Massimo Ferraro
Toho University
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Circulation | 1996
Patrick Hall; Shigeru Nakamura; Luigi Maiello; Akira Itoh; Simonetta Blengino; Giovanni Martini; Massimo Ferraro; Antonio Colombo
BACKGROUND Previous studies have shown that it is feasible to withhold anticoagulation after a successful intracoronary stent procedure with a low incidence of stent thrombosis. The importance of specific antiplatelet agents when stenting is performed without anticoagulation is unknown. METHODS AND RESULTS After successful intravascular ultrasound-guided stenting, 226 patients were randomly assigned to receive either aspirin therapy alone (n = 103) or a combination of ticlopidine and short-term aspirin therapy (n = 123). Primary angiographic and clinical end points were stent thrombosis, death, myocardial infarction, the need for postprocedure coronary artery bypass surgery or repeated angioplasty, and significant medication side effects requiring termination of the medication within the first month of a successful procedure. At 1 month, the rate of stent thrombosis was 2.9% in the aspirin only group and 0.8% in the ticlopidine-aspirin group (P = .2). Cumulative major clinical events after successful stenting occurred in 3.9% of the patients in the aspirin group and in 0.8% in the ticlopidine-aspirin group (P = .1). There were no medication side effects in the aspirin group; in the combined ticlopidine-aspirin group, medication side effects occurred in 3 patients (P = .2). CONCLUSIONS At 1 month, there was no difference in the incidence of stent thrombosis or other clinical end points between the two poststent antiplatelet regimens. However, the relatively small size of the study and the low incidence of thrombosis events may have contributed to the failure to detect differences in angiographic and clinical end points between the two groups.
Journal of the American College of Cardiology | 1998
Tatsuro Akiyama; Issam Moussa; Bernhard Reimers; Massimo Ferraro; Yoshio Kobayashi; Simonetta Blengino; Lucia Di Francesco; Leo Finci; Carlo Di Mario; Antonio Colombo
OBJECTIVES Stent implantation reduces restenosis in vessels > or =3 mm compared with balloon angioplasty, but few data are available for stents implanted in vessels <3 mm. The aim of this study was to evaluate immediate and follow-up patient outcomes after stent implantation in vessels <3 mm compared to stent implantation in vessels > or =3 mm. METHODS Between March 1993 and May 1996, a total of 1,298 consecutive patients (1,673 lesions) underwent coronary stenting. The study population was divided into two groups based on angiographic vessel diameter. In case of multivessel stenting, patients were randomly assigned only one lesion. Group I included 696 patients (696 lesions) in whom stents were implanted in vessels > or =3 mm, and group II included 602 patients (602 lesions) in whom stents were implanted in vessels <3 mm. RESULTS There was no difference in procedural success (95.4% in group I and 95.9% in group II), or subsequent subacute stent thrombosis (1.5% in group I and 1.4% in group II, p=NS). The postprocedure residual diameter stenosis was 3.31+/-12.4% in group I and -2.45+/-16.2% in group II. Angiographic follow-up was performed in 75% of patients, restenosis occurred in 19.9% of patients in group I and 32.6% in group II (p <0.0001). Absolute lumen gain was significantly higher in group I compared to group II, but absolute late lumen loss was similar in the two groups (1.05+/-0.91 mm in group I vs. 1.11+/-0.85 mm in group II, p=NS). Subsequently, the loss index was more favorable in group I (0.45 vs. 0.56; p=0.0006). Independent predictors of freedom from restenosis by multivariate logistic regression in the total population were: larger baseline reference diameter (odds ratio 2.032 p=0.006), larger postprocedure minimal stent cross-sectional area (odds ratio 1.190, p=0.0001) and shorter lesions (odds ratio 1.037, p=0.01). At long-term clinical follow-up, patients with small vessels had a lower rate of event-free survival (63% vs. 71.3%, p=0.007). CONCLUSIONS Coronary stenting can be performed in small vessels with a high success rate and low incidence of stent thrombosis. However, the long-term angiographic and clinical outcome of patients undergoing stent implantation in small vessels is less favorable than that of patients with large vessels.
Journal of the American College of Cardiology | 1997
Bernhard Reimers; Issam Moussa; Tatsuro Akiyama; Gina Tucci; Massimo Ferraro; Giovanni Martini; Simonetta Blengino; Carlo Di Mario; Antonio Colombo
OBJECTIVES This study evaluated the long-term clinical outcome of successful repeat percutaneous intervention after in-stent restenosis. BACKGROUND Recurrence of symptoms and angiographic restenosis after stent implantation are observed in 15% to 35% of cases. Repeat percutaneous treatment for in-stent restenosis has been shown to be safe, with high immediate success, but little is known about the long-term clinical outcome. METHODS Clinical follow-up (minimum 9 months) was obtained in a consecutive series of 124 patients (127 vessels) presenting with stent restenosis who were successfully treated with repeat percutaneous intervention. RESULTS Clinical follow-up was obtained in all 124 patients at a mean [+/-SD] of 27.4 +/- 14.7 months (range 9 to 66); a stress test was available in 88 patients (71%). Recurrence of clinical events occurred in 25 patients (20%) and included death from any cause in 2 patients (2%), target vessel revascularization in 14 (11%), myocardial infarction in 1 (1%) and positive stress test results or recurrence of symptoms (Canadian Cardiovascular Society class I to IV) treated medically in 8 (6%). Cumulative event-free survival at 12 and 24 months was 86.2% and 80.7%, respectively. Significant predictive factors of recurrence of clinical events were repeat intervention in saphenous vein grafts, multivessel disease, low ejection fraction and a < or = 3-month interval between stent implantation and repeat intervention. CONCLUSIONS In-stent balloon angioplasty for stent restenosis in native vessels seems to be an effective method in terms of a low long-term clinical event rate.
