Bio

Academic Appointments


Administrative Appointments


  • Member, Panel 3 Stanford Human Subjects Committee (2005 - 2012)
  • Board Chairman, Biocardia Inc. San Carlos, CA (2008 - Present)

Honors & Awards


  • Adjunct Professor, Williams College (2008-2011)
  • Doctor Honoris Causa, Salvador School of Medicine, BA, Arg. (2006)

Professional Education


  • Fellowship, New York University, Cardiovascular Medicine (1967)
  • Residency, New York University, Medicine (1965)
  • Internship, UCSF, San Francisco, Straight Surgery (1962)
  • M.D., New York University, Medicine (1961)
  • Certificat de Physiologie, University of Paris, Sorbonne,Paris ,France, Certificat de Physiologie Cardiovasculaire (1956)
  • A.B., Union College, Humanities, Pre-Medicine (1957)

Research & Scholarship

Current Research and Scholarly Interests


Coronary Angioplasty; Intramyocardial Stem cell delivery

Teaching

2013-14 Courses


Publications

Journal Articles


  • Transendocardial autologous bone marrow in chronic myocardial infarction using a helical needle catheter: 1-year follow-up in an open-label, nonrandomized, single-center pilot study (the TABMMI study) AMERICAN HEART JOURNAL de la Fuente, L. M., Stertzer, S. H., Argentieri, J., Penaloza, E., Miano, J., Koziner, B., Bilos, C., Altman, P. A. 2007; 154 (1)

    Abstract

    Cell therapy has shown benefit in preclinical and clinical studies, although debate continues on the mechanism of action and the most appropriate methods for performing such therapies. We assessed the hypothesis that helical needle transendocardial (TE) delivery of autologous bone marrow (ABM) mononuclear cells around regions of hypo- or akinesia in patients after chronic myocardial infarction (MI) would be safe and possibly improve ejection fraction (EF).Ten stable post-MI patients with an EF <40% were enrolled. Autologous bone marrow cells were aspirated from the iliac crest and delivered percutaneously with a TE helical needle catheter. A total of 86 x 10(6) cells were injected into 7.1 +/- 3.1 sites around the infarct to target the peri-infarct zones. Two-dimensional echocardiographic left ventricle EF measurements, 24-hour Holter, and exercise tolerance testing were performed at baseline, day of procedure, 1 and 12 weeks, and 6 and 12 months. There were no adverse events associated with the catheter-based cell transplantation procedure. At 6 and 12 months, all patients showed an improvement in left ventricle EF over baseline (35.2 +/- 4.6 to 40.8 +/- 4.5, P = .003 at 6 months; 35.2 +/- 4.6 to 42.3 +/- 5.1, P = .0001 at 12 months).Autologous bone marrow cells delivered with the helical needle TE catheter was safe in this small uncontrolled study in patients with chronic MI. Increased EF and other positive data trends support continued development of this therapeutic strategy in larger controlled trials.

    View details for DOI 10.1016/j.ahj.2007.04.051

    View details for Web of Science ID 000247919300013

    View details for PubMedID 17584556

  • The artery: half full or half empty? Journal of interventional cardiology Stertzer, S. H. 2003; 16 (4): 323-?

    View details for PubMedID 14562672

  • 7-hexanoyltaxol-eluting stent for prevention of neointimal growth - An intravascular ultrasound analysis from the study to COmpare REstenosis rate between QueST and QuaDS-QP2 (SCORE) CIRCULATION Kataoka, T., Grube, E., Honda, Y., Morino, Y., Hur, S. H., Bonneau, H. N., Colombo, A., Di Mario, C., Guagliumi, G., Hauptmann, K. E., Pitney, M. R., Lansky, A. J., Stertzer, S. H., Yock, P. G., Fitzgerald, P. J. 2002; 106 (14): 1788-1793

    Abstract

    Inhibition of neointimal tissue growth has been demonstrated in preliminary human feasibility studies with a stent-based polymer sleeve delivering 7-hexanoyltaxol. The Study to COmpare REstenosis rate between QueST and QuaDS-QP2 (SCORE) trial is a human, randomized, multicenter trial comparing 7-hexanoyltaxol (QP2)-eluting stents (qDES) with bare metal stents (BMS) in the treatment of de novo coronary lesions. The purpose of this substudy was to evaluate the acute expansion property and long-term neointimal responses of qDES compared with BMS as assessed by intravascular ultrasound (IVUS).A total of 122 (qDES 66, BMS 56) patients were enrolled into the IVUS substudy. All IVUS images (immediately after the procedure and at 6-month follow-up) were analyzed at an independent core laboratory in a blind manner. At baseline, qDES achieved stent expansion similar to BMS. At follow-up, qDES showed reduced neointimal growth by 70% at the tightest cross section and by 68% over the stented segment (P<0.0001 for both), resulting in a significantly larger lumen in qDES than in BMS. Unlike intracoronary brachytherapy, there was no evidence of negative edge effects, unhealed dissections, or late stent-vessel wall malapposition over the stented and adjacent references segments in either group.Detailed IVUS analysis revealed that qDES had comparable acute mechanical and superior long-term biological effects to BMS. Although the long-term benefits and limitations of this technology require further investigation, the reduction in neointimal thickenings demonstrated that local delivery of 7-hexanoyltaxol through polymer sleeves augments conventional mechanical treatment of atherosclerotic disease.

    View details for Web of Science ID 000178385700012

    View details for PubMedID 12356631

  • Initial results of the quanam drug eluting stent (QuaDS-QP-2) registry (BARDDS) in human subjects CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS de la Fuente, L. M., Miano, J., Mrad, J., Penaloza, E., Yeung, A. C., Eury, R., Froix, M., Fitzgerald, P. J., Stertzer, S. H. 2001; 53 (4): 480-488

    Abstract

    Thirty-two patients presenting with varied coronary syndromes and anatomy were treated with a new coronary multisleeve drug delivery coronary stent (QuaDS-QP-2) containing up to 4,000 microg of a taxol-derived lipophilic microtubule inhibitor (QP2). The device was successfully implanted in 32 patients who have been followed for up to 2 years. Twenty-five patients have undergone stress ECHO or SPECT Thallium and all are currently asymptomatic. Thirteen patients have already been restudied angiographically, by IVUS and/or by SPECT Thallium testing and are detailed in this report. Angiographic, IVUS, and SPECT Thallium have been controlled at a mean of 11.2 months (range, 6-15 months) in this 13-patient cohort. Although all 13 QuaDS-QP-2 (QDES) stents were angiographically and IVUS patent, two reinterventions have been required in the 32-patient study group thus far, both relate to either new disease or to distal, small-vessel disease beyond the stent. There was no evidence of significant proliferation in the QDES devices. On the basis of this preliminary data and a European pilot study, a controlled randomized trial (SCORE) is currently in progress in western Europe.

    View details for Web of Science ID 000170252200010

    View details for PubMedID 11514998

  • Novel drug-delivery stent - Intravascular ultrasound observations from the first human experience with the QP2-eluting polymer stent system CIRCULATION Honda, Y., Grube, E., de la Fuente, L. M., Yock, P. G., Stertzer, S. H., Fitzgerald, P. J. 2001; 104 (4): 380-383

    Abstract

    The aim of this study was to use serial intravascular ultrasound (IVUS) to evaluate the long-term effect of stent-based 7-hexanoyltaxol (QP2, a taxane analogue) delivery on neointimal tissue growth within the stent and on vessel dimensions at the adjacent reference segments.Serial IVUS analyses (immediately after intervention and at follow-up at 8.3 months) were performed in 15 native coronary lesions treated with the QuaDS-QP2 stent. IVUS measurements were performed at 8 cross-sections in each target segment (4 cross-sections within the stent and 2 cross-sections in each reference segment). At baseline, no significant plaque protrusion or thrombus was detected in the target segment. Mild incomplete stent apposition and edge dissection were observed in one and two cases, respectively. Percent expansion of the stent (minimum stent area/average reference lumen area) was 96.0+/-21.7%. At follow-up, mean neointimal area within the stent was 1.2+/-1.3 mm(2), and mean cross-sectional narrowing (neointimal area/stent area) was 13.6+/-14.9%. At the vessel segments immediately adjacent to the stent, a significant increase in plaque area (1.9+/-2.6 mm(2), P=0.001) was observed, but vessel area remained unchanged. However, no patients showed clinically significant in-stent or edge restenosis (diameter stenosis >/=50%) during the follow-up period.The first human experience with the new drug-delivery stent showed a minimal amount of neointimal proliferation in the stented segment. Late lumen loss at the reference sites adjacent to the stent was acceptable and predominantly due to plaque proliferation.

    View details for Web of Science ID 000170116200003

    View details for PubMedID 11468196

  • Evaluation of the percutaneous intramyocardial injection for local myocardial treatment CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS Rezaee, M., Yeung, A. C., Altman, P., Lubbe, D., Takeshi, S., Schwartz, R. S., Stertzer, S., Altman, J. D. 2001; 53 (2): 271-276

    Abstract

    Therapeutic angiogenesis requires the induction of new blood vessel formation for the treatment of peripheral vascular and coronary artery disease. Efficacious application of this new therapy requires optimizing multiple factors, including the therapeutic agent, dosing, frequency of administration, and delivery modality. In this study, a helical needle drug infusion catheter was applied for optimal application of percutaneous intramyocardial delivery (PIMD). (125)Iodine-labeled albumin was injected by PIMD into the left ventricle myocardium in eight swine. After 1 hr, PIMD resulted in a high concentration of radiolabel at the treatment site; 16.4% +/- 2.1% of delivered and 81.4% +/- 2.6% of the total cardiac activity was concentrated at the site of delivery. The depth of needle penetration correlated with the myocardial retention of delivered protein. The myocardial retention of radiolabel in animals with shallow injections was 10.1% +/- 0.8%, compared to 18.9% +/- 3.3% retention after deep injections. The specific activity at the treatment site (radioactive counts per gram of tissue) was 115 +/- 36, 226 +/- 55, and 47 +/- 10 times higher compared to liver, lung, and kidney, respectively. Continuous coronary sinus and aortic blood sampling indicates that within 15 min following intramyocardial injection, a significant amount of nonretained protein is found within the coronary sinus. This study defines some of the parameters that can affect optimal application of PIMD and demonstrates that PIMD is a safe and efficient method for local drug delivery.

    View details for Web of Science ID 000169010600024

    View details for PubMedID 11387620

  • Images in cardiology. Giant left ventricular pseudoaneurysm. Clinical cardiology Fearon, W. F., Lo, S., Stertzer, S. 2001; 24 (4): 345-?

    View details for PubMedID 11303706

  • Ultrasound logic: The value of intracoronary imaging for the interventionist CATHETERIZATION AND CARDIOVASCULAR INTERVENTIONS Oesterle, S. N., Limpijankit, T., Yeung, A. C., Stertzer, S., Pomerantsev, E., Yock, P. G., Fitzgerald, P. J. 1999; 47 (4): 475-490

    View details for Web of Science ID 000081733400019

    View details for PubMedID 10470481

  • Coronary stents: In vitro aspects of an angiographic and ultrasound quantification with in vivo correlation. Circulation Pomerantsev, E. V., Kobayashi, Y., Fitzgerald, P. J., Grube, E., Sanders, W. J., Alderman, E. L., Oesterle, S. N., Yock, P. G., Stertzer, S. H. 1998; 98 (15): 1495-1503

    Abstract

    The validity of quantitative coronary angiography (QCA) after stent placement has been questioned because the optical density of a metallic stent, added to the density of a contrast-filled lumen, could affect border definition. METHODS andWe deployed 3.0- and 4.0-mm Palmaz-Schatz, Wiktor, Multilink, NIR, and InStent stents in precision-cast phantoms. Central lumens of 2.0 mm were created. There was no difference between the "true" diameters of any stented lumen by both QCA and quantitative ultrasonic (QCU) measurement poststenting. QCA systematic error (SE) varied from 0.01 for the Wiktor stents to 0.14 mm for the Palmaz-Schatz stents; the random error (RE) was 0.03 to 0.14 mm. QCU SE varied from 0.05 to 0.11 mm, and RE ranged from 0.01 to 0.07 mm. At the next stage, 4.0-mm Wiktor and Palmaz-Schatz stents were deployed into the phantom lumens; 1.5-, 2.0-, 2.5- and 3.0-mm lumens were created inside the stents. QCA and QCU measurements of 1.5- to 2.5-mm residual lumens were overestimated by 0.1 to 0.3 mm. In the 3. 0-mm residual lumen within the Wiktor stent, QCA underestimated the luminal size by -0.1 mm. There was no QCA inaccuracy for a 3.0-mm lumen within the Palmaz-Schatz stent. In patients, in 25 stented segments in both the Palmaz-Schatz and Wiktor groups, there was no difference between QCA and QCU diameters.QCU is sufficiently precise for the assessment of the coronary lumen after stenting. QCA can be used as an accurate method of poststent assessment, except when a very mild recurrence within a highly opaque stent is measured. In that instance, QCA may underestimate the luminal diameter.

    View details for PubMedID 9769302

  • The stent decade: 1987 to 1997 AMERICAN HEART JOURNAL Oesterle, S. N., Whitbourn, R., Fitzgerald, P. J., Yeung, A. C., Stertzer, S. H., Dake, M. D., Yock, P. G., Virmani, R. 1998; 136 (4): 578-599

    Abstract

    In January 1997, experts from the United States, Europe, and Japan gathered at Stanford University to review their collective experience with intracoronary and noncoronary stenting and to identify and prioritize issues requiring further clinical investigation. This report summarizes the discussions that took place during this stent summit. Knowledge of stent-tissue interaction from animal and human pathologic specimens was reviewed in the context of evolving stent designs. The relative merits of coil and slotted tubular stent designs were discussed. Stent deployment routines, including self-expansion, balloon expansion, and high-pressure delivery were debated. The potential for covered stents and coated stents was explored. Problems surrounding the routine deployment of stents were identified: small vessel disease, long lesions, bifurcation stenoses, vein graft disease, ostial disease, left main stenoses, and intrastent restenosis. The value of intravascular ultrasound, as an adjunct to stenting, was explored and debated. An algorithm for "provisional stenting" based on ultrasound criteria was developed. Noncoronary stenting of the aorta, iliacs, and carotids were discussed. Clinical applications that may lead to randomized clinical trials were identified.

    View details for Web of Science ID 000076316800005

    View details for PubMedID 9778060

  • Coronary AVE micro stents: Serial quantitative angiography and histology in a canine model CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Pomerantsev, E. V., Kim, C., Kernoff, R. S., Oesterle, S. N., Yeung, A., Fitzgerald, P. J., Virmani, R., Yock, P. G., Stertzer, S. H. 1997; 41 (2): 213-224

    Abstract

    The AVE Micro Stent (AVE Inc., Santa Rosa, CA) is composed of helically welded 3 mm long, zigzag crowns with stent lengths from 6 to 39 mm and diameters from 2.5 to 4.5 mm. Quantitative coronary angiography and histologic analyses of acute and chronic implantation were obtained in 52 stented coronary segments of 18 dogs. Three hearts with 8 stented coronary segments were harvested after 24 hr, 3 hearts with 9 stented segments were harvested after 2 weeks, 6 hearts with 15 stented segments were harvested at 8 weeks, and 6 hearts with 20 stented segments were harvested at 24 weeks post-deployment. There were no procedural complications, deaths, or acute vessel closures. The average lumen diameter of the stented segment was largest at 2 weeks (3.3 +/- 0.3 mm). The smallest average diameters were observed at 8 weeks after the stent deployment (2.7 +/- 0.4, P < 0.05) with an increase again at 24 weeks (2.9 +/- 0.6). The pre-explant percent of stenosis was <30% in all animals. Histologically, a peak of inflammation was visible at 2 weeks; however, the extent of luminal narrowing reached its peak at 8 weeks and the lumen dimension increased somewhat at 24 weeks. The degree of intimal thickening remained relatively constant throughout the different time points (<200 microm). Overall, these data suggest that constrictive remodeling within the stented segment occurs at 8 weeks in this animal model. The later increase of the stented segment dimensions as well as higher net gain at 24 weeks compared to 8 weeks after deployment suggests that this constriction is a transitory phenomenon.

