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Yoshihiro Imai, Takehiro Yamashita, On Topaz
RATIONALE: Thin-cap fibroatheroma (TCFA) and red thrombus are suggested as a high-risk of embolic complications during percutaneous coronary intervention (PCI). Intracoronary aspiration procedures occasionally result in either an insufficient thrombus removal or provide no significant effects on TCFA. PATIENT CONCERNS: A 76-year-old male underwent coronary angiography for chest pain. DIAGNOSES: Coronary angiography revealed a tight stenosis at the right coronary artery which resulted in treatment by PCI...
October 2017: Medicine (Baltimore)
Antonio Mangieri, Richard J Jabbour, Akihito Tanaka, Andrea Aurelio, Antonio Colombo, Azeem Latib
: Excimer coronary laser atherectomy (ECLA) has been shown to be both well tolerated and effective for plaque modification. Its technology is based on ultraviolet energy and is capable of disintegrating atheroma, without burning or grossly fragmenting it. ELCA has proven effective in the percutaneous treatment of a variety of complex lesions. Here we present a case of multiple heavy calcified lesions successfully prepared with ELCA and finally treated with the implantation of multiple bioresorbable scaffolds...
December 2016: Journal of Cardiovascular Medicine
Yit-Heng Chooi, Guozhi Zhang, Jinyu Hu, Mariano Jordi Muria-Gonzalez, Phuong N Tran, Amber Pettitt, Alexander G Maier, Russell A Barrow, Peter S Solomon
Parastagonospora nodorum is an important pathogen of wheat. The contribution of secondary metabolites to this pathosystem is poorly understood. A biosynthetic gene cluster (SNOG_08608-08616) has been shown to be upregulated during the late stage of P. nodorum wheat leaf infection. The gene cluster shares several homologues with the Cercospora nicotianae CTB gene cluster encoding the biosynthesis of cercosporin. Activation of the gene cluster by overexpression (OE) of the transcription factor gene (SNOG_08609) in P...
May 2017: Environmental Microbiology
Shunsuke Hirose, Takashi Ashikaga, Yu Hatano, Shunji Yoshikawa, Taro Sasaoka, Yasuhiro Maejima, Mitsuaki Isobe
Treatment of in-stent restenosis (ISR) is associated with a high incidence of recurrence. This study evaluated the clinical safety and 6-month efficacy of excimer laser coronary angioplasty (ELCA) before scoring balloon dilatation for the treatment of ISR. Twenty-three patients with ISR were included and treatment strategy of ISR was dependent on each operator. Twelve patients among those were treated with ELCA before scoring balloon dilatation (ELCA group) and 11 patients were treated with scoring balloon alone (non-ELCA group)...
November 2016: Lasers in Medical Science
Masami Nishino, Naoki Mori, Shin Takiuchi, Daisuke Shishikura, Naofumi Doi, Toru Kataoka, Takayuki Ishihara, Noriyuki Kinoshita
BACKGROUND: Excimer laser coronary atherectomy (ELCA) recently became available in Japan, but ELCA's effectiveness and safety are not clear. METHODS AND RESULTS: We enrolled consecutive patients who underwent ELCA and were registered in the Utility of Laser for Transcatheter Atherectomy-Multicenter Analysis around Naniwa (ULTRAMAN) registry comprising six Japanese medical centers around Naniwa in Japan with patients registered from April 2006 to June 2015. We evaluated the catheter sizes used and compared the success rate, thrombolysis in myocardial infarction (TIMI) flow, blush score, and complications between the rich-thrombus (RT) group [acute coronary syndrome (ACS) and saphenous vein graft (SVG)] and the poor-thrombus (PT) group [in-stent restenosis (ISR), chronic total occlusion (CTO), calcification, and long or bifurcation (L&B) lesions]...
January 2017: Journal of Cardiology
Takashi Ashikaga, Shunji Yoshikawa, Mitsuaki Isobe
Stent underexpansion is a risk factor for in-stent restenosis (ISR) and stent thrombosis. Although excimer laser coronary atherectomy (ELCA) with contrast medium was shown to be effective to improve stent underexpansion in undilatable lesions, precise mechanism of this technique was not well understood. We report a case of ISR with stent underoptimal implantation within a circumferential-calcified atherosclerotic plaque beneath the stent strut that could not be dilated by repeated high-pressure balloon inflations...
November 2015: Catheterization and Cardiovascular Interventions
Vittorio Ambrosini, Giovanni Sorropago, Eugenio Laurenzano, Luca Golino, Alfredo Casafina, Vittorio Schiano, Gabriele Gabrielli, Federica Ettori, Giuliano Chizzola, Guglielmo Bernardi, Leonardo Spedicato, Pietro Armigliato, Carmine Spampanato, Martina Furegato
AIM: An innovative xenon-chlorine (excimer) pulsed laser catheter (ELCA X80) has been recently used for the treatment of complex coronary lesions, as calcified stenosis, chronic total occlusions and non-compliant plaques. Such complex lesions are difficult to adequately treat with balloon angioplasty and/or intracoronary stenting. The aim of this study was to examine the acute outcome of this approach on a cohort of patients with coronary lesions. METHODS AND RESULTS: Eighty patients with 100 lesions were enrolled through four centers, and excimer laser coronary angioplasty was performed on 96 lesions (96%)...