Jacc-cardiovascular Interventions | 2010
Alaide Chieffo; Valeria Magni; Azeem Latib; Francesco Maisano; Alfonso Ielasi; Matteo Montorfano; Mauro Carlino; Cosmo Godino; Massimo Ferraro; Giliola Calori; Ottavio Alfieri; Antonio Colombo
OBJECTIVES We sought to evaluate at 5 years the occurrence of cardiac death; cardiac death, and/or myocardial infarction (MI); cardiac death, MI, and/or stroke; target vessel revascularization; and major adverse cardiac and cerebrovascular events following percutaneous coronary intervention (PCI) with drug-eluting stent (DES) versus coronary artery bypass graft (CABG) in unprotected left main coronary artery lesions. BACKGROUND Preliminary results at 1 year showed comparable occurrence of major adverse cardiac and cerebrovascular events in our center between PCI and CABG. METHODS All consecutive patients with an unprotected left main coronary artery stenosis electively treated with DES implantation versus CABG in our center, between March 2002 and July 2004, were analyzed. A propensity analysis was performed to adjust for baseline differences between the 2 cohorts. RESULTS We included 249 patients in the study: 107 were treated with PCI and DES implantation and 142 with CABG. At 5-year clinical follow-up, no difference was found between PCI and CABG in the occurrence of cardiac death (adjusted odds ratio [OR]: 0.502; 95% confidence interval [CI]: 0.162 to 1.461; p = 0.24). The PCI group showed a trend toward a lower occurrence of the composite end point of cardiac death and MI (adjusted OR: 0.408; 95% CI: 0.146 to 1.061; p = 0.06). Percutaneous coronary intervention was associated with a lower rate of the composite end point of death, MI, and/or stroke (OR: 0.399; 95% CI: 0.151 to 0.989; p = 0.04). Indeed, CABG was correlated with lower target vessel revascularization (adjusted OR: 4.411; 95% CI: 1.825 to 11.371; p = 0.0004). No difference was detected in the occurrence of major adverse cardiac and cerebrovascular events (adjusted OR: 1.578; 95% CI: 0.825 to 3.054; p = 0.18). CONCLUSIONS At 5-year clinical follow-up, there was still no difference in the occurrence of major adverse cardiac and cerebrovascular events between elective PCI with DES implantation and CABG in unprotected left main coronary artery lesions in this single-center experience. There was an advantage of PCI in the composite end point of death, MI, and/or stroke, whereas a benefit in the need for reintervention was still found in CABG.
Circulation | 1997
Remo Albiero; Patrick Hall; Akira Itoh; Simonetta Blengino; Shigeru Nakamura; Giovanni Martini; Massimo Ferraro; Antonio Colombo
BACKGROUND Previous studies have shown that stents can be inserted in coronary arteries of patients who are subsequently treated safely with antiplatelet therapy only (ticlopidine and/or aspirin) with a low incidence of stent thrombosis, provided that stent expansion is adequate and there are no other flow-limiting lesions present. However, it is unknown whether ticlopidine combined with aspirin is superior to aspirin alone in preventing stent thrombosis. METHODS AND RESULTS From March 1993 through July 1995, 801 consecutive patients assigned to receive either aspirin therapy alone (ASA, 264 patients, 348 lesions) or a combination of ticlopidine and aspirin (TIC-ASA, 537 patients, 737 lesions) after a successful stent insertion, in most accomplished with intravascular ultrasound guidance, were evaluated retrospectively. At 1 month, there was no difference in the ASA group compared with the TIC-ASA group in the rate of any stent thrombosis (1.9% versus 1.9%; P = 1), subacute stent thrombosis (1.9% versus 1.3%; P = .5), cumulative major adverse clinical events (1.9% versus 2.0%; P = 1), and peripheral vascular complications (0.5% versus 0.2%; P = .3). Medication side effects that required termination of antiplatelet therapy occurred only in 1.9% of patients in the TIC-ASA group (P = .04). CONCLUSIONS At 1-month clinical follow-up, stent thrombosis and other adverse clinical outcomes were not significantly different between the ASA and TIC-ASA groups. Medication side effects occurred only in patients treated with ticlopidine. These results provide further evidence of the safety of treatment with antiplatelet therapy only after optimal stent implantation and support the efficacy of aspirin alone in preventing stent thrombosis