    View details for Web of Science ID A1997XC51700023

    View details for PubMedID 9184299

  • High-speed rotational atherectomy: Six-month serial quantitative coronary angiographic follow-up AMERICAN HEART JOURNAL Stertzer, S. H., Pomerantsev, E. V., Fitzgerald, P. J., Yock, P. G., Yeung, A. C., Shaw, R. E., Walton, A. S., Singer, A. H., Sanders, W. J., Oesterle, S. N. 1996; 131 (4): 639-648

    Abstract

    One hundred twenty-three patients treated with high-speed rotational atherectomy (HSRA) were restudied 6.9 +/- 1.2 months later. At the follow-up, the number of focal concentric lesions increased from 32.2 percent to 63.0 percent, p<0.01, with decrease of type C lesions from 54.8 percent to 30.8 percent, p<0.05. Comparison of the degree of the net gain (NG) showed more severe baseline lesions in the high-gain group (NG >20 percent) compared with the moderate-gain group (20 percent > NG > 0 percent) and to the loss group (minimal luminal diameter [MLD] 0.8 +/- 0.4 mm vs 1.0 +/ 0.4 mm, p<0.05; and 1.2 +/- 0.5 mm; p<0.01, respectively). Highest initial gain (36.5 percent +/- 26.2 percent vs 24.5 percent +/- 18.1 percent; p<0.015; and 19.0 percent +/- 23.2 percent; p<0.001) as well as lowest late loss (1.8 percent +/- 21.7 percent vs 14.0 percent +/-18.4 percent; p<0.01 and 28.1 percent +/- 25.0 percent; p<0.01) were found in the high NG group. A higher interaction between burr and atheroma resulted in the lowest restenosis rate of 6 percent.

    View details for Web of Science ID A1996UE42100002

    View details for PubMedID 8721633

  • Outcome of narrowing related side branches after high-speed rotational atherectomy AMERICAN JOURNAL OF CARDIOLOGY Walton, A. S., Pomerantsev, E. V., Oesterle, S. N., Yeung, A. C., Singer, A. H., Shaw, R. E., Stertzer, S. H. 1996; 77 (5): 370-373

    Abstract

    High-speed rotational atherectomy (HSRA) is advocated for calcified and diffusely narrowed coronary arteries. There are often side branches involving these kinds of lesions. The presence of significant lesion-related side branches has been considered a relative contraindication to rotational atherectomy. This study was performed to determine the rate, predictors, and outcome of side branch occlusion after HSRA. The angiograms of 418 patients were examined with 320 side branches in 240 target vessels of > or = 1 mm in diameter being identified. Vessels were scored as either perfused (Thrombolysis In Myocardial Infarction 2 or 3 flow) or occluded (Thrombolysis In Myocardial Infarction 0 or 1 flow before and after the procedure. A detailed quantitative angiographic analysis was performed on a total of 108 side branches including all cases of branch occlusion. Clinical outcomes were determined in all cases with side branch loss. There were 24 occlusions in 21 patients after the procedure, giving a rate of branch loss of 7.5%. Follow-up angiography of > or = 24 hours was available for 13 of the occluded branches and 12 were found to be patent. In the 21 patients with branch occlusion, 6 sustained a myocardial infarct (of which 5 were non-Q-wave), 2 underwent coronary artery bypass grafting, and 2 died. There are frequently lesion-associated side branches in the types of vessels to undergo HSRA. These branches remained patent 92.5% of the time, with occlusion occurring infrequently and usually being transient. When occlusion did occur, there was a 29% incidence of myocardial infarction.

    View details for Web of Science ID A1996TV89600008

    View details for PubMedID 8602565

  • Effects of technique modification on immediate results of high speed rotational atherectomy in 710 procedures on 656 patients CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Stertzer, S. H., Pomerantsev, E. V., Fitzgerald, P. J., Shaw, R. E., Walton, A. S., Singer, A. H., Yeung, A., Yock, P. G., Oesterle, S. N. 1995; 36 (4): 304-310

    Abstract

    Seven hundred ten high speed rotational atherectomy (HSRA) procedures were performed in a single consecutive series of 656 patients. Stand alone HSRA was performed in 253 patients (35%). HSRA with adjunctive low pressure (< or = 2 ATM) balloon angioplasty (LP BA) was performed in 221 patients (31%), and HSRA with adjunctive high pressure (> or = 4 ATM) balloon angioplasty (HP BA) was performed in 236 patients (34%). Prognostically unfavorable Type B2 and C lesions dominated the study group (74.7%). Procedural success rate was 96%. Emergency coronary artery bypass surgery was performed in 1.4% of cases, Q wave myocardial infarction occurred in 3.4% and death, related to procedure, was consequent in 0.5% of cases. Incidence of flow limiting dissections was 3.1%, distal spasm was 5.3%, and "no reflow" phenomenon was 1.8%. The recent technique modifications included continuous advancer/guiding catheter infusion of the nitroglycerin-verapamil mixture, limitation of duration of lesion engagement by the burr, stepwise increase in the burr size, decrease of rotational speed, and strict control of rpm drop during lesion ablation. Evolution of the interventional technique involved trends towards decrease of the use of HP BA in conjunction with steady increase in the percentage of SA and LP BA procedures over time. These technique changes resulted in complete absence of "no reflow" in 1994, as well as a generalized decrease in overall coronary vascular reactivity from all burr passes.

    View details for Web of Science ID A1995TM65600002

    View details for PubMedID 8719378

  • QUANTITATIVE LEFT VENTRICULOGRAPHY - METHODS OF ASSESSMENT OF THE REGIONAL CONTRACTILITY JOURNAL OF INVASIVE CARDIOLOGY Pomerantsev, E. V., Stertzer, S. H., Shaw, R. E. 1995; 7 (1): 11-18

    Abstract

    To compare different approaches to the quantitative analysis of regional left ventricular (LV) function, six different protocols with various long axis definitions, with or without alignment, with radial or hemiaxial segmental definitions were used. Study group consisted of 20 patients with single vessel coronary artery disease after Q-wave anterior myocardial infarction (MI) and 20 patients after Q-wave diaphragmatic MI. Control group consisted of 100 patients. Analytic protocol with the long axis drawn between the apex of the LV and the center of aortic valve plane, radial coordinate system originating from the midpoint of the long axis and alignment of the long axes in systole and diastole, was found to be most sensitive and specific for detection of both anterior and diaphragmatic contraction abnormalities. Original method to measure both severity and length of the regional contraction abnormality is suggested.

    View details for Web of Science ID A1995QF82400002

    View details for PubMedID 10155652

  • COMPARATIVE-STUDY OF THE ANGIOGRAPHIC MORPHOLOGY OF CORONARY-ARTERY LESIONS TREATED WITH PTCA, DIRECTIONAL CORONARY ATHERECTOMY, OR HIGH-SPEED ROTATIONAL ABLATION CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Stertzer, S. H., Pomerantsev, E. V., Shaw, R. E., BOUCHER, R. A., Millhouse, F., ZIPKIN, R. E., HIDALGO, B. O., Murphy, M. C., HANSELL, H. N., Myler, R. K. 1994; 33 (1): 1-9

    Abstract

    To evaluate trends in morphology-based intervention selection, series of 110 consecutive procedures of each of three devices, percutaneous transluminal balloon coronary angioplasty (PTCA), directional coronary atherectomy (DCA), or high-speed rotational ablation (HSRA), were reviewed. PTCA was used mainly in discrete, concentric, smooth, ACC/AHA type A and B1 lesions. PTCA was used less frequently on a bend, branching points or in calcified lesions. Using PTCA as a reference, DCA was used more often for the treatment of discrete, proximal, eccentric, and noncalcified lesions, often complicated with thrombus and located on straight segments. HSRA was used more frequently in diffuse, calcified multiple complicated and B2+C type lesions with frequent side branches and bend points. These results suggest that directional atherectomy and rotational ablation may be helpful in expanding the capacity of the operator to approach prognostically unfavorable lesions.

    View details for Web of Science ID A1994PJ20500001

    View details for PubMedID 8001093

  • Triple vessel revascularization: coronary angioplasty versus coronary artery bypass surgery: initial results and five-year follow-up. Comparative costs and loss of working days and wages. journal of invasive cardiology Myler, R. K., Shaw, R. E., Stertzer, S. H., Zapolanski, A., Zipkin, R., Murphy, M. C., Hecht, H., Chan, J., Mengarelli, L., Cumberland, D. C. 1994; 6 (4): 125-135

    Abstract

    The purpose of this study was to compare early and late outcomes in patients undergoing PTCA or CABG for triple vessel disease.Although early results of PTCA/CABG randomized trials have recently become available, at present little data exists on long-term medical and socioeconomic effects of these treatment modalities in patients with triple vessel revascularization.During 1986-87, 76 patients undergoing triple vessel PTCA and 85 patients having triple vessel CABG were selected from a consecutive series of patients having multivessel revascularization. Initial results and 5 year outcome, hospital stay and charges and out-of-work time were assessed from prospectively collected data.Clinical and morphological factors were similar in the PTCA and CABG groups. Hospital success and complications were also similar, except for higher mortality in the CABG cohort (0 vs. 3.5%). Five year follow-up showed no differences in survival, nonfatal infarction and angina-free status; however, there was a difference in need for repeat revascularization (PTCA 55.4% vs. CABG 6.3%, p less than 0.001). Repeat PTCA accounted for 49% of the revascularization in the PTCA cohort. Crossovers were similar (PTCA[CABG 6.8%; CABG[PTCA 6.3%, pNS). Predictors of late death in the entire population were female gender (p less than 0.0001), diabetes (p<0.05) and depressed LVEF (p less than 0.05). The choice of revascularization procedure (PTCA vs. CABG) was not an independent predictor of late death or MI. Analysis of initial hospital charges showed a 2:1 advantage in favor of PTCA but this advantage was lost in late followup due to the need for repeat revascularization in the PTCA group. However, the PTCA cohort lost fewer working days than CABG patients (3017 vs 5874 days) and therefore, lost less wages ($7,022 vs. $14,685).The study shows that for selected triple vessel disease patients, PTCA and CABG results are comparable after 5 years, though repeat revascularization (mainly due to restenosis) was necessary in the PTCA group to maintain these favorable results. After 5 years, hospital charges are similar in the 2 groups, though out-of-work time and lost wages were 2:1 in favor of PTCA.

    View details for PubMedID 10147165

  • CORONARY STENTING WITH A NEW ULTRA-SHORT BALLOON-EXPANDABLE DEVICE - EARLY AND LATE ANIMAL RESULTS CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Anwar, A., Stertzer, S. H., HIDALGO, B. O., DELAFUENTE, L., Morales, M. C., Fischer, E. I., Shaw, R. E., Murphy, M. C., Myler, R. K. 1994; 31 (1): 85-89

    Abstract

    The early and late effects of a new balloon-expandable coronary stent (Boneau II) were studied in 16 adult mongrel dogs. Thirty-three balloon-expandable stents were deployed using standard transfemoral coronary angioplasty technique. Single stents were placed in eight dogs and multiple (two to four) stents were placed in eight dogs. Intravenous heparin (3,000 units) was administered at the beginning of the procedure. Aspirin, dipyridamole, dextran, and warfarin were not administered before or after the procedure. All stent deployments were successful. Angiographic or pathologic examinations were performed within 24 hr of deployment on two of the dogs, at 2 weeks on two of the dogs, at 2 months on three of the dogs, at 6 months on six of the dogs, and at 1 year on three of the dogs. All successfully deployed stents were noted to be widely patent. There was no evidence of side-branch vessel occlusion. There was no evidence of acute or late vessel thrombosis. Histologic examination at 2 months showed a mean intimal thickness of 153 microns. The stainless steel Boneau II coronary stent is relatively short and easily deployed. This balloon-expandable coronary stent was successfully deployed in normal canine arteries without the use of anticoagulation or antiplatelet therapy before or after the procedure. The Boneau II intracoronary stent has a very low thrombogenic potential in dogs.

    View details for Web of Science ID A1994MP59000016

    View details for PubMedID 8118865

  • RESTENOSIS AFTER CORONARY ANGIOPLASTY - PATHOPHYSIOLOGY AND THERAPEUTIC IMPLICATIONS .2. JOURNAL OF INVASIVE CARDIOLOGY Myler, R. K., Shaw, R. E., Stertzer, S. H., Hecht, H., Ryan, C., Cumberland, D. 1993; 5 (9): 319-333

    View details for Web of Science ID A1993MK57000002

    View details for PubMedID 10146596

  • LATE OUTCOME OF MULTIVESSEL CORONARY-ARTERY DISEASE AFTER ANGIOPLASTY OR BYPASS-SURGERY JOURNAL OF INVASIVE CARDIOLOGY BACIEWICZ, P. A., Shaw, R. E., Rosenblum, J., Myler, R. K., Zapolanski, A., Anwar, A., Stertzer, S. H., Murphy, M. C., HANSELL, H. N., Chan, J., Leary, L. 1993; 5 (5): 179-187

    Abstract

    Background. Results from randomized trials to determine optimal treatment for patients with multivessel coronary disease are not yet available. Thus, the early and late outcomes of 191 PTCA and 221 CABG patients done in 1985-86 were evaluated. Methods and Results. CABG patients selected had more coronary risk factors and more severe coronary artery disease compared to PTCA patients. Comparison of the initial outcome showed that clinical success without major cardiovascular events was similar (93.7% for PTCA vs. 90.0% for CABG; p=n.s.). Five year followup was obtained in 99.0% of PTCA patients and 94.4% of CABG patients. In the PTCA group, 89.8% were alive, 4.8% had sustained an MI, and repeat revascularization was required in 46.8%. In the CABG group, 87.1% were alive, 3.2% had had a MI, and 3.5% required repeat revascularization. Statistical comparison demonstrated no difference between the groups in survival or late cardiac events, but rate of repeat revascularization was significantly higher for PTCA patients (p less than 0.0001). Incompleteness of revascularization (p<0.01) was independently associated with an increased need for repeat revascularization in the PTCA group. In the CABG group, depressed left ventricular function (p less than 0.001) and female sex (p<0.01) were associated with lower survival rates. An analysis of cost per patient showed that the strategies were comparable. Conclusions. PTCA and CABG in multivessel disease patients have similar early results and comparable rates of survival and late cardiac events. Significantly more repeat revascularization is required in PTCA patients to maintain these results.(ABSTRACT TRUNCATED AT 250 WORDS)

    View details for Web of Science ID A1993LG39400002

    View details for PubMedID 10146581

  • THE EVOLUTION OF A CLINICAL DATABASE TO EVALUATE THE TREATMENT OF CORONARY-ARTERY DISEASE JOURNAL OF INVASIVE CARDIOLOGY Shaw, R. E., Myler, R. K., Murphy, M. C., Mooney, J., HANSELL, H. N., Stertzer, S. H. 1993; 5 (4): 162-169

    Abstract

    The field of invasive cardiology has evolved rapidly since the initial use of catheters for treatment of coronary artery disease in the late 1970's. The pace of this change coupled with the complexity of the clinical setting and proliferation of devices and drugs used for therapy have made it extremely difficult to construct and maintain a viable clinical database.Using a standard hardware and software system with the direct clinical input from a multidisciplinary team of physicians, nurses and biostatisticians, a clinical database was developed that is capable of tracking complex in-hospital and longterm follow-up data in patients undergoing treatment of coronary artery disease.The database has provided the basis for in-depth analysis of angioplasty results in patients with vessels and lesions of varying morphology, showing greater than 90% success in most complex lesion morphology using contemporary balloon technology and/or new devices. Longterm analysis (14 years) of patients after angioplasty has demonstrated that 76% survived without major cardiac events. Other analyses of various clinical and morphologic subsets have shown favorable results with angioplasty. The databases for angioplasty and coronary bypass surgery have been combined, showing comparable survival and freedom from cardiac events in multivessel disease patients treated with these procedures.The development of a dynamic and clinically relevant database that has evolved has contributed valuable information to the understanding and effective management of patients with coronary artery disease.(ABSTRACT TRUNCATED AT 250 WORDS)

    View details for Web of Science ID A1993LC41500005

    View details for PubMedID 10146579

  • DIGITAL SUPINE BICYCLE STRESS ECHOCARDIOGRAPHY - A NEW TECHNIQUE FOR EVALUATING CORONARY-ARTERY DISEASE JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Hecht, H. S., DEBORD, L., Shaw, R., Dunlap, R., Ryan, C., Stertzer, S. H., Myler, R. K. 1993; 21 (4): 950-956

    Abstract

    The objective of this study was to determine the accuracy of digital supine bicycle stress echocardiography, a new technique for evaluating coronary artery disease during peak exercise.Prior stress echocardiographic techniques have not utilized peak exercise imaging to determine the extent and location of coronary artery disease.Two-hundred twenty-two patients were studied: 180 underwent both supine bicycle stress echocardiography and coronary arteriography; 42 had a < 5% likelihood of disease. Forty-three patients had normal coronary arteries, 55 had single-vessel, 42 had double-vessel and 40 had triple-vessel coronary artery disease.Supine bicycle stress echocardiography was 93% sensitive, 86% specific and 92% accurate for identifying patients with coronary artery disease irrespective of prior myocardial infarction or achievement of > or = 85% maximal predicted heart rate. The "normalcy" rate in the low probability group was 100%. Supine bicycle stress echocardiography was 87% sensitive, 89% specific and 88% accurate for specific vessel identification. The sensitivity was greatest for the left anterior descending compared with the right coronary artery and the left circumflex coronary artery (95% vs. 81% vs. 78%, p < 0.01) and for vessels in patients with double- and triple-vessel compared with single-vessel disease (90% vs. 89% vs. 78%, p < 0.05). The procedure was significantly more sensitive for detection of vessels with 90% to 100% compared with 50% to 70% diameter stenosis (91% vs. 81%, p < 0.05) and was 88% correct in the prediction of multivessel disease.Supine bicycle stress echocardiography is a highly accurate tool for evaluating coronary artery disease, identifying both the patient with coronary artery disease and the location and extent of disease.