April 2015: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Anna Irene De Luca, Nathalie Iofrida, Alfio Strano, Giacomo Falcone, Giovanni Gulisano
UNLABELLED: Recently, Social Life Cycle Assessment (S-LCA) has been developed under the methodological framework of Life Cycle Thinking (LCT) to evaluate the social impacts that emerge during the overall life cycle of a product or service. There is not yet a standardized methodology for S-LCA as there is for environmental LCA (eLCA), due to the nature of social impacts that do not depend only on the processes themselves, but also on the behavior and context of actors (manufactures, consumers, local community members, etc...
July 2015: Integrated Environmental Assessment and Management
Takashi Ashikaga, Shunji Yoshikawa, Mitsuaki Isobe
Stent underexpansion is known as a major cause of restenosis and stent thrombosis in calcified coronary lesions. We report a case of calcified nodule pretreated with excimer laser coronary angioplasty (ELCA) in acute coronary syndrome (ACS). Excimer laser use altered underlying lesion morphology such as calcified nodule and accompanied plaque and thrombus. Pretreatment of ELCA may be a useful tool to get a full expansion of the deployed stent without distal embolism for calcified nodule in ACS.
April 2015: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Lorenzo Azzalini, Hung Q Ly
Excimer laser coronary atherectomy (ELCA) is based on ultraviolet energy and is capable of disintegrating atheroma, without burning or grossly fragmenting it. ELCA has proven effective in the percutaneous treatment of a variety of complex lesions, including chronic total occlusions (CTO) and severely calcified lesions, in case of balloon failure-tocross or failure-to-expand. Here we present a case of a successful CTO recanalization with ELCA after balloon failure, review the literature on this topic, and present an algorithm outlining the management of this challenging clinical scenario...
2014: International Heart Journal
Wouter De Soete, Sam Debaveye, Steven De Meester, Geert Van der Vorst, Wim Aelterman, Bert Heirman, Philippe Cappuyns, Jo Dewulf
The pharmaceutical and fine chemical industries are eager to strive toward innovative products and technologies. This study first derives hotspots in resource consumption of 2839 Basic Operations in 40 Active Pharmaceutical Ingredient synthesis steps through Exergetic Life Cycle Assessment (ELCA). Second, since companies are increasingly obliged to quantify the environmental sustainability of their products, two alternative ways of simplifying (E)LCA are discussed. The usage of averaged product group values (R(2) = 3...
October 21, 2014: Environmental Science & Technology
Tadayuki Kadohira, Aron I Schwarcz, Joseph De Gregorio
We report the successful retrieval of an entrapped interventional guide wire between a newly deployed coronary stent and severely calcified vessel wall. Using a buddy wire technique, the stent was deployed at high pressure in a culprit lesion of the left anterior descending (LAD) artery. The buddy wire in the LAD artery was entrapped between the deployed stent and severely calcified vessel wall, as it was not removed before stent deployment, and could not be retrieved. Neither balloon catheters nor a microcatheter were able to be advanced behind the stent over the entrapped guide wire...
February 1, 2015: Catheterization and Cardiovascular Interventions
Sarah Owens
The purpose of the presentation is to highlight innovation in practice with regards how the end of life care for all e-learning programme was implemented and integrated within a hospice. Key concepts include the introduction of e- learning to the clinical staff as a way of learning. How then could this programme be integrated into the working day and how best to monitor the progress of that integration. The issues were around availability of facilities, such as IT equipment. The varying levels of ability of the staff using the computers, and how those who were less confident could be supported...
September 2011: BMJ Supportive & Palliative Care
Sarah Russell, Carolyn Doyle, Emma Jane Harris, Vanessa Convey
INTRODUCTION: The ABC End of Life Programme is a blended approach to end of life education across the East of England regions of Bedfordshire, Hertfordshire, Anglia and Essex. It has been funded by NHS East of England for 2 years. It represents collaboration across settings contributing to the improvement of the end of life care experience for staff, patients and families. AIMS: To improve the end of life experience of patients and carers (including advance care planning) and reduce inappropriate hospital admissions...
