent over its balloon, after a successful stent delivery. The membrane was dislodged from the balloon in the ostium of the right coronary artery as the delivery balloon was being pulled back into the guiding catheter. All attempts to retrieve the membrane, to cover it with another stent, or to push it into a terminal segment of the artery to limit the jeopardized myocardial mass were unsuccessful. No CABG was performed because the left coronary system was normal and the procedure occurred 2 months after an incomplete inferior myocardial infarction. There was no increase in cardiac enzymes nor electrocardiographic signs of a new myocardial infarction at discharge or at 1-mo follow-up. It seems preferable to avoid further use of stents tied to their balloons with an intermediary, and possibly detachable, element.
Cathet Cardiovasc Diagn 1998 Jan
PMID:Coronary embolization of the membrane fixing a "Multilink" stent to its delivery balloon. 947 95


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