    View details for Web of Science ID A1993KT86500014

    View details for PubMedID 8450164

  • PROPHYLACTIC VERSUS STANDBY CARDIOPULMONARY SUPPORT FOR HIGH-RISK PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Teirstein, P. S., Vogel, R. A., Dorros, G., Stertzer, S. H., Vandormael, M. G., Smith, S. C., Overlie, P. A., Oneill, W. W. 1993; 21 (3): 590-596

    Abstract

    Data from a national registry of 23 centers using cardiopulmonary support (CPS) were analyzed to compare the risks and benefits of prophylactic CPS versus standby CPS for patients undergoing high risk coronary angioplasty.Early data from the CPS registry documented a high angioplasty success rate as well as a high procedural morbidity rate. Because of this increased morbidity some high risk patients were placed on standby CPS instead of prophylactic CPS.Patients in the prophylactic CPS group had 18F or 20F venous and arterial cannulas inserted and cardiopulmonary bypass initiated. Patients in the standby CPS group were prepared for institution of cardiopulmonary bypass, but bypass was not actually initiated unless the patient sustained irreversible hemodynamic compromise.There were 389 patients in the prophylactic CPS group and 180 in the standby CPS group. The groups were comparable with respect to most baseline characteristics, except that left ventricular ejection fraction was lower in the prophylactic CPS group. Thirteen of the 180 patients in the standby CPS group sustained irreversible hemodynamic compromise during the angioplasty procedure. Emergency institution of CPS was successfully initiated in 12 of these 13 patients in < 5 min. Procedural success was 88.7% for the prophylactic and 84.4% for the standby CPS group (p = NS). Major complications did not differ between groups. However, 42% of patients in the prophylactic CPS group sustained femoral access site complications or required blood transfusions, compared with only 11.7% of patients in the standby CPS group (p < 0.01). Among patients with an ejection fraction < or = 20%, procedural morbidity remained significantly higher in the prophylactic CPS group (41% vs. 9.4%, p < 0.01), but procedural mortality was higher in the standby group (4.8% vs. 18.8%, p < 0.05).Patients in the standby and prophylactic CPS groups had comparable success and major complication rates, but procedural morbidity was higher in the prophylactic group. When required, standby CPS established immediate hemodynamic support during most angioplasty complications. For most patients, standby CPS was preferable to prophylactic CPS during high risk coronary angioplasty. However, patients with extremely depressed left ventricular function (ejection fraction < 20%) may benefit from institution of prophylactic CPS.

    View details for Web of Science ID A1993KP17700006

    View details for PubMedID 8436739

  • CORONARY ROTATIONAL ABLATION - INITIAL EXPERIENCE IN 302 PROCEDURES JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Stertzer, S. H., Rosenblum, J., Shaw, R. E., Sugeng, I., Hidalgo, B., Ryan, C., HANSELL, H. N., Murphy, M. C., Myler, R. K. 1993; 21 (2): 287-295

    Abstract

    The aim of this study was to assess the utility of percutaneous transluminal coronary rotational ablation in the treatment of coronary artery disease.Although numerous advances have been made in the treatment of coronary artery disease, there are lesions with complex morphology that are not amenable to current intravascular therapy.A consecutive series of 242 patients having 302 coronary rotational ablation procedures was analyzed. One hundred nineteen (49%) of the patients had previously undergone attempted coronary angioplasty, which was unsuccessful in 31 patients (13%). The left ventricular ejection fraction was normal in 196 patients (81%). The ablation procedure was attempted in 308 vessels and 346 lesions. Of the 346 lesions treated, 26 (7.5%) were classified as American College of Cardiology/American Heart Association type A, and 320 (92.5%) as either type B or type C.Procedural success was achieved in 284 (94%) of the 302 procedures and 330 (95.4%) of the 346 lesions in which ablation was attempted. Five procedures (1.7%) were unsuccessful, but no cardiac event occurred during the hospital stay. A major cardiac event occurred in 13 cases (4.3%); 9 (3%) of these complications were due to the ablation procedure. Six patients sustained a Q wave myocardial infarction alone, two had a Q wave infarction and required emergency surgery and one needed emergency surgery but did not have a Q wave infarction. No procedural deaths were attributed to the ablation procedure. Follow-up has been obtained in 182 of the 242 patients at a mean interval of 9 +/- 5 months. Of the 182 patients, 174 (95.6%) were alive and free of myocardial infarction. Angiographic follow-up is available thus far in 87 patients. By combining angiographic and clinical outcome, an overall estimated restenosis rate of 37.4% (68 of 182) was calculated.These data suggest that coronary rotational ablation can be performed on lesions with a variety of morphologic features with high initial success rates. The overall rate of restenosis is similar to that of balloon angioplasty.

    View details for Web of Science ID A1993KL12600002

    View details for PubMedID 8425988

  • USEFULNESS OF SUPINE BICYCLE STRESS ECHOCARDIOGRAPHY FOR DETECTION OF RESTENOSIS AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY AMERICAN JOURNAL OF CARDIOLOGY Hecht, H. S., DEBORD, L., Shaw, R., Dunlap, R., Ryan, C., Stertzer, S. H., Myler, R. K. 1993; 71 (4): 293-296

    Abstract

    The role of supine bicycle stress echocardiography (SBSE) for detecting restenosis after percutaneous transluminal coronary angioplasty (PTCA) was evaluated in 80 patients: 41 (51%) with single and 39 (49%) with multivessel PTCA (total 129 dilated vessels). Total revascularization was performed in 54 (68%) and partial revascularization in 26 (32%) patients. Restenosis was angiographically demonstrated in 60 patients (75%) and in 72 vessels (56%) 6.1 +/- 2.9 months after PTCA. The results for detecting restenosis were: (1) SBSE versus exercise electrocardiographic sensitivity, 87 versus 55% (p < 0.001); (2) specificity, 95 versus 79%; and (3) accuracy, 89 versus 61% (p < 0.001). SBSE was 83% sensitive, 95% specific and 88% accurate for restenosis detection in specific vessels with comparable results for single versus multivessel PTCA and total versus partial revascularization. Sensitivity, specificity and accuracy were: 91, 93 and 91% for the left anterior descending coronary artery; 77, 94 and 85% for the right coronary artery; and 76, 96 and 88% for the left circumflex coronary artery. Ninety-four percent of the nondilated diseased vessels were correctly identified. It is concluded that SBSE is an excellent tool for identifying restenosis after PTCA.

    View details for Web of Science ID A1993KK28400007

    View details for PubMedID 8427170

  • ROTATIONAL ABLATION OF BALLOON ANGIOPLASTY FAILURES JOURNAL OF INVASIVE CARDIOLOGY Rosenblum, J., Stertzer, S. H., Shaw, R. E., Hidalgo, B., HANSELL, H. N., Murphy, M. C., Myler, R. K. 1992; 4 (6): 312-318

    Abstract

    In this series, we evaluated the use of rotational ablation in stenoses that were previously refractory to balloon angioplasty. Forty-one stenoses were treated; in 26, the balloon did not adequately expand within the lesion and in 15 the balloon could not be delivered to the stenosis. Rotational ablation was technically successful in 40 of 41 (97.6%) of the lesions attempted. Twenty-four patients have been followed (mean time = 9 +/- 5 months) and the restenosis rate was similar to that of balloon angioplasty. Rotational ablation appears well suited and may be the treatment of choice for heavily calcified, severely angulated, and diffusely diseased vessels.

    View details for Web of Science ID A1992JJ57900006

    View details for PubMedID 10147818

  • LESION MORPHOLOGY AND CORONARY ANGIOPLASTY - CURRENT EXPERIENCE AND ANALYSIS JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Myler, R. K., Shaw, R. E., Stertzer, S. H., Hecht, H. S., Ryan, C., Rosenblum, J., Cumberland, D. C., Murphy, M. C., HANSELL, H. N., Hidalgo, B. 1992; 19 (7): 1641-1652

    Abstract

    From July 1, 1990 to February 28, 1991, 533 consecutive patients with 764 target vessels and 1,000 lesions underwent coronary angioplasty. Procedural success was achieved in 92.3%, untoward (major cardiac) events occurred in 3% (0.8% myocardial infarction, 1.3% emergency coronary bypass grafting and 0.9% both; there were no deaths). An unsuccessful uncomplicated outcome occurred in 4.7%. Lesion analysis using a modified American College of Cardiology/American Heart Association classification system showed that 8% were type A, 47.5% were type B and 44.5% were type C (36% of type B and 11% of type C were occlusions). Angioplasty success was achieved in 99% of type A, 92% of type B and 90% of type C lesions (A vs. B, p less than 0.05; B vs. C, p = NS; A vs. C, p less than 0.01). Untoward events occurred in 1.2% of type A, 1.9% of type B and 2% of type C lesions (p = NS). An unsuccessful uncomplicated outcome occurred in 0% of type A, 6% of type B and 7% of type C lesions (A vs. B, p less than 0.05; B vs. C, p = NS; A vs. C, p less than 0.05). Among the unsuccessful uncomplicated outcome group, occlusion occurred in 49%: 38% of type B and 59% of type C lesions. With B1 and B2 subtypes, success was obtained in 95% and 89.5% and untoward events occurred in 1.5% and 2.3% and an unsuccessful uncomplicated outcome in 3.7% and 8%, respectively. C1 and C2 subtyping showed success in 91% and 86%, untoward events in 1.3% and 6% and an unsuccessful uncomplicated outcome in 7.5% and 8.5%, respectively. Among the 764 vessels, success was obtained in 89.5% and untoward events occurred in 2.5% and an unsuccessful uncomplicated outcome in 8%. Assessment of lesion-vessel combinations showed a less favorable outcome with type C lesions and combinations of A-B, B-C and multiple (more than three lesions) type B and C vessels. Statistical analysis of morphologic factors associated with angioplasty success included absence of (old) occlusion (p less than 0.0001) and unprotected bifurcation lesion (p less than 0.001), decreasing lesion length (p less than 0.003) and no thrombus (p less than 0.03). The only significant factor associated with untoward events was the presence of thrombus (p less than 0.003). Predictors of an unsuccessful uncomplicated outcome included old occlusion (p less than 0.0001) and increasing lesion length (greater than 20 mm) (p less than 0.001), unprotected bifurcation lesion (p less than 0.05) and thrombus (p less than 0.03).

    View details for Web of Science ID A1992HX98500040

    View details for PubMedID 1593061

  • EFFECT OF VALVE DEFORMITY ON RESULTS AND MITRAL REGURGITATION AFTER INOUE BALLOON COMMISSUROTOMY CIRCULATION Feldman, T., Carroll, J. D., Isner, J. M., Chisholm, R. J., Holmes, D. R., Massumi, A., Pichard, A. D., Herrmann, H. C., Stertzer, S. H., Oneill, W. W., Dorros, G., SUNDRAM, P., Bashore, T. M., Ramaswamy, K., Jones, L. S., Inoue, K. 1992; 85 (1): 180-187

    Abstract

    The effect of valve deformity and patient age adversely affect the results of percutaneous transvenous mitral commissurotomy (PTMC) with conventional balloons.These factors were characterized after PTMC with the Inoue balloon. The increases in mitral valve area and mitral regurgitation after the procedure were evaluated comparing echocardiographic score of 8 or less versus more than 8, age of less than 60 versus age of 60 years or more, and age of less than 70 versus age of 70 years or more. One hundred sixty-two patients (mean age, 52 +/- 14 years) were studied. For the entire group, mitral valve area increased from 1.0 to 1.8 cm2 (p less than 0.001). Valve area increased from 1.0 +/- 0.3 to 1.8 +/- 0.6 cm2 in patients with echocardiographic score of 8 or less (n = 102) and from 1.0 +/- 0.3 to 1.7 +/- 0.5 cm2 with echocardiographic score of more than 8 (n = 44). Patients less than 60 years old (n = 104) had increases in valve area from 1.0 +/- 0.3 to 1.8 +/- 0.6 cm2 versus 1.0 +/- 0.4 to 1.8 +/- 0.6 cm2 for those 60 years old or older (n = 50) (p = NS). There was no significant difference in resultant valve area when the age division was increased to less than 70 versus 70 years or more. Similarly, the percentage of patients with 2+ or greater increase in mitral regurgitation was not different for those with higher than for those with lower echocardiographic scores (4% versus 12%, p = NS), age of less than 60 versus age of 60 years or more (10% versus 10%, p = NS), or age of less than 70 versus age of 70 or more years (9% versus 18%, p = NS). Valve replacement for mitral regurgitation was performed in four patients (one emergency), all with echocardiographic scores of less than 8.Age and extent of valve deformity do not have significant effects on acute results of PTMC using the Inoue balloon. Unique balloon geometry or the controlled, stepwise balloon sizing may explain these acceptable acute results in patients with more-deformed valves.

    View details for Web of Science ID A1992GY58200022

    View details for PubMedID 1728448

  • CAUSES AND CORRELATES OF DEATH AFTER UNSUPPORTED CORONARY ANGIOPLASTY - IMPLICATIONS FOR USE OF ANGIOPLASTY AND ADVANCED SUPPORT TECHNIQUES IN HIGH-RISK SETTINGS AMERICAN JOURNAL OF CARDIOLOGY Ellis, S. G., Myler, R. K., King, S. B., Douglas, J. S., Topol, E. J., Shaw, R. E., Stertzer, S. H., Roubin, G. S., Murphy, M. C. 1991; 68 (15): 1447-1451

    Abstract

    To better understand the factors predisposing a patient to death after elective percutaneous transluminal coronary angioplasty (PTCA) and to gain insight into indications for high-risk PTCA both with and without adjunctive use of support devices, the outcomes of 8,052 consecutive procedures were reviewed. Death occurred after 32 procedures (0.4%) and was directly related to coronary artery closure in 26 (81%) of these cases. Left ventricular failure due to vessel closure at the dilated site, the most common cause of death, was independently correlated with female sex (p less than 0.001), "jeopardy score" (p less than 0.001) and PTCA of a proximal right coronary artery site (p = 0.002), but not with left ventricular ejection fraction or presence of multivessel disease. Right ventricular failure after closure of the proximal right coronary artery, and left main coronary dissection accounted for the majority of the remaining deaths. Systolic blood pressure immediately after coronary artery closure was also closely correlated with jeopardy score, and cardiogenic shock was frequent in women with scores greater than or equal to 3.5 and in men with scores greater than or equal to 5.0. These data highlight the superiority of the jeopardy score versus ejection fraction in the determination of risk, stress the importance of gender in determining outcome and point to the need for better means of right ventricular protection from severe ischemia. Therefore, an initial framework for rational use of PTCA and support devices in the high-risk setting is established.