September 2011: BMJ Supportive & Palliative Care
Azeem Latib, Kensuke Takagi, Giuliano Chizzola, Jonathan Tobis, Vittorio Ambrosini, Giampaolo Niccoli, Gennaro Sardella, Maria Elena DiSalvo, Pietro Armigliato, Marco Valgimigli, Giandomenico Tarsia, Gabriele Gabrielli, Lawrence Lazar, Diego Maffeo, Antonio Colombo
BACKGROUND/OBJECTIVES: Stent underexpansion is a risk factor for in-stent restenosis and stent thrombosis. Existing techniques to optimize stent expansion are sometimes ineffective. The aim of this study was to evaluate the effectiveness and feasibility of Excimer Laser Coronary Angioplasty (ELCA) in improving stent expansion when high-pressure non-compliant balloon inflation was ineffective. METHODS AND RESULTS: ECLA ablation was performed at high energy during contrast injection and only within the underexpanded stent...
January 2014: Cardiovascular Revascularization Medicine: Including Molecular Interventions
John Rawlins, Suneel Talwar, Mark Green, Peter O'Kane
The indications for Excimer laser coronary atherectomy (ELCA) have been refined in modern interventional practice. With the expanding role for optical coherence tomography (OCT) providing high-resolution intra-coronary imaging, this article examines the appearance of the coronary lumen after ELCA. Each indication for ELCA is discussed and illustrated with a clinical case, followed by detailed analysis of the OCT imaging pre and post ELCA. The aim of the article is to provide information to interventional cardiologists to facilitate decision making during PCI, when ELCA has been used as part of the interventional strategy...
January 2014: Cardiovascular Revascularization Medicine: Including Molecular Interventions
Giampaolo Niccoli, Flavia Belloni, Nicola Cosentino, Francesco Fracassi, Elena Falcioni, Marco Roberto, Roberta Antonazzo Panico, Rocco Mongiardo, Italo Porto, Antonio Maria Leone, Francesco Burzotta, Carlo Trani, Filippo Crea
Laser atherectomy might decrease procedural complications during percutaneous coronary intervention (PCI) of degenerated saphenous vein grafts (SVGs) in case of unstable or thrombotic lesions because of its ability to debulk and vaporize thrombus. We aimed at prospectively evaluating the safety and efficacy of excimer laser coronary angioplasty (ELCA) as a primary treatment strategy in consecutively unstable patients undergoing PCI of degenerated SVG lesions. Seventy-one consecutive patients with non-ST elevation acute coronary syndrome (mean age 69 ± 10 years, 66 men [89%]) undergoing PCI of degenerated SVG were enrolled in a prospective case-control registry, using 2 different distal protection devices (DPDs; FilterWire EZ [Boston Scientific, Natick, Massachusetts; n = 24] and SpiderRX [Ev3, Plymouth, Minnesota; n = 23]) or ELCA (n = 24)...
November 15, 2013: American Journal of Cardiology
Soichiro Ebisawa, Yusuke Miyashita, Tatsuya Saigusa, Takashi Miura, Uichi Ikeda
During the treatment of coronary artery disease, the no-reflow phenomenon can lead to severe impairment of viable cardiac muscle and all necessary measures should be taken to prevent it. Excimer laser coronary atherectomy (ELCA) may be indicated for lesions with a large thrombus burden due to potential to ablate thrombi and necrotic plaques. However, there are few reports on the use of ELCA for the prevention of distal embolism. Here, we report a case involving severe left ventricular dysfunction with a previous extensive anterior infarction, where ELCA was used in the right coronary artery to prevent the no-reflow phenomenon...
October 2013: Cardiovascular Intervention and Therapeutics
Daisuke Shishikura, Satoru Otsuji, Shin Takiuchi, Atsushi Fukumoto, Katsuaki Asano, Masashi Ikushima, Tokuki Yasuda, Katsuyuki Hasegawa, Toshikazu Kashiyama, Masanori Yabuki, Toshiaki Hanafusa, Yorihiko Higashino
BACKGROUND:  Mechanical reperfusion has proven to be an unquestionably superior treatment strategy over that of thrombolytic therapy in patients with acute coronary syndrome (ACS). Excimer laser coronary angioplasty (ELCA) is a unique revascularization device that has a lytic effect on thrombus, in addition to its debulking effect on the atherosclerotic plaque beneath the thrombus. METHODS AND RESULTS:  This single-center retrospective analysis consisted of consecutive ACS patients treated with ELCA (n=50) and age- and sex-matched ACS patients treated with manual aspiration (n=48) without use of a distal protection device...
2013: Circulation Journal: Official Journal of the Japanese Circulation Society
Juan P Fernandez, Alex R Hobson, Daniel McKenzie, Nimit Shah, Manas K Sinha, Tim A Wells, Terry M Levy, Rosie A Swallow, Suneel Talwar, Peter D O'Kane
AIMS: To establish success and complication rates of excimer laser coronary atherectomy (ELCA) in a contemporary series of patients with balloon failure during percutaneous coronary intervention (PCI) of both chronic total occlusions (CTO) and lesions with distal TIMI 3 flow. METHODS AND RESULTS: We identified 58 cases of balloon failure treated with ELCA±rotational atherectomy (RA) over four years, representing 0.84% of all PCI performed in our centre during this period...
June 22, 2013: EuroIntervention
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