Cases reported "Coronary Restenosis"

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1/92. Iatrogenic left anterior descending artery stenosis in response to the nose cone of a directional atherectomy device: a different sort of restenosis.

    Restenosis after percutaneous transluminal coronary angioplasty (PTCA) is well described and refers to the development of a significant narrowing at the site of the lesion treated. A case is reported of a female patient who underwent directional coronary atherectomy (DCA) and stent insertion at the origin of the left anterior descending artery. This was performed without complication. Repeat angiography was performed because of return of angina after ten weeks; it demonstrated a widely patent stent, but also a significant stenosis distal to the stent where the nose cone of the DCA device had been positioned. This stenosis was successfully stented. The patient remains well at follow-up.
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keywords = stenosis
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2/92. Successful balloon angioplasty of in-stent restenosis of left internal mammary artery.

    The development of disease in left internal mammary artery bypass grafts is uncommon. Furthermore, development of restenosis following successful angioplasty is very low. We report a patient with in-stent restenosis of left internal mammary graft treated successfully by balloon dilatation.
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ranking = 0.54545454545455
keywords = stenosis
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3/92. Abnormal stress echocardiography results after coronary stenting.

    In a patient with a recently placed stent, a stress echocardiogram clearly indicated ischemia in the territory of the stented vessel. Subsequent coronary angiography, undertaken because of presumed restenosis, showed the stented area to be widely patent. This prompted a review of stress echocardiograms performed in patients within 6 weeks of coronary stenting. Of 21 such cases, 3 additional patients were found to have false-positive results in the territory served by the stented vessel.
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ranking = 0.090909090909091
keywords = stenosis
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4/92. Intracoronary brachytherapy in the treatment of in-stent restenosis. Initial experience in brazil.

    Intracoronary brachytherapy using beta or gamma radiation is currently the most efficient type of therapy for preventing the recurrence of coronary in-stent restenosis. Its implementation depends on the interaction among interventionists, radiotherapists, and physicists to assure the safety and quality of the method. The authors report the pioneering experience in brazil of the treatment of 2 patients with coronary in-stent restenosis, in whom beta radiation was used as part of the international multicenter randomized PREVENT study (Proliferation REduction with Vascular ENergy Trial). The procedures were performed rapidly and did not require significant modifications in the traditional techniques used for conventional angioplasty. Alteration in the radiological protection devices of the hemodynamic laboratory were also not required, showing that intracoronary brachytherapy using beta radiation can be incorporated into the interventional tools of cardiology in our environment.
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ranking = 0.54545454545455
keywords = stenosis
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5/92. Rotational atherectomy of a stent-jailed septal perforator: a good verdict for the prisoner.

    A 61-year-old man is described, in whom percutaneous coronary intervention was done to treat critical ostial stenosis of the first and second septal perforators. The first branch originated from the stented portion of a previously treated left anterior descending artery, while the second branch was distal to the stent. During balloon angioplasty, the balloon catheter could not be delivered to the lesion site in the first branch, although the second branch was easily amenable to balloon dilatation. Rotational atherectomy was done to treat the former. Besides advocating rotational atherectomy as a novel strategy for managing jailed septal perforators, the case presents an insight into the vastly differing interventional situations of stent-jailed branch vis-a-vis de novo branch ostial stenosis.
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ranking = 0.18181818181818
keywords = stenosis
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6/92. Angiogenesis, vascular endothelial growth factor and platelet-derived growth factor-BB expression, iron deposition, and oxidation-specific epitopes in stented human coronary arteries.

    Pathogenesis of in-stent restenosis remains poorly understood because information from human histopathologic studies is scarce. We used an improved saw-grinding and cutting method on methacrylate-embedded samples containing metal stents, which allows in situ hybridization and immunohistochemical analysis of in-stent restenosis. Twenty-one samples were collected 3 hours to 3 years after stenting from 6 patients aged 36 to 81 years. Except in very early samples collected within hours after the stent deployment, neovascularization was present in all segments studied. At advanced stages, extensive neovascularization was located mainly at the luminal side of the stent struts and was only rarely accompanied by inflammatory cells. The neovessels colocalized with vascular endothelial growth factor (VEGF)-A mRNA and protein expression as well as with iron deposits and oxidation-specific epitopes, which imply the presence of chronic oxidative stress. VEGF-A expression was detected in the same areas containing macrophages, endothelial cells, and, to a lesser extent, smooth muscle cells, which also showed platelet-derived growth factor-BB expression. We conclude that in-stent restenosis features neovascularization, VEGF-A and platelet-derived growth factor-BB expression, and iron deposition, which is most probably derived from microhemorrhages. These mechanisms may play an important role in the development of neointimal thickening and could provide useful targets for the prevention and treatment of in-stent restenosis.
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ranking = 0.36363636363636
keywords = stenosis
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7/92. Non-flow limiting dissection leading to late coronary restenosis following intracoronary brachytherapy.

    We report a coronary dissection detected during routine repeat angiography 6 months following balloon angioplasty and intracoronary radiation. No dissection was seen immediately following the initial procedure. Subsequent late healing of the dissection led to marked restenosis and the development of angina 14 months after the index procedure.
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ranking = 0.45454545454545
keywords = stenosis
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8/92. Severe acute coronary spasm following intracoronary radiation for in-stent restenosis: a case report.

    Intracoronary radiation therapy is currently the only available treatment for the prevention of recurrence of in-stent restenosis. We report a case of severe coronary spasm after excimer laser angioplasty, balloon angioplasty, and intracoronary gamma radiation in the right coronary artery (RCA) that resulted in an acute myocardial infarction. Treatment with 600 microg of intracoronary nitroglycerin resulted in minimal improvement; therefore, diltiazem 400 microg was administered intracoronary with total resolution of the spasm, restoring normal coronary blood flow without trace of acute dissection or thrombus inside the artery.
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ranking = 0.45454545454545
keywords = stenosis
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9/92. Successful long-term therapy following saphenous vein-covered stent deployment for atherosclerotic coronary aneurysm.

    We describe a case of atherosclerotic aneurysm involving the left main coronary artery in a patient with prior coronary artery bypass surgery. A saphenous vein-covered stent was used to seal the aneurysm in conjunction with conventional stenting of an associated native vessel coronary stenosis. Focal late restenosis involving the stent graft was successfully treated with repeat angioplasty and brachytherapy. Autologous vein-covered stent deployment should be considered in the treatment of symptomatic or progressively enlarging coronary aneurysms.
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ranking = 0.18181818181818
keywords = stenosis
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10/92. Repeated intracoronary beta radiation for recurrent in-stent restenosis.

    More than 70% of percutaneous coronary interventions are followed by a stent implantation. In-stent restenosis still occurs in 20-30% of patients and remains a therapeutic challenge. At present only vascular brachytherapy has been shown to be an effective treatment option. We report here one case of recurrent in-stent restenosis after vascular brachytherapy that was successfully treated by a second beta radiation treatment.
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ranking = 0.54545454545455
keywords = stenosis
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