    View details for Web of Science ID A1991GT33100007

    View details for PubMedID 1746425

  • ROTATIONAL ABLATION OF A SEVERELY ANGULATED STENOSIS PREVIOUSLY NOT AMENABLE TO BALLOON ANGIOPLASTY AMERICAN HEART JOURNAL Rosenblum, J., Odonnell, M. J., Stertzer, S. H., SCHECHTMANN, N. S., BACIEWICZ, P. A., Hidalgo, B., Myler, R. K. 1991; 122 (6): 1766-1768

    View details for Web of Science ID A1991GT94500034

    View details for PubMedID 1957773

  • ROTATIONAL ABLATION OF CHRONIC CORONARY OCCLUSIONS CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS SCHECHTMANN, N. S., Rosenblum, J., Stertzer, S. H., Hidalgo, B., BACIEWICZ, P. A., FEIND, C. R., Ward, K., Myler, R. K. 1991; 24 (4): 295-299

    Abstract

    Rotational ablation was performed successfully in three chronic coronary occlusions. At 3 months follow-up, two of the three lesions were patent. These cases illustrate the overall advantages and unique technical aspects of this device.

    View details for Web of Science ID A1991GT72300015

    View details for PubMedID 1756569

  • EMERGENCY CORONARY-ARTERY BYPASS-SURGERY FOLLOWING FAILED BALLOON ANGIOPLASTY - ROLE OF THE INTERNAL MAMMARY ARTERY GRAFT JOURNAL OF CARDIAC SURGERY Zapolanski, A., Rosenblum, J., Myler, R. K., Shaw, R. E., Stertzer, S. H., Millhouse, F. G., ZATZKIS, M., Wulff, C., SCHECHTMANN, N. S., Siegel, S., Bronstein, M., ELLERTSON, D., Leary, L. 1991; 6 (4): 439-448

    Abstract

    During a 4-year period (1986-1989), 3,502 patients had percutaneous transluminal coronary angioplasty (PTCA) in our institution. One hundred nineteen (3.4%) patients required emergency coronary artery bypass graft surgery (CABG) because of abrupt vessel closure following PTCA. Factors associated with vessel closure included lesion angulation greater than or equal to 90 degrees (p less than 0.007), the presence of thrombus (p less than 0.02), or a long (greater than or equal to 2 cm) lesion (p less than 0.03). Of these 119 emergency CABG patients, 108 (91%) arrived in the operating room in a stable condition (group I) and 11 (9%) were in cardiogenic shock (group II). Five (45%) of the group II patients were admitted to the hospital with an acute myocardial infarction and all 11 patients had a higher incidence of multivessel disease (p less than 0.05) and lower left ventricular ejection fraction (p less than 0.001) than group I patients. The overall surgical mortality was 10.1%; however, in group I the mortality was 5.6% and in group II it was 54.5% (p less than 0.001). The vessel that abruptly closed ("culprit vessel") was the left anterior descending (LAD) in 60%, the right coronary artery in 27%, and the left circumflex in 13%. The internal mammary artery was utilized to bypass the culprit artery in 51 (43%) patients, including 50% of the culprit LADs. With group I culprit LAD patients, when the left IMA was the bypass conduit, there were no hospital deaths nor strokes and there was a 6.3% incidence of perioperative infarction.

    View details for Web of Science ID A1991GX17000002

    View details for PubMedID 1815767

  • BRACHIAL ROTATIONAL ATHERECTOMY CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Rosenblum, J., Stertzer, S. H., SCHECHTMANN, N. S., Hidalgo, B., BACIEWICZ, P. A., Myler, R. K. 1991; 24 (1): 32-36

    Abstract

    The brachial approach adds a new dimension to rotational atherectomy. The two cases presented included a large ectopic right coronary artery and a right internal mammary graft where both outcomes were successful. These cases demonstrate that the brachial approach can facilitate rotational atherectomy when greater guide support is necessary.

    View details for Web of Science ID A1991GC02900007

    View details for PubMedID 1913789

  • MULTIPLE CORONARY-ARTERY ANEURYSMS IN AN ADULT ASSOCIATED WITH EXTENSIVE THROMBUS FORMATION RESULTING IN ACUTE MYOCARDIAL-INFARCTION - SUCCESSFUL TREATMENT WITH INTRACORONARY UROKINASE, INTRAVENOUS HEPARIN, AND ORAL ANTICOAGULATION CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Myler, R. K., SCHECHTMANN, N. S., Rosenblum, J., COLLINSWORTH, K. A., BASHOUR, T. T., Ward, K., Murphy, M. C., Stertzer, S. H. 1991; 24 (1): 51-54

    Abstract

    A 37-yr-old white female was admitted to hospital with an evolving anterior myocardial infarction. Coronary arteriography revealed multiple aneurysms in the left anterior descending (and right) coronary arteries. In the left anterior descending artery, there was evidence of extensive thrombus formation. The patient was successfully treated with intracoronary urokinase, intravenous heparin, and oral warfarin. There was partial thrombolysis in 16 hr and complete thrombolysis noted 6 wk later. This case of multiple coronary aneurysms, secondary to presumed Kawasaki disease, is the first documentation of antemortem intra-aneurysmal coronary thrombosis treated successfully by thrombolytic and anticoagulant therapy.

    View details for Web of Science ID A1991GC02900011

    View details for PubMedID 1913793

  • Coronary angioplasty and coronary bypass surgery. journal of invasive cardiology Myler, R. K., Stertzer, S. H., Shaw, R. E. 1991; 3 (4): 180-190

    View details for PubMedID 10149126

  • CORONARY ANGIOPLASTY IN OCTOGENARIANS - COMPARISONS TO CORONARY-BYPASS SURGERY CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Myler, R. K., Webb, J. G., NGUYEN, K. P., Shaw, R. E., Anwar, A., SCHECHTMANN, N. S., BASHOUR, T. T., Stertzer, S. H., Zapolanski, A. 1991; 23 (1): 3-9

    Abstract

    Coronary angioplasty was performed in 74 patients 80 years of age and older (mean 83 +/- 3). Single vessel coronary disease was present in 34% and multivessel coronary disease in 66%. Angioplasty of a single vessel was performed in 51 patients (69%), while 23 (31%) had angioplasty of multiple vessels. Angioplasty was successful in 59 of 74 patients (80%). Angioplasty was unsuccessful but uncomplicated in 12 (16%) due to (unyielding) calcified lesions or (impassable) old occlusions. Of these 12, 8 were discharged on medical therapy and 4 underwent elective uncomplicated bypass surgery prior to discharge. Three (4%) patients required emergency coronary bypass surgery due to abrupt vessel closure during the angioplasty procedure, with one hospital death (1.4%). Follow-up (mean 24 +/- 22 months) was obtained in all patients. Of the 59 successful angioplasty patients, late mortality was 10% (cardiac 7% and non-cardiac 3%). Survival and survival without myocardial infarction were both 90%; survival without either infarction or bypass surgery was 86%. Actuarial 3-year survival was 91% and 3-year freedom from death, infarction or bypass surgery was 87% by life-table analysis. Repeat angioplasty for restenosis was performed in 7 patients (12%) without complications.

    View details for Web of Science ID A1991FH60200002

    View details for PubMedID 1863958

  • SILENT ISCHEMIA AFTER CORONARY ANGIOPLASTY - EVALUATION OF RESTENOSIS AND EXTENT OF ISCHEMIA IN ASYMPTOMATIC PATIENTS BY TOMOGRAPHIC TL-201 EXERCISE IMAGING AND COMPARISON WITH SYMPTOMATIC PATIENTS JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Hecht, H. S., Shaw, R. E., Chin, H. L., Ryan, C., Stertzer, S. H., Myler, R. K. 1991; 17 (3): 670-677

    Abstract

    One hundred sixteen patients were evaluated to determine the ability of single photon emission computed tomographic (SPECT) thallium-201 exercise and redistribution imaging to detect silent ischemia secondary to restenosis in asymptomatic patients after single and multiple vessel percutaneous transluminal coronary angioplasty and the findings were compared with SPECT imaging detection of restenosis in symptomatic patients. The value of exercise electrocardiography (ECG) and the amount of ischemic myocardium in symptomatic and asymptomatic patients were determined. Forty-one patients were asymptomatic after angioplasty; 77% of these had chest pain before angioplasty. Seventy-five patients had chest pain after angioplasty; 99% of these had chest pain before angioplasty. Restenosis occurred in 61% of asymptomatic and 59% of symptomatic patients and in 46% of the vessels in both asymptomatic and symptomatic patients. Sensitivity, specificity and accuracy for detection of restenosis by SPECT in individual patients were 96%, 75% and 88% versus 91%, 77% and 85%, respectively, in the asymptomatic versus symptomatic groups (p = NS). Sensitivity, specificity and accuracy for restenosis detection in individual vessels were 90%, 89% and 89% versus 84%, 77% and 84%, respectively, in the asymptomatic and symptomatic groups (p = NS), with similar results for the three major arteries. Sensitivity and accuracy of exercise ECG were significantly less than those of SPECT imaging for the patients with silent (40% and 44%) and symptomatic (59% and 64%) ischemia (p less than 0.001). Restenosis of vessels in the patients with silent and symptomatic ischemia was associated with an equal amount and degree of severity of ischemic myocardium in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

    View details for Web of Science ID A1991EY74100015

    View details for PubMedID 1993787

  • CORONARY ANGIOPLASTY IN YOUNG-ADULTS - INITIAL RESULTS AND LATE OUTCOME JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Webb, J. G., Myler, R. K., Shaw, R. E., Anwar, A., Stertzer, S. H. 1990; 16 (7): 1569-1574

    Abstract

    The initial and late outcome of coronary angioplasty was studied in 148 patients less than 40 years of age (mean 36.4 +/- 3). Angioplasty was performed on a single vessel in 70% of patients and on multiple vessels in 30%; it was performed on a totally occluded vessel in 20%. Angioplasty was successful in 90.5% of patients, unsuccessful but uncomplicated in 7.4% and complicated by myocardial infarction in 0.7%, emergency bypass surgery in 0.7% and death in 0.7%. At late (mean 3.7 +/- 3 years; range 0.5 to 11.5) follow-up study after successful angioplasty, 94% of patients were alive, 79% were free of angina and 85% had returned to work; late myocardial infarction occurred in 4%. Actuarial survival at 5 years was 95%, and 85% of patients were free from death, infarction or bypass surgery. A second angioplasty was performed in 29 patients (22%) (mean 6.1 +/- 8.4 months) and was successful in 27 (93%), with no deaths. Elective coronary bypass surgery was performed in 8.5% of patients, with perioperative infarction in 9% and no deaths. By univariate analysis, late death was more likely to occur in hypertensive patients (15% versus 2.5%; p less than 0.01) and diabetic patients (21.4% versus 3.6%; p less than 0.01). Cox proportional hazard regression analysis identified hypertension (p = 0.007) and diabetes (p = 0.04) as independent time-related predictors of subsequent death. Thus, early and late results after coronary angioplasty in young adults are favorable, but certain risk factors are important predictors of outcome. Late revascularization procedures (repeat angioplasty or surgery) for restenosis or disease progression are common.

    View details for Web of Science ID A1990EP09900009

    View details for PubMedID 2254540

  • USEFULNESS OF TOMOGRAPHIC TL-201 IMAGING FOR DETECTION OF RESTENOSIS AFTER PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY AMERICAN JOURNAL OF CARDIOLOGY Hecht, H. S., Shaw, R. E., BRUCE, T. R., Ryan, C., Stertzer, S. H., Myler, R. K. 1990; 66 (19): 1314-1318

    Abstract

    The role of tomographic thallium-201 exercise and redistribution imaging in the detection of restenosis after percutaneous transluminal coronary angioplasty (PTCA) was evaluated in 116 patients: 61 (53%) with 1- and 55 (47%) with multivessel PTCA, with a total of 185 dilated vessels. Complete revascularization was performed in 89 (77%) and partial revascularization in 27 (23%) of the patients. Restenosis was angiographically demonstrated in 69 (60%) of the patients and 85 (46%) of the vessels 6.4 +/- 3.1 months after PTCA. Disease progression in previously normal vessels was noted in 11 patients. The results were: (1) for detection of restenosis in the group of patients, single-photon emission computed tomographic (SPECT) versus exercise electrocardiographic sensitivity was 93 vs 52% (p less than 0.001), specificity 77 vs 64%, and accuracy 86 vs 57% (p less than 0.001). The results were similar in the complete and partial revascularization groups. (2) SPECT was 86% sensitive, specific and accurate for restenosis detection in specific vessels with comparable results for 1-versus multivessel PTCA and complete versus partial revascularization. Sensitivity, specificity and accuracy were: 89, 95 and 92% for the left anterior descending coronary artery; 88, 79 and 82% for the right coronary artery; and 76, 83 and 85% for the left circumflex coronary artery. Eighty-one percent of the diseased nondilated vessels were correctly identified. (3) Disease progression to greater than 50% stenosis was detected with 91% sensitivity, 84% specificity and 85% accuracy. SPECT thallium-201 imaging is an excellent tool for the detection of restenosis and disease progression after PTCA in the settings of 1- and multivessel angioplasty and complete and partial revascularization.

    View details for Web of Science ID A1990EK56700008

    View details for PubMedID 2244560

  • Early clinical experience with a hot tip laser wire in patients with chronic coronary artery occlusions. journal of invasive cardiology Bowes, R. J., Oakley, G. D., Fleming, J. S., Myler, R. K., Stertzer, S. H., Shaw, R. E., Cumberland, D. C. 1990; 2 (6): 241-245

    Abstract

    Chronic coronary artery occlusions remain one of the problems limiting the use of percutaneous transluminal coronary angioplasty (PTCA). We have studied the use of an 0.018 inch laser hot tip wire. It was coupled either to a continuous wave argon or Nd-YAG laser generator and introduced through a balloon catheter to try and cross and dilate a series of chronic coronary artery occlusions in which initial conventional attempts had failed. Four LAD and 6 RCA occlusions were attempted; we successfully crossed and dilated 6 (60%) lesions, 4 (40%) using the laser wire alone to recanalize the occlusion and in 2 a combination of laser wire and conventional means.

    View details for PubMedID 10148982

  • CORONARY ANGIOPLASTY AFTER CORONARY-BYPASS SURGERY - INITIAL RESULTS AND LATE OUTCOME IN 422 PATIENTS JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Webb, J. G., Myler, R. K., Shaw, R. E., Anwar, A., Mayo, J. R., Murphy, M. C., Cumberland, D. C., Stertzer, S. H. 1990; 16 (4): 812-820

    Abstract

    From 1978 to 1988, coronary angioplasty was performed in 422 patients with prior coronary artery bypass surgery (264 patients with native coronary artery angioplasty and 158 patients with graft angioplasty). Angioplasty was successful in 84%, unsuccessful but uncomplicated in 11% and complicated by one or more major cardiac events in 5% (myocardial infarction 5%, emergency bypass surgery 2% and death 0.2%). Follow-up data were obtained in 99% of 356 patients with successful angioplasty. At a mean of 33 +/- 26 months, 92% were alive, 73% had improvement in angina and 61% were free of angina. One or more of the following late events occurred in 67 patients (19%): myocardial infarction (6%), elective reoperation (13%) and cardiac death (6%). Repeat angioplasty was performed in 27%, with a success rate of 89% and no deaths. Initial success rates were equal in native vessel versus graft angioplasty, but late outcome was less favorable with the latter because of a higher rate of infarction (11% versus 4%, p less than 0.05) and need for reoperation (19% versus 10%, p less than 0.05). The initial success rate was higher in vein grafts less than 1 year old compared with grafts 1 to 4 years or greater than 4 years after operation (92% versus 85% versus 83%, respectively) and adverse late events were less frequent after angioplasty in recent vein grafts (less than 1 year 13%, 1 to 4 years 35%, greater than 4 years 29%; less than 1 versus greater than 1 year, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

    View details for Web of Science ID A1990EC92500009

    View details for PubMedID 2212363

  • DOES PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY ACCELERATE ATHEROSCLEROTIC LESIONS CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS NGUYEN, K. P., Shaw, R. E., Myler, R. K., Webb, J. G., Stertzer, S. H. 1990; 21 (1): 1-6

    Abstract

    Recent reports have suggested that angioplasty may cause or accelerate coronary arterial stenoses secondary to traumatic injury. Ninety-four coronary angiograms performed in a 1 yr period were reviewed in patients who had successful coronary angioplasty 6 to 30 mo (mean 10.7) prior to restudy. Restenosis was found in 43 of 140 dilated lesions (31%) and in 41 of 94 patients (44%). Thirty-three (35%) patients had new or progressive lesions outside the angioplasty site. New or progressive lesions occurred with similar frequency in the arteries that did not have angioplasty (23/155 = 15%) as in the arteries that did (13/127 = 10%; chi-square n.s.). In the arteries which underwent angioplasty, new or progressive lesions occurred as commonly proximal to the PTCA site (7/14, 50%) as distal (6/13, 46%). New or progressive lesions occurred in 29% of patients with concomitant restenosis, and 40% of those without restenosis (chi-square n.s.). No clinical, angiographic, or procedural factors distinguished patients with new and progressive lesions in target vessels from those without these lesions in target vessels. Patients with progressive lesions anywhere in the coronary tree were more likely to have had a shorter duration of anginal symptoms before angioplasty and a family history of coronary disease when compared with patients without progressive atherosclerosis. In conclusion, new and progressive lesions outside the angioplasty site occur after the procedure but appear unrelated to the restenosis process or traumatic injury by angioplasty instrumentation.

    View details for Web of Science ID A1990DW60400001

    View details for PubMedID 2208259

  • Unstable angina and coronary angioplasty. Circulation Myler, R. K., Shaw, R. E., Stertzer, S. H., BASHOUR, T. T., Ryan, C., Hecht, H. S., Cumberland, D. C. 1990; 82 (3): II88-95

    Abstract

    Of 2,122 consecutive patients undergoing elective coronary angioplasty from 1982 to 1985, 62% had stable angina pectoris (SAP), and 38% had unstable angina pectoris (UAP). There were differences between the two groups in clinical and morphological factors and in initial and late results of angioplasty. UAP patients were more likely than SAP patients to be smokers and to have had prior myocardial infarctions. Lesions in UAP patients were more severe, longer, more eccentric, more irregular, and more likely to have intracoronary thrombi than were lesions in SAP patients. Coronary angioplasty success was achieved in 84% of UAP and in 88% of SAP patients (p less than 0.05), and complications occurred in 6.7% of UAP and in 4.7% of SAP patients (p less than 0.05). Hospital death rates were low and similar, 0.2% for both groups. Follow-up (mean, 37 months) showed recurrent Canadian Cardiovascular Society (CCVS) class III/IV angina in 30.1% of UAP and in 25.2% of SAP patients (p less than 0.05). There was a return to work in 86% of UAP and in 91% of SAP patients (p less than 0.05). When UAP patients' durations of symptoms were further fractionated, it was found that the earlier angioplasty was performed after onset of angina, the lower was the success rate and the higher the complication rate and incidence of late follow-up untoward events. When coronary angioplasty was performed within 1 week of onset of angina ("early"), success was 79.1%; when angioplasty was performed 2 weeks or more after onset of angina ("later"), success was 86.3%. Major cardiac events occurred in 11.5% in the early group and in 4.8% in the later group (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

    View details for PubMedID 2203565

  • ANGIOPLASTY OF SMALL-DIAMETER CORONARY-ARTERIES USING AN ANGIOGRAPHIC CATHETER AND PROBE CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Webb, J. G., Myler, R. K., Stertzer, S. H., GUERMONPREZ, J. L., JAIS, J. M., MAOUAD, J. 1990; 20 (4): 261-266

    View details for Web of Science ID A1990DT30900010

    View details for PubMedID 2208255

  • Left ventricular support during high risk coronary angioplasty: an argument for the use of cardiopulmonary support. journal of invasive cardiology Stertzer, S. H., Myler, R. K. 1990; 2 (4): 155-156

    View details for PubMedID 10148974

  • BIDIRECTIONAL CROSSOVER AND LATE OUTCOME AFTER CORONARY ANGIOPLASTY AND BYPASS-SURGERY - 8 TO 11 YEAR FOLLOW-UP JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Webb, J. G., Myler, R. K., Shaw, R. E., Anwar, A., Murphy, M. C., Mooney, J. F., Mooney, M. R., Stertzer, S. H. 1990; 16 (1): 57-65

    Abstract

    Between March 1978 and July 1981, 217 symptomatic patients underwent coronary angioplasty as an alternative to coronary bypass surgery. Angioplasty was successful in 143 patients (66%), unsuccessful but uncomplicated in 65 (30%) and complicated in 9 (4%) by one or more of the following criteria: Q wave myocardial infarction (2%), emergency surgery (4%) or death (0.5%). Late follow-up evaluation was obtained in 213 patients at a mean of 9 +/- 1 years. Of patients in whom angioplasty was successful, 59 (42%) of 140 required another revascularization procedure (repeat angioplasty in 26% and bypass surgery in 16%). The actuarial survival rate at 5, 9 and 10 years after successful angioplasty was 98%, 93% and 92%, respectively. Of the 65 patients with unsuccessful and uncomplicated angioplasty (usually as a result of technical factors), 58 underwent elective bypass surgery within 2 months and 56 survived. These 56 surgical patients were compared with the 140 patients with successful angioplasty. Univariate analysis of prognostic factors did not reveal significant differences between these two groups. At late follow-up study, the successful angioplasty and the successful surgical groups had similar rates of survival (93% versus 95%, p = NS) and of death or infarction, or both (11% versus 12.5%, p = NS). Repeat revascularization was required more frequently after successful angioplasty than after surgery (42% versus 18%, p less than 0.001). Crossover from angioplasty to surgery occurred slightly more often than from surgery to angioplasty (16% versus 12.5%, p = NS). The time to crossover from angioplasty to surgery occurred earlier than from surgery to angioplasty (mean 21 versus 76 months, p less than 0.001).

    View details for Web of Science ID A1990DM22900011

    View details for PubMedID 2358604

  • Intra-aortic balloon counterpulsation support for elective coronary angioplasty in the setting of poor left ventricular function: a two center experience. journal of invasive cardiology Anwar, A., Mooney, M. R., Stertzer, S. H., Mooney, J. F., Shaw, R. E., Madison, J. D., VanTassel, R. A., Murphy, M. C., Myler, R. K. 1990; 2 (4): 175-180

    Abstract

    A two-center elective coronary angioplasty experience with intra-aortic balloon pump support for patients with severe left ventricular dysfunction is reported. To prevent hemodynamic collapse, an intra-aortic balloon pump was inserted percutaneously before coronary angioplasty in 97 patients with a left ventricular ejection fraction less than 35% (26% of whom had ejection fractions less than 25%). The cohort was predominantly male (71%) with a mean age of 64 +/- 9 years. Angioplasty was successfully performed in 83 (85.6%) patients and 80 (82.5%) of these successful patients were discharged from the hospital. Seven patients had unsuccessful angioplasty without a major cardiac event. Seven patients (7.2%) suffered a major cardiac event; 4 had emergent coronary bypass surgery with q-wave infarction, 2 had uneventful emergency coronary bypass surgery, and one patient died in the operating room after a failed angioplasty. Using logistic regression analysis, the presence of multivessel disease and a history of prior myocardial infarction were associated with more complications during angioplasty (p less than 0.05). Intra-aortic balloon pump placement did not interfere with the angioplasty procedure. Two patients had limb ischemia which resolved when the intra-aortic balloon pump was removed. Of the 80 successful patients discharged, 72 were followed for a mean of 22 months. At the latest follow-up, 52 had not suffered a myocardial infarction and were alive. Of the 20 late deaths, 16 were cardiac and 4 non-cardiac.(ABSTRACT TRUNCATED AT 250 WORDS)

    View details for PubMedID 10148978

  • PERCUTANEOUS TRANSLUMINAL AORTIC VALVULOPLASTY - THE ACUTE OUTCOME AND FOLLOW-UP OF 149 PATIENTS WHO UNDERWENT THE DOUBLE BALLOON TECHNIQUE EUROPEAN HEART JOURNAL Dorros, G., LEWIN, R. F., Stertzer, S. H., King, J. F., Waller, B. F., Myler, R. K., Mathiak, L., Murphy, M., Shaw, R. E., Assa, J., Anderson, A. J. 1990; 11 (5): 429-440

    Abstract

    Double balloon percutaneous transluminal aortic valvuloplasty (PTAV) was performed on 149 patients (76 male (51%), mean age 76 +/- 11 years) whose symptoms included severe congestive heart failure in 127 cases (82%), syncope in 21 (14%) and angina in six (4%). Significant changes (P less than 0.05) in peak systolic (83 +/- 36 to 38 +/- 30 mmHg) and mean gradient (68 +/- 25 to 36 +/- 21 mmHg), and aortic valve area (0.6 +/- 0.2 to 1.0 +/- 0.4 cm2) were achieved in 130/149 patients (87%). Complications included an overall in-hospital mortality of 13%, (10.0% excluding the six deaths occurring in 18 moribund patients), a neurologic deficit incidence of 3%, and surgical arterial entry site repair 3.0% (14/47) of patients. Multivariate analysis identified congestive heart failure (NYHA Class IV), left ventricular ejection fraction, cardiac output and coronary artery disease as independent variables significantly affecting in-hospital mortality. Predictors of poor long-term survival were degree of heart failure, and coronary artery disease. The cumulative probability of survival at 24 months was 52 +/- 5% (excluding non-cardiac deaths, was 66 +/- 3%). Follow-up (mean time: 16 +/- 7 months) of 130 patients discharged alive revealed 41 late deaths (26 cardiac related). Sixty-two patients (70%) were symptomatically improved; 17 patients had symptom recurrence and underwent repeat valvuloplasty, and 10 patients valve replacement. Follow-up catheterization of 18 asymptomatic patients revealed that 11 patients had silently restenosed. These data indicate that aortic valvuloplasty is a palliative therapy for elderly patients, who are poor surgical candidates, with symptomatic calcific aortic stenosis with reasonable clinical success and long-term survival when considering their clinical status, but with a significant restenosis rate.

    View details for Web of Science ID A1990DE06600008

    View details for PubMedID 2354704

  • PERIPHERAL ARTERIAL OCCLUSIONS - INITIAL RESULTS FROM PERCUTANEOUS ANGIOPLASTY WITH A HYBRID LASER PROBE RADIOLOGY Belli, A. M., Cumberland, D. C., Myler, R. K., Crew, J. R., Stertzer, S. H. 1990; 174 (2): 447-449

    Abstract

    Percutaneous laser-assisted angioplasty performed with a laser-heated metal-capped fiber has been shown to be safe and effective. A hybrid probe was developed that allows a small percentage of laser light to emerge, converting the rest to heat. The probe was used to recanalize 37 peripheral arterial occlusions (10 in the iliac segment, 2-7 cm long, and 27 in the femoropopliteal segment, 1-35 cm long) in 37 patients. Primary success was defined as successful recanalization and continued patency during the first 24 hours, as assessed at physical examination. Primary success in the iliac segments was 70% and in the femoropopliteal segments was 85% (overall, 81%). The only complication was an arterial wall perforation, which had no sequelae. The probe is safe for use in peripheral arterial occlusions. There was no increase in the rate of perforation compared with the rate with the "hot-tip" laser probe, and the technique may have advantages over use of the original "hot-tip" laser probe.

    View details for Web of Science ID A1990CK84400029

    View details for PubMedID 2136955

  • CARDIOPULMONARY SUPPORT - THE RISK AND BENEFITS OF ASSISTED CORONARY ANGIOPLASTY JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Myler, R. K., Stertzer, S. H. 1990; 15 (1): 30-31

    View details for Web of Science ID A1990CH62200005

    View details for PubMedID 2295740

  • GUIDING CATHETER SELECTION FOR RIGHT CORONARY-ARTERY ANGIOPLASTY CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Myler, R. K., BOUCHER, R. A., Cumberland, D. C., Stertzer, S. H. 1990; 19 (1): 58-67

    View details for Web of Science ID A1990CK78200016

    View details for PubMedID 2306771

  • TREATMENT OF CORONARY-ARTERY STENOSIS AND CORONARY ARTERIOVENOUS-FISTULA BY INTERVENTIONAL CARDIOLOGY TECHNIQUES CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Nguyen, K., Myler, R. K., Hieshima, G., Ashraf, M., Stertzer, S. H. 1989; 18 (4): 240-243

    Abstract

    Complications associated with coronary arteriovenous fistulae (CAVF) include congestive heart failure, bacterial endocarditis, fistula rupture, and angina secondary to the "coronary steal" phenomenon. Traditional treatment of large CAVF is surgical ligation. In this report, we describe a modified microcoil embolization and guidewire technique for percutaneous closure of CAVF.

    View details for Web of Science ID A1989CE56700008

    View details for PubMedID 2605627

  • The setting of coronary angioplasty in multivessel disease: current status and future directions. Cardiology clinics Stertzer, S. H., Shaw, R. E., Myler, R. K., O'Donnell, M. J. 1989; 7 (4): 771-782

    Abstract

    In summary, the use of coronary angioplasty in the setting of multivessel coronary disease has become more common in recent years. Reports indicate that, in carefully selected patients, a high initial success rate and low incidence of complications can be achieved. We have presented a schema for the triage of multivessel disease patients. Examples of each subgroup have been presented to illustrate the basis for this categorization. Our experience using this schema at the San Francisco Heart Institute has been valuable in understanding the initial and long-term results of coronary angioplasty in these patients. It is important that this paradigm (or a similar classification schema) be adopted to assist clinicians in making judgments about alternative approaches in patients with multivessel disease and to provide a common organization for the dissemination of research findings and collaboration among members of the medical community.

    View details for PubMedID 2598196

  • ANGIOPLASTY OF UNUSUALLY LARGE CORONARY-ARTERIES USING THE HUGGING BALLOON TECHNIQUE VIA A SINGLE GUIDING CATHETER CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Mayo, J. R., Myler, R. K., Stertzer, S. H., Cumberland, D. C., BASHOUR, T., MANUBENS, S., Hidalgo, B. 1989; 17 (2): 87-91

    Abstract

    Unusually large native coronary arteries, in particular those supplying expansive regions of myocardium, may not be adequately dilated using currently available coronary angioplasty catheters. The "hugging balloon" technique, in which two dilatation catheter balloons are simultaneously inflated side-by-side, has been previously described for lesions in large saphenous vein grafts using the double guiding catheter (and dual entry site) technique. With the development of large lumen guiding catheters and lower profile dilatation catheters, we report the initial use of the hugging balloon technique via a single guiding catheter in oversized native coronary arteries.

    View details for Web of Science ID A1989U742000005

    View details for PubMedID 2524269

  • CORONARY BIFURCATION STENOSES - THE KISSING BALLOON PROBE TECHNIQUE VIA A SINGLE GUIDING CATHETER CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Myler, R. K., MCCONAHAY, D. R., Stertzer, S. H., Johnson, W., Cumberland, D. C., BOUCHER, R. A., Hidalgo, B. 1989; 16 (4): 267-278

    Abstract

    A new technique employing two balloon probes via a single (large-lumen) guiding catheter is described. Examples involving the left anterior descending, diagonal, left main (protected), left circumflex-obtuse marginal, and atrioventricular branches and the right coronary artery-posterior descending and posterolateral branches are described and illustrated. This new technology (balloon probes and large-lumen guiding catheter) permits an effective and simplified alternative to the use of the single-guide/two-wire and double-guide/two-dilatation catheter-wire approaches in selected cases in which significant branch vessels (vis-a-vis myocardial regional blood supply) are at risk.

    View details for Web of Science ID A1989T904100012

    View details for PubMedID 2523247

  • CURRENT CONCEPTS IN UNSTABLE MYOCARDIAL ISCHEMIA AMERICAN HEART JOURNAL BASHOUR, T. T., Myler, R. K., ANDREAE, G. E., Stertzer, S. H., Clark, D. A., RYAN, C. J. 1988; 115 (4): 850-861

    View details for Web of Science ID A1988M767000021

    View details for PubMedID 2965500

  • IN-HOSPITAL CARDIAC MORTALITY AFTER ACUTE CLOSURE AFTER CORONARY ANGIOPLASTY - ANALYSIS OF RISK-FACTORS FROM 8,207 PROCEDURES JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Ellis, S. G., Roubin, G. S., King, S. B., Douglas, J. S., Shaw, R. E., Stertzer, S. H., Myler, R. K. 1988; 11 (2): 211-216

    Abstract

    Cardiac death consequent to acute vessel closure after coronary angioplasty occurred in 13 of 294 closures from 8,207 consecutive procedures performed at two centers since 1981 (0.16% cardiac mortality rate). To determine the predictors of cardiac death after acute coronary closure, 50 clinical, angiographic and procedural variables were analyzed by an observer unaware of the clinical outcome for each of the 13 patients who died and also 100 patients randomly chosen, in whom vessel closure after angioplasty did not result in death during hospitalization. Univariate analysis found female gender (p less than 0.0001), collateral channels from the vessel dilated (p less than 0.0001), use of balloon counterpulsation (p less than 0.0002), pre- and postprocedural hypotension (p = 0.0003 and p = 0.003, respectively), jeopardy score greater than or equal to 2.5 (p = 0.003), left ventricular hypertrophy (p = 0.013), hypertension (p = 0.02), diabetes (p = 0.02) and multivessel disease (p = 0.03) to be predictive of death. Multivariate analysis found collateral vessels, female gender and multivessel disease to be independent predictors of death. Thus, cardiac death after elective coronary angioplasty is very rare in experienced centers and occurs most often in women with a large amount of potentially ischemic myocardium. Hypotension often precedes the fatal closure event. Close attention to the amount of potentially ischemic myocardium and to the fluid volume status of these patients would seem to be especially warranted.

    View details for Web of Science ID A1988M490600001

    View details for PubMedID 2963055

  • THE BALLOON ON A WIRE DEVICE - A NEW ULTRA-LOW-PROFILE CORONARY ANGIOPLASTY SYSTEM CONCEPT CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Myler, R. K., Mooney, M. R., Stertzer, S. H., Clark, D. A., HIDALGO, B. O., FISHMAN, J. 1988; 14 (2): 135-140

    Abstract

    A new ultra-low-profile coronary angioplasty device, a "balloon probe," is presented. This device consists of a balloon on a coronary guidewire and is the lowest profile dilatation system presently available. The balloon material is polyethylene terephthalate, a new polymer with high inflation pressure limits and very low compliance. This report discusses this device and its usage in coronary artery disease.

    View details for Web of Science ID A1988M516100015

    View details for PubMedID 2966676

  • CORONARY ANGIOGRAPHY AND ANGIOPLASTY CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS BOUCHER, R. A., Myler, R. K., Clark, D. A., Stertzer, S. H. 1988; 14 (4): 269-285

    View details for Web of Science ID A1988N902400010

    View details for PubMedID 2969290

  • TRANS-LUMINAL CORONARY ANGIOPLASTY IN THE TREATMENT OF SILENT ISCHEMIA CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Bergin, P., Myler, R. K., Shaw, R. E., Stertzer, S. H., Clark, D. A., Ryan, C., Murphy, M. C. 1988; 15 (4): 223-228

    Abstract

    Fifty-four asymptomatic patients with positive thallium exercise tests underwent coronary angiography followed by coronary angioplasty (PTCA), as the primary therapy for silent ischemia. The procedure was technically successful in 89% of these patients. Emergency bypass graft surgery was necessary in 2 (3.6%) and q-wave myocardial infarction occurred in 1 (1.8%) of these. All fifty-four patients have been followed for a mean of 35 months since angioplasty. Of the 48 patients with initially successful PTCA, 12 had either clinical restenosis (9/14 or 19%) or a new lesion (3/48 or 6%) during follow-up, which required a repeat PTCA. At the longest follow-up, 46 (85%) had been successfully treated with on or more PTCA procedures. Two patients (3.6%) had sustained late q-wave myocardial infarction and two additional patients reported angina pectoris. There were no deaths. Angioplasty as a primary therapy for silent ischemia appears efficacious, with success and restenosis rates comparable to those in the symptomatic population. Event-free survival is improved, compared with natural history data for patients with silent ischemia from other studies. Prudent risk/benefit analysis may help to define subgroups most likely to benefit from this intervention.

    View details for Web of Science ID A1988R570900002

    View details for PubMedID 2976304

  • MULTICENTER STUDY OF PERCUTANEOUS TRANS-LUMINAL ANGIOPLASTY FOR RIGHT CORONARY-ARTERY OSTIAL STENOSIS JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Topol, E. J., Ellis, S. G., FISHMAN, J., Leimgruber, P., Myler, R. K., Stertzer, S. H., Oneill, W. W., Douglas, J. S., Roubin, G. S., King, S. B. 1987; 9 (6): 1214-1218

    Abstract

    Over a 5 year period at three centers, 53 patients underwent percutaneous transluminal angioplasty of a right coronary artery ostial stenosis. The procedure was successful in 42 patients (79%) and unsuccessful in 11, of whom 5 (9.4%) required emergency coronary artery bypass grafting because of abrupt closure. The right coronary ostial lesion had distinctive technical requirements to achieve success, including high pressure balloon inflation (10 +/- 4 atm) and the need for unconventional right coronary guide catheters. Technical factors that account for increased difficulty in these patients include: problems with guide catheter impaction and ostial trauma; inability to inflate the balloon with adequate guide catheter support; and need for increased intracoronary manipulation. The stenoses were quite discrete (4 +/- 5 mm) and calcified in the majority (40) of the 53 patients. Long-term follow-up (mean 12.5 months, range 4 to 60) of these patients demonstrated clinical recurrence of angina in 20 patients (48%) and angiographically proved restenosis in 16 (38%). Repeat coronary angioplasty was successful in three of six patients for relief of symptoms for over 6 months. In conclusion, angioplasty of the right coronary ostial lesion compared with nonostial dilation leads to a suboptimal early success rate; an apparent high risk of emergency bypass surgery; and a high restenosis rate. Careful assessment of the patient with this lesion and improved technology appear to be warranted.

    View details for Web of Science ID A1987H646300002

    View details for PubMedID 2953771

  • RECURRENCE AFTER CORONARY ANGIOPLASTY CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Myler, R. K., Shaw, R. E., Stertzer, S. H., Clark, D. A., FISHMAN, J., Murphy, M. C. 1987; 13 (2): 77-86

    Abstract

    Recurrence (restenosis) after coronary angioplasty has undermined the initial success of the procedure and has compromised, to some extent, the attractiveness of the technique in the treatment of ischemic heart disease. Assessment of recurrence predictors has been problematic due to lack of coordination of angioplasty recurrence research and includes: incomplete angiographic documentation, variations in definitions of restenosis anatomically and the results of restenosis physiologically (ie, myocardial ischemia), the dirth of morphologic specifications of subsets under investigation and late outcome pathology, limitations in statistical analyses used, and minimal efforts to classify the available data on recurrence. A review of the literature suggests that all findings regarding recurrence after angioplasty can be organized in four categories: clinical, morphologic, technical (or procedural), and pharmacologic. The reported findings with high concordance as risk factors for recurrence after angioplasty include the clinical factors of diabetes mellitus, hyperlipidemia, and angina of short duration or unstable presentation. Morphologic factors which have been corroborated vis-à-vis recurrence include stenoses with diameter reduction of greater than 90% before and greater than 30% after angioplasty, residual trans-stenotic pressure gradients of greater than 20 mmHg after angioplasty, and lesions that are diffuse, long, eccentric, or calcified. Technical factors associated with recurrence include lower balloon/vessel (or graft) ratios and the absence of (uncomplicated) "intimal dissection." The category most deficient in research regarding recurrence after angioplasty is pharmacologic. Since there are statistically documented and reproducible factors predictive of restenosis, to ignore or minimize these findings or resist further evaluation (because of the ease and safety of performing repeat angioplasty) is to deny the opportunity to understand the mechanisms and favorably affect the incidence of recurrence. This review concludes with two major implications of the restenosis research: certain clinical, technical, and pharmacologic factors, if addressed, may predictably decrease the rate of restenosis and certain clinical and morphologic factors may increase the risk of restenosis; these factors may be less readily modified (eg, diabetes, lesion calcification) and thus must be considered in the decision for angioplasty.(ABSTRACT TRUNCATED AT 400 WORDS)

    View details for Web of Science ID A1987G788900001

    View details for PubMedID 2953435

  • PERCUTANEOUS TRANS-LUMINAL ANGIOPLASTY OF STENOTIC CORONARY-ARTERY BYPASS GRAFTS - 5 YEARS EXPERIENCE JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY Cote, G., Myler, R. K., Stertzer, S. H., Clark, D. A., FISHMANROSEN, J., Murphy, M., Shaw, R. E. 1987; 9 (1): 8-17

    Abstract

    In a 60 month period (January 1981 to December 1985), 82 patients (79% male with a mean age of 60 years) had 83 saphenous vein grafts and 5 internal mammary artery grafts with a total of 101 stenotic sites treated with percutaneous transluminal coronary angioplasty. The mean time between bypass surgery and angioplasty was 51.2 months. The procedure was technically successful in 85% of patients, 86% of grafts and 85% of the sites attempted. In these cases, the mean diameter stenosis was reduced from 77 +/- 14 to 27 +/- 20% (p less than 0.001), the mean pressure gradient from 49 +/- 16 to 7 +/- 6 mm Hg (p less than 0.001). Emergency coronary artery bypass graft surgery was necessary in one patient (1.2%) whereas myocardial infarction occurred in three patients (3.6%). There were no hospital deaths. Clinical follow-up was obtained in all 82 patients. Before angioplasty, 23% were in Canadian Cardiovascular Society functional class II, 60% in class III and 17% in class IV. With a mean clinical follow-up period of 21.4 +/- 2.3 months, 71% are in class I, 17% in class II and 12% in class III. There were two deaths, 3 months or more after angioplasty, one probably due to graft closure. So far, angiographic follow-up (at 7.9 +/- 2.1 months) has been available in 26 patients. Ten patients (with 10 grafts) exhibited graft restenosis; six of them have had second successful repeat angioplasty. Among the many variables analyzed, statistically significant predictors of success were a higher measured balloon/graft ratio (p less than 0.001), smaller diameter graft (p less than 0.001), and shorter lesion length (p less than 0.01). The only predictor of complication was diffuseness of disease in the graft (p less than 0.05). The statistically significant predictors of recurrence were the residual stenosis after the initial angioplasty (p less than 0.01) and the measured balloon/graft ratio (p less than 0.01). Angioplasty of coronary artery grafts appears to be a feasible and efficacious procedure with a low complication rate. The technique is a satisfactory alternative to repeat surgery in selected patients.

    View details for Web of Science ID A1987F480200002

    View details for PubMedID 2947947

  • MULTIPLE VESSEL CORONARY ANGIOPLASTY - CLASSIFICATION, RESULTS, AND PATTERNS OF RESTENOSIS IN 494 CONSECUTIVE PATIENTS CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Myler, R. K., Topol, E. J., Shaw, R. E., Stertzer, S. H., Clark, D. A., FISHMAN, J., Murphy, M. C. 1987; 13 (1): 1-15

    Abstract

    We report the immediate results and 6 month follow-up data of 494 consecutive patients who underwent coronary angioplasty in two or more major epicardial arteries. Clinical success was achieved in 95% of the 494 patients. The technical success rate of the 1,117 vessels dilated was 89%, defined as at least a 35% reduction (mean = 53%) of the initial percent diameter stenosis and a decrease in the transstenotic gradient to less than or equal to 15 mmHg (mean = 9 mmHg). Complications of the procedure included emergency bypass surgery (2.8%), myocardial infarction (3.0%), and hospital death (0.4%) inclusive. At least one of these complications (major cardiac event) occurred in 3.8% of patients. Prior to angioplasty, 46% of patients were in Canadian Cardiovascular Society Class II, 42% in Class III, and 12% in Class IV. Follow-up clinical evaluation (mean follow-up period of 16.9 months) showed 83% of patients in Class I, 14% in Class II, and 3% in Class III. Of the 286 successful patients who have reached 6 month follow-up plateau (mean follow-up period of 20.5 months), 164 (57%) have so far had repeat coronary angiography and exhibited three different patterns: all lesions patent (N = 54), some lesions restenosed (N = 60), and all lesions restenosed (N = 32). There were 18 patients with new vessel lesions (not previously dilated). Logistic regression analyses demonstrated that clinical factors including diabetes (P less than .05), hypercholesterolemia, (P less than .01), new onset angina (P less than .05), current smoking (P less than .01), and morphologic and technical factors such as preangioplasty diameter stenosis greater than 95% (P less than .05) and higher balloon inflation pressure (P less than .05) were predictive of increased risk of recurrence. Patients were classified into two groups based on the anatomy of the target lesions. In Group A (N = 217), patients had a single lesion in each of the vessels to be dilated; Group B (N = 277) patients had a complex lesion in at least one of the vessels dilated. Group B patients were more likely to develop recurrence (P less than .05). Of the original 494 patients, 488 (99%) are alive. Coronary angioplasty (either initially or with repeat PTCA) has been the definitive treatment in 453 of the 494 patients for an overall success of 92%.(ABSTRACT TRUNCATED AT 400 WORDS)

    View details for Web of Science ID A1987F967600001

    View details for PubMedID 2949849

  • PSYCHOLOGIC PREDICTORS OF PSYCHOSOCIAL AND MEDICAL OUTCOMES IN PATIENTS UNDERGOING CORONARY ANGIOPLASTY PSYCHOSOMATIC MEDICINE Shaw, R. E., Cohen, F., FISHMANROSEN, J., Murphy, M. C., Stertzer, S. H., Clark, D. A., Myler, R. K. 1986; 48 (8): 582-597

    Abstract

    The relationship between psychologic variables (the match between repressive style and level of cardiac information, and anxiety level) and medical complications, re-stenosis (renarrowing), and psychosocial adjustment was studied in 97 patients undergoing percutaneous transluminal coronary angioplasty (PTCA) for treatment of narrowed coronary arteries. Three major findings emerged for outcomes measured 6 months after PTCA: repressors with a high level of cardiac information (coping style-information level mismatch) and no history of heart attack were at higher risk for late medical complications (p less than 0.001); sensitizers with a low level of cardiac information (coping style-information level mismatch) and whose PTCA was only moderately successful were at higher risk for re-stenosis of the artery previously widened during PTCA (p less than 0.01); and patients who were more anxious during hospitalization had poorer social functioning and more mood disturbance 6 months after PTCA (p less than 0.05). Thus, psychologic, information, and medical factors are important in predicting 6-month outcomes in patients undergoing PTCA.

    View details for Web of Science ID A1986F254000005

    View details for PubMedID 2949334

  • BALLOON ANGIOPLASTY OF CORONARY BIFURCATION LESIONS - THE KISSING BALLOON TECHNIQUE CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS George, B. S., Myler, R. K., Stertzer, S. H., Clark, D. A., Cote, G., Shaw, R. E., FISHMANROSEN, J., Murphy, M. 1986; 12 (2): 124-138

    Abstract

    Initial experience with the technique of "kissing balloon" angioplasty is described in 52 patients undergoing coronary angioplasty. Guiding catheters employing both the femoral and brachial approach were used in all but two of the coronary angioplasties and, in addition, the bilateral femoral approach was used in the renal and peripheral angioplasties. Initial success was achieved in 51 (98%) patients. Abrupt closure requiring urgent coronary revascularization occurred in one patient six hours following the completion of the procedure. Another patient developed a new Q-wave on the electrocardiogram and moderate elevation of CPK-MB fraction following the procedure due to loss of a diagonal branch. No deaths occurred in this series. Angiographic restenosis developed in ten patients. In the recurrence group, five had repeat kissing balloon angioplasty, two had repeat single vessel angioplasty, and three patients chose elective surgical revascularization. Based on our experience, the technique of kissing balloon coronary angioplasty can be performed safely utilizing the brachio-femoral technique. The risk of major side branch occlusion can be minimized with this technique and the overall complication rate does not significantly differ from that of our experience in single vessel coronary angioplasty. Patient selection criteria are based upon the angiographic relationship of the major branch to the side branch and is important in determining the initial and long-term success of this technique.

    View details for Web of Science ID A1986C033600011

    View details for PubMedID 2939962

  • CORONARY ANGIOPLASTY AT THE TIME OF INITIAL CARDIAC-CATHETERIZATION - AD HOC ANGIOPLASTY POSSIBILITIES AND CHALLENGES CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Myler, R. K., Stertzer, S. H., Clark, D. A., Shaw, R. E., FISHMANROSEN, J., Murphy, M. C. 1986; 12 (4): 213-214

    View details for Web of Science ID A1986D776500001

    View details for PubMedID 2944591

  • SELECTION OF DILATATION HARDWARE FOR PTCA - 1985 CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Topol, E. J., Myler, R. K., Stertzer, S. H. 1985; 11 (6): 629-637

    Abstract

    Selection of the proper dilatation hardware in performing coronary angioplasty will facilitate the procedure, minimize its cost, and enhance its safety. Over the past 3 years, there has been an acceleration of growth in PTCA catheter and wire technology. We evaluated all currently approved dilatation systems as well as some investigational equipment and herein discuss their relative merits and disadvantages. To aid in operator selection of equipment, the concept of a risk: benefit ratio of potential for intimal trauma vs maximal back-up support is introduced. This information combined with objective data may be helpful in choosing the optimal dilatation equipment, which must be highly individualized for operator preferences and for each patient and his respective coronary anatomy.

    View details for Web of Science ID A1985AXJ8800011

    View details for PubMedID 2936462

  • PERCUTANEOUS TRANS-LUMINAL ANGIOPLASTY OF LEFT INTERNAL MAMMARY ARTERY GRAFTS AMERICAN JOURNAL OF CARDIOLOGY Kereiakes, D. J., George, B., Stertzer, S. H., Myler, R. K. 1985; 55 (9): 1215-1216

    View details for Web of Science ID A1985AFS5600018

    View details for PubMedID 3157310

  • PERCUTANEOUS TRANS-LUMINAL CORONARY ANGIOPLASTY IN LEFT MAIN STEM CORONARY STENOSIS - A 5-YEAR APPRAISAL INTERNATIONAL JOURNAL OF CARDIOLOGY Stertzer, S. H., Myler, R. K., INSEL, H., Wallsh, E., Rossi, P. 1985; 9 (2): 149-159

    Abstract

    Left main stem coronary stenosis is now uniformly treated with coronary artery bypass grafting. The advent of percutaneous transluminal coronary angioplasty has permitted a non-operative improvement in myocardial blood flow in many cases of single- and multi-vessel coronary atherosclerosis. The use of percutaneous transluminal coronary angioplasty in left main stem coronary stenosis has been sporadic and controversial. Twenty percutaneous transluminal coronary angioplasties were attempted in 19 patients as the treatment of choice for left main stem coronary stenosis in the past 66 months. The primary success rate was 95% (19/20 patients). The emergency surgery was performed only once (5%), and no death occurred secondary to percutaneous transluminal coronary angioplasty itself. In the follow-up (mean 41 months) period, 12 patients (63%) remained in satisfactory condition with no further need for surgical intervention. Seven patients (37%) ultimately required coronary artery bypass grafting. Although coronary artery bypass grafting will remain the fundamental treatment for left main stem coronary stenosis, this series delineates those anatomic and clinical exceptions wherein percutaneous transluminal coronary angioplasty may be utilized as the primary therapy for left main stem coronary stenosis.

    View details for Web of Science ID A1985ARV2500003

    View details for PubMedID 2932396

  • Complex coronary angioplasty: multiple coronary dilatations. American journal of cardiology Dorros, G., Stertzer, S. H., Cowley, M. J., Myler, R. K. 1984; 53 (12): 126C-130C

    Abstract

    Selected patients underwent PTCA of multiple stenoses in different vessels or in the same vessel. Three hundred nine patients underwent 685 PTCA procedures in various combinations of arterial and vein graft stenoses. A multiple dilatation procedure was defined as successful when all lesions attempted were successfully dilated, or when the considered-critical-stenosis was successfully dilated and this resulted in a patient clinical improvement. Angiographic success was achieved in 599 of 685 lesions attempted (87.4%) and in 285 of 309 patients (92.2%). Complications included a mortality rate of 1.0%, an MI rate of 4.2% per patient and 1.9% per lesion attempted, and a 3.6% incidence of emergency CABG. Follow-up data show that 58 patients (20.4%) had clinical evidence of a lesion recurrence, and that 92.5% (37 of 40 patients) who underwent repeat angioplasty had a successful procedure. A sustained clinical improvement was obtained in 264 of 309 patients (85.4%). The data indicate that multiple dilatations are feasible with good success rates and acceptable complication rates. Further evaluation of this extended application of PTCA is needed to clearly establish its role in the therapy of CAD.

    View details for PubMedID 6233876

  • HUMAN CORONARY LASER RECANALIZATION CLINICAL CARDIOLOGY Choy, D. S., Stertzer, S. H., Myler, R. K., Marco, J., Fournial, G. 1984; 7 (7): 377-381

    Abstract

    Five patients undergoing distal saphenous vein bypass had an attempt at intraoperative laser vaporization of a proximal coronary stenosis. Laser treatment of three patients was technically successful. One patient's successfully treated native vessel was competing with the graft at angiographic restudy 25 days after the procedure. This first human intraoperative laser recanalization trial generated questions regarding the energy source, power parameters, and catheter modifications required for satisfactory clinical laser therapy. The trial is directing future experiments toward more efficient and complete laser vaporization of atherosclerotic plaques in the human coronary vasculature.

    View details for Web of Science ID A1984SY71900001

    View details for PubMedID 6611232

  • CURRENT STATUS OF INTRA-AORTIC BALLOON COUNTERPULSATION IN CRITICAL CARE CARDIOLOGY CRITICAL CARE MEDICINE ALCAN, K. E., Stertzer, S. H., Wallsh, E., Bruno, M. S., DePasquale, N. P. 1984; 12 (6): 489-495

    Abstract

    Retrospective analysis revealed that intra-aortic balloon counterpulsation was attempted in 321 patients at our institute from August 1, 1974, to July 1, 1982. The intra-aortic balloon pump (IABP) was successfully inserted in 298 cases (93%). Indications for an IABP included: cardiogenic shock (84 cases), preoperative hemodynamic coverage (15 cases), low-output syndrome (73 cases), pre- and postinfarction angina (75 cases), intractable congestive heart failure (12 cases), refractory ventricular arrhythmia (9 cases), percutaneous transluminal coronary angioplasty (14 cases), cardiac arrest (7 cases), and a miscellaneous group (9 cases). The overall major complication rate was 9%. The data from this experience support aggressive management of cardiogenic shock, i.e., early balloon insertion, angiography, and cardiac surgery, which significantly increases the survival rate (83%) over medical therapy combined with balloon counterpulsation alone. The IABP was also extremely effective in managing other high-risk categories when combined with some form of definitive mechanical correction, e.g., coronary revascularization, valve replacement, or percutaneous transluminal coronary angioplasty. Left ventricular (LV) function was a significant indicator of long-term survival in our series. Patients with normal or moderately impaired LV function had higher survival rates (95% and 82%, respectively) than patients with poor LV function (42%).

    View details for Web of Science ID A1984SW29100004

    View details for PubMedID 6233091

  • ADJUNCTIVE OPERATIVE CORONARY-ARTERY BALLOON-CATHETER DILATATION - REVIEW OF LENOX-HILL EXPERIENCE AMERICAN HEART JOURNAL Wallsh, E., Weinstein, G. S., FRANZONE, A. J., Clavel, A., Stertzer, S. H. 1984; 107 (4): 856-858

    Abstract

    Operative transluminal coronary angioplasty (OTCA) has been used as an adjunct to coronary artery bypass surgery in 65 patients over a 56-month period beginning in May 1978. Experience has led us to use OTCA primarily in the left anterior descending coronary artery. The angioplasty catheter has undergone a number of modifications. Late restudy (8 to 56 months; mean, 24.1) data in 17 patients demonstrated that 15 of 19 angioplasty segments (78.9%) were patent.

    View details for Web of Science ID A1984SL16000056

    View details for PubMedID 6230917

  • Percutaneous transluminal coronary angioplasty: brief review of first 1,500 cases in the NHLBI registry. Applied radiology Dorros, G., Stertzer, S. H. 1983; 12 (4): 69-?

    Abstract

    Percutaneous transluminal coronary angioplasty has proved to be a relatively safe and efficacious interventional technique in selected cases of atherosclerotic coronary disease. While long-term results remain to be determined by randomized controlled study, the data from the first 1,500 cases seem comparable to those for coronary artery bypass.

    View details for PubMedID 10313689

  • TRANS-LUMINAL CORONARY ANGIOPLASTY - COMPARISON OF BRACHIAL AND FEMORAL-ARTERY METHODS CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Dorros, G., Stertzer, S. H., Myler, R. K., Kaltenbach, M., Spring, D. A. 1983; 9 (6): 547-552

    Abstract

    The brachial and femoral artery methods for (percutaneous) transluminal coronary angioplasty are compared. We attempted 901 angioplasties with 539 (59.8%) via the brachial and 362 (40.2%) via the femoral artery. The stenosis was crossed in 670 attempts (74%); in 410 (76%) via the brachial, and in 260 (72%) via the femoral artery. Successful angioplasty was achieved in 607 attempts (67%): in 370 (69%) via the brachial, and in 237 (65%) via the femoral artery. There was no difference between the techniques in crossing the stenosis or achieving a primary success. The left anterior descending artery stenosis was statistically more likely to be crossed than a stenosis in the right (p less than 0.001), circumflex (p less than 0.05), left main coronary artery (p less than 0.05), or saphenous vein graft (p less than 0.05); the left anterior descending artery stenosis was more likely (p less than 0.05) to be successfully dilated if the lesion were crossed (410 of 445 cases, 92%) than a right coronary stenosis (117 of 136 cases, 80%). The brachial and femoral artery methods are comparable techniques. Interventional angiographers performing coronary angioplasty should utilize the angiographic approach with which they are most familiar.

    View details for Web of Science ID A1983RW04300002

    View details for PubMedID 6229337

  • COMPARISON OF WIRE-GUIDED PERCUTANEOUS INSERTION AND CONVENTIONAL SURGICAL INSERTION OF INTRA-AORTIC BALLOON PUMPS IN 151 PATIENTS AMERICAN JOURNAL OF MEDICINE ALCAN, K. E., Stertzer, S. H., Wallsh, E., FRANZONE, A. J., Bruno, M. S., DEPASQUALE, N. N. 1983; 75 (1): 24-28

    Abstract

    Over a 25-month period, percutaneous wire-guided balloon catheter insertion was attempted in 51 patients, and intra-aortic balloon pump insertion was attempted by conventional surgical method in 100 patients. The success rate in the group undergoing percutaneous insertion was 90.2 percent (46 of 51) and 90 percent in the group undergoing surgical insertion (90 of 100). The indications for intra-aortic balloon counterpulsation were diverse in both groups. The major complication rate in the patient population undergoing percutaneous intra-aortic balloon pump insertion was 15.2 versus 15.6 percent for the surgical group, and there were no cases of leg amputation or aortic dissection in the percutaneous group; however, two cases of leg amputation and one case of aortic dissection resulting in death occurred in the surgical group. The percutaneous intra-aortic balloon pump insertion technique was successfully employed in conjunction with percutaneous transluminal coronary angioplasty in six cases. It is concluded that the wire-guided percutaneous balloon catheter method is a highly successful and rapid means of instituting intra-aortic balloon counterpulsation in a wide variety of clinical situations. However, because of the significant associated complication rate, the decision to institute balloon counterpulsation must weigh the benefit-to-risk ratio, and this procedure must still be evaluated on a case-by-case basis.

    View details for Web of Science ID A1983QY35800006

    View details for PubMedID 6859082

  • THE ROLE OF INTRA-AORTIC BALLOON COUNTERPULSATION IN PATIENTS UNDERGOING PERCUTANEOUS TRANS-LUMINAL CORONARY ANGIOPLASTY AMERICAN HEART JOURNAL ALCAN, K. E., Stertzer, S. H., Wallsh, E., DePasquale, N. P., Bruno, M. S. 1983; 105 (3): 527-530

    Abstract

    Between June, 1979, and July, 1982, 14 patients required an IABP in conjunction with PTCA. The clinical indications for balloon counterpulsation, in the performance of PTCA were (1) clinically unstable situations where PTCA might otherwise be contraindicated, e.g., left main stem disease, multivessel coronary artery disease, unstable anginal syndromes, and cardiogenic shock; (2) preoperative insertion of an IABP for added safety following unsuccessful angioplasty; (3) abrupt vessel closure during a PTCA procedure in which the patient becomes hemodynamically unstable; and (4) late vessel closure following an initially successful angioplasty resulting in hemodynamic compromise. Of the 14 cases requiring balloon counterpulsation, 13 survived hospitalization and were alive at the time this report was submitted. We conclude that IABP is a useful adjunct to PTCA in a variety of clinical circumstances.

    View details for Web of Science ID A1983QF05800032

    View details for PubMedID 6219566

  • PERCUTANEOUS TRANS-LUMINAL CORONARY ANGIOPLASTY - REPORT OF COMPLICATIONS FROM THE NATIONAL-HEART-LUNG-AND-BLOOD-INSTITUTE PTCA REGISTRY CIRCULATION Dorros, G., Cowley, M. J., Simpson, J., BENTIVOGLIO, L. G., Block, P. C., Bourassa, M., Detre, K., GOSSELIN, A. J., GRUNTZIG, A. R., Kelsey, S. F., Kent, K. M., Mock, M. B., Mullin, S. M., Myler, R. K., Passamani, E. R., Stertzer, S. H., Williams, D. O. 1983; 67 (4): 723-730

    Abstract

    The complications reported in the first 1500 patients enrolled in the National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty (PTCA) Registry are analyzed. Data were contributed from 73 centers between September 1977 and April 1981. PTCA was successful in 63% of attempts. Five hundred forty-three in-hospital complications occurred in 314 patients (21%). The most frequent complications were prolonged angina in 121, myocardial infarction (MI) in 72, and coronary occlusion in 70. One hundred thirty-eight patients (9.2%) had major complications (MI, emergency surgery or in-hospital death). One hundred two patients (6.8%) required emergency surgery, usually for coronary dissection or coronary occlusion. Sixteen patients (1.1%) died in-hospital; the mortality rate was 0.85% in patients with one-vessel disease and 1.9% in those with multivessel disease. The mortality rate was significantly higher in patients who had had bypass surgery (p less than 0.001). Nonfatal complications were significantly influenced by the presence of unstable angina (p less than 0.001) and initial lesion severity greater than 90% diameter stenosis (p less than 0.001). This report delineates and assesses the complications encountered with PTCA during its initial 3 1/2-year clinical experience. These results support the relative safety of PTCA as a method of nonsurgical myocardial revascularization in carefully selected patients.

    View details for Web of Science ID A1983QG71000003

    View details for PubMedID 6218938

  • TRANS-LUMINAL CORONARY ANGIOPLASTY - 1981 ARCHIVES OF INTERNAL MEDICINE Stertzer, S. H. 1982; 142 (4): 679-680

    View details for Web of Science ID A1982NL78000001

    View details for PubMedID 6462120

  • USE OF OPERATIVE TRANS-LUMINAL CORONARY ANGIOPLASTY AS AN ADJUNCT TO CORONARY-ARTERY BYPASS JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Wallsh, E., FRANZONE, A. J., Weinstein, G. S., Alcan, K., Clavel, A., Stertzer, S. H. 1982; 84 (6): 843-848

    Abstract

    Operative transluminal coronary angioplasty (OCTA) was used to improve coronary artery bypass graft (CABG) runoff in patients having complex segmental and diffuse coronary artery obstructions. OTCA was performed during CABG through the bypass arteriotomy on 64 arteries in 58 patients. An angioplasty system specifically designed for operative use was employed. In 13 cases, angioplasty was performed both proximal and distal to the coronary arteriotomy, for a total of 77 angioplasty sites. Elective restudy was performed on 36 angioplasty sites in 28 arteries in 24 patients: Sixteen patients were restudied between 18 and 21 days (mean 16) and eight between 4 and 32 months (mean 20.5). Patency rate, as assessed at each angioplasty site, was 86.1% (20/24 studied early and 11/12 studied late). Three coronary perforations (4.7%) occurred and were repaired without perioperative infarction or other sequelae. The one operative death (1.7%) occurred in a patient with preoperative refractory cardiogenic shock. There were seven perioperative infarctions (12.1%), of which three (4.7%) were in the distribution of the coronary artery undergoing OTCA. The favorable short-term and medium-term patency rates indicate that OTCA is a useful adjunct to CABG that permits more complete revascularization of small or diffusely diseased coronary arteries.

    View details for Web of Science ID A1982PT39000008

    View details for PubMedID 6216373

  • LASER CORONARY ANGIOPLASTY - EXPERIENCE WITH 9 CADAVER HEARTS AMERICAN JOURNAL OF CARDIOLOGY Choy, D. S., Stertzer, S. H., ROTTERDAM, H. Z., Bruno, M. S. 1982; 50 (6): 1209-1211

    Abstract

    Experience with laser angioplasty in 16 coronary arteries in 9 cadaver hearts is presented. Coronary obstructions were due to experimentally created thrombi as well as to naturally occurring calcified plaques. Successful laser angioplasty was achieved in 14 of 15 arteries. One artery was sacrificed to determine factors necessary for deliberate perforation of the arterial wall. This procedure required more than 30 seconds of laser energy at 3.0 W with the catheter tip almost perpendicular to the wall. Penetration of the arterial wall occurred only in the second left anterior descending artery which was plaque-occluded because of operator inexperience.

    View details for Web of Science ID A1982PT01900003

    View details for PubMedID 6216806

  • THE BRACHIAL-ARTERY METHOD TO TRANS-LUMINAL CORONARY ANGIOPLASTY CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS Dorros, G., Stertzer, S. H., Bruno, M. S., Kaltenbach, M., Myler, R. K., Spring, D. A. 1982; 8 (3): 233-242

    Abstract

    The development of a brachial artery guiding catheter for (percutaneous) transluminal coronary angioplasty is described. Three-hundred angioplasty procedures were attempted with 196 (65%) via the branchial and 104 (35%) via the femoral artery. The coronary stenosis was crossed in 202 attempts (67%); in 138 via the brachial (70%) and 64 via the femoral artery (62%). A successful angioplasty occurred in 117 via the brachial (85%) and in 50 via the femoral artery (78%). Successful angioplasty of the left anterior descending artery was equally effective with either technique. Successful angioplasty of the right coronary artery was more difficult (P less than 0.05) using the femoral artery. An unsuccessful angioplasty with one technique was occasionally overcome by use of the other technique. No brachial artery complications were encountered. The brachial method to transluminal coronary angioplasty is an acceptable and complementary alternative to the femoral technique. Those laboratories contemplating percutaneous transluminal coronary angioplasty may desire to utilize both approaches.

    View details for Web of Science ID A1982NU99500004

    View details for PubMedID 6213307

  • PERCUTANEOUS TRANS-LUMINAL CORONARY ANGIOPLASTY - REPORT FROM THE REGISTRY OF THE NATIONAL-HEART-LUNG-AND-BLOOD-INSTITUTE AMERICAN JOURNAL OF CARDIOLOGY Kent, K. M., BENTIVOGLIO, L. G., Block, P. C., Cowley, M. J., Dorros, G., GOSSELIN, A. J., Gruntzig, A., Myler, R. K., Simpson, J., Stertzer, S. H., Williams, D. O., Fisher, L., Gillespie, M. J., Detre, K., Kelsey, S., Mullin, S. M., Mock, M. B. 1982; 49 (8): 2011-2020

    Abstract

    Data have been collected from 34 centers in the United States and Europe performing percutaneous transluminal coronary angioplasty since September 1977. The procedure was carried out in 631 patients, with an average age of 51 years (range 23 to 76), of whom 80 percent had single vessel coronary disease, 17 percent had double or triple vessel disease and 3 percent had stenosis of the left main coronary artery. Coronary angioplasty was successful (greater than 20 percent decrease of coronary stenosis) in 59 percent of the stenosed arteries. The mean degree of stenosis was reduced from 83 to 31 percent. Emergency coronary bypass operation was required in 40 patients (6 percent). Myocardial infarction occurred in 29 patients (4 percent). In-hospital death occurred in six patients (1 percent), three with single vessel and three with multivessel disease. Ninety-one patients have been followed up for at least 1 year after coronary angioplasty. Of the 65 patients with an initially successful angioplasty, 83 percent were in improved condition compared with their status before angioplasty. Thus, the initial satisfactory results obtained in a few centers have now been confirmed in many centers using transluminal coronary angioplasty.

    View details for Web of Science ID A1982NS79200026

    View details for PubMedID 6211084

  • MANUAL CORONARY ENDARTERECTOMY WITH SAPHENOUS BYPASS - EXPERIENCE WITH 263 PATIENTS ANNALS OF THORACIC SURGERY Wallsh, E., FRANZONE, A. J., CLAUSS, R. H., Armellini, C., Steichen, F., Stertzer, S. H. 1981; 32 (5): 451-457

    Abstract

    From January, 1972, until August, 1980, 271 manual coronary endarterectomies with bypass were performed in 263 patients. All patients underwent additional cardiac procedures simultaneously. The group contained 254 distal right and 17 left endarterectomies (including 8 double endarterectomies). Clinical follow-up was 100%, operative mortality was 2.3% (6 out of 263), and the rate of perioperative infarction was 4.9% (13 out of 263). Cineangiography was performed on 72 patients between 1 and 60 months after operation (mean, 15.4 months). Patency was 85% (61 out of 72). Endarterectomy in a dominant right coronary artery could be planned electively. Left coronary endarterectomy was performed only when diffuse disease prevented standard bypass. Coronary endarterectomy may be used to extend operability with excellent clinical results, low perioperative mortality, and high late patency. Careful attention to technical aspects of core removal and myocardial protection are necessary for consistent results.

    View details for Web of Science ID A1981MP59600005

    View details for PubMedID 6975607

  • TRANS-LUMINAL CORONARY ANGIOPLASTY DURING SAPHENOUS CORONARY-BYPASS SURGERY - PRELIMINARY-REPORT ANNALS OF SURGERY Wallsh, E., FRANZONE, A. J., CLAUSS, R. H., Bruno, M. S., Steichen, F., Stertzer, S. H. 1980; 191 (2): 234-237

    Abstract

    A previously described balloon tipped dilatation catheter has been used during revascularization surgery to dilate lesions which potentially could limit the runoff of the saphenous bypass grafts. A total of 34 lesions were dilated in 25 patients. Restudy of 12 patients (15 lesions) demonstrated positive results and no clinically significant complications. These preliminary results suggest an important role for transluminal coronary dilatation in the operative treatment of coronary artery disease.

    View details for Web of Science ID A1980JD72800017

    View details for PubMedID 6965850

  • EVALUATION OF A RECHARGEABLE PACEMAKER SYSTEM PACE-PACING AND CLINICAL ELECTROPHYSIOLOGY Stertzer, S. H., DePasquale, N. P., Cohn, L. J., Bruno, M. S. 1978; 1 (2): 186-188

    Abstract

    A rechargeable-demand nickel-cadmium pulse generator for permanent transvenous cardiac pacing was evaluated in 66 patients. During a cumulative follow-up period of 2,333 patient months (194.4 patient years), failure of the pacing circuit occurred in 3 patients at 21, 25, and 27 months, respectively. Nine patients had difficulty accepting the recharging concept and, in 3 of these patients, it became necessary to replace the rechargeable generator with a conventional energy source. The overall failure rate of approximately 3% per year (including the 3 patients in whom it was necessary to remove the generator because of failure to recharge properly), coupled with the inconvenience of recharging, limits the usefulness of the rechargeable system compared to the newer lithium-powered generator.

    View details for Web of Science ID A1978FY60400006

    View details for PubMedID 83632

  • REDUCED INCIDENCE OF INTRAOPERATIVE MYOCARDIAL-INFARCTION DURING CORONARY-BYPASS SURGERY WITH USE OF INTRACORONARY SHUNT TECHNIQUE AMERICAN JOURNAL OF CARDIOLOGY FRANZONE, A. J., Wallsh, E., Stertzer, S. H., DePasquale, N. P., Bruno, M. S. 1977; 39 (7): 1017-1020

    Abstract

    Intraoperative myocardial infarction is a recognized complication of aortocoronary bypass surgery. One major cause of such infarction may be interruption of coronary blood flow, particularly in patient with poor coronary collateral circulation. In 30 patients use of an intracoronary shunt made it possible to limit the period of coronary occulusion during graft construction to a few minutes. Use of this shunt was associated with a reduced incidence of intraoperative myocardial infarction (as judged by the appearance of new Q waves) when these patients were compared with 50 patients operated on without this procedure (6 of 50 [12 percent] versus 0 of 30). The incidence of postoperative persistent S-T segment elevation was reduced from 21 of 50 (42 percent) to 5 of 30 (17 percent). Except for use of the shunt, the surgical technique was identical in the two groups of patients.

    View details for Web of Science ID A1977DJ13500012

    View details for PubMedID 301346

  • DISTAL RIGHT CORONARY ENDARTERECTOMY WITH SAPHENOUS CORONARY-BYPASS FOR DIFFUSE CORONARY-DISEASE - LONG-TERM RESULTS NEW YORK STATE JOURNAL OF MEDICINE Wallsh, E., FRANZONE, A. J., Weinstein, G., Stertzer, S. H. 1976; 76 (11): 1827-1833

    View details for Web of Science ID A1976CG76700009

    View details for PubMedID 1086446

  • ENDOCARDITIS OF AORTIC VALVULAR PROSTHESIS DUE TO LISTERIA-MONOCYTOGENES CHEST Weinstein, G. S., NICHOLS, N. J., Rogers, M. R., FRANZONE, A. J., Stertzer, S. H., Wallsh, E. 1976; 69 (6): 807-808

    View details for Web of Science ID A1976BT59200034

    View details for PubMedID 819225

  • EARLY EVALUATION OF A RECHARGEABLE PACEMAKER SYSTEM JOURNAL OF ELECTROCARDIOLOGY Stertzer, S. H., DePasquale, N. P., Bruno, M. S., Cohn, L. J. 1976; 9 (4): 391-393

    Abstract

    A rechargeable demand pulse generator for permanent transvenous cardiac pacing was evaluated in 66 patients. During a cumulative follow-up period of 895 patient months there was no instance of failure of either the pulse generator or of the recharging circuit. Acceptance of the recharging concept was high, there being only one patient in whom it was necessary to replace the rechargeable generator because of inability to master the recharging technique. The early findings indicate that with proper patient selection the rechargeable pulse generator promises to be an important contribution to pacemaker therapy.

    View details for Web of Science ID A1976CJ00300019

    View details for PubMedID 978092

  • RIGHT VENTRICULAR APEXANGIOGRAPHY FOR PRECISE PLACEMENT OF TRANSVENOUS ELECTRODE CATHETERS CHEST Stertzer, S. H., DePasquale, N. P., Bruno, M. S., Cohn, L. J. 1976; 69 (2): 222-223

    Abstract

    A simple angiographic technique (right ventricular apexangiography) for positioning permanent transvenous pacemakers is described. With this technique, electrode failure occurred in only five (3%) of 186 patients followed for more than two years, as compared to an average failure rate of 23% in 11 reported series. Right ventricular apexangiography should be particularly useful in those patients in whom problems arise during insertion of a permanent transvenous electrode catheter.

    View details for Web of Science ID A1976BE67200021

    View details for PubMedID 1248278

  • Letter: Cleveland Clinic experience with triple coronary artery bypass. Annals of thoracic surgery Weinstein, G. S., Wallsh, E., Stertzer, S. H. 1975; 19 (2): 231-?

    View details for PubMedID 1078764

  • Coronary arteriographic appearances in patients with left anterior hemiblock. European journal of cardiology De Pasquale, Bruno, M. S., Stertzer, S. H. 1975; 2 (3): 295-297

    Abstract

    24 of 163 consecutive patients (14.7%) undergoing selective coronary arteriography were found to have electrocardiographic evidence of left anterior hemiblock. 3 patients (2 of whom had alcoholic cardiomyopathy) had normal coronary arteries, 15 patients had triple vessel disease, 3 patients had double vessel disease, and 3 patients had single vessel disease. 18 patients (75%) had moderate to severe left ventricular enlargement as estimated by left ventriculogram. Comparison of these angiographic findings with those of 88 patients with normal intraventricular conduction showed the distribution of the coronary artery disease to be essentially similar in the two groups but that significant left ventricular enlargement was at least three times more frequent in patients with left anterior hemiblock than in patients with normal intraventricular conduction. It is suggested that the development of left anterior hemiblock depends more upon the presence of left ventricular enlargement than on the distribution of the coronary artery disease.

    View details for PubMedID 1080108

  • Subvalvular stenosis of aortic prostheses. A complication of the suture buttress technique. journal of thoracic and cardiovascular surgery Weinstein, G., FRANZONE, A. J., Stertzer, S. H., Wallsh, E. 1974; 68 (1): 17-20

    View details for PubMedID 4275920

  • DISAPPEARANCE OF PAPILLARY MUSCLE DYSFUNCTION AFTER BYPASS SURGERY ARCHIVES OF SURGERY DEPASQUA, N. P., Bruno, M. S., Stertzer, S. H., Wallsh, E. 1973; 107 (1): 99-100

    View details for Web of Science ID A1973Q142300022

    View details for PubMedID 4541365

  • ANASTOMOSIS OF INTERNAL MAMMARY ARTERY TO DISTAL LEFT ANTERIOR DESCENDING CORONARY ARTERY CIRCULATION Green, G. E., Stertzer, S. H., Gordon, R. B., Tice, D. A. 1970; 41 (5): II79-?

    View details for Web of Science ID A1970G684000014

    View details for PubMedID 4952697

  • ARTERIAL AND VENOUS MICROSURGICAL BYPASS GRAFTS FOR CORONARY ARTERY DISEASE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY Green, G. E., Spencer, F. C., Tice, D. A., Stertzer, S. H. 1970; 60 (4): 491-?

    View details for Web of Science ID A1970H547000004

    View details for PubMedID 5511883

  • Coronary arterial bypass grafts. Annals of thoracic surgery Green, G. E., Stertzer, S. H., REPPERT, E. H. 1968; 5 (5): 443-450

    View details for PubMedID 5647933

Conference Proceedings


  • SURGICAL TREATMENT OF MITRAL INSUFFICIENCY SECONDARY TO CORONARY ARTERY DISEASE Spencer, F. C., REPPERT, E. H., Stertzer, S. H. AMER MEDICAL ASSOC. 1967: 853-?

    View details for Web of Science ID A1967A288400001

    View details for PubMedID 6058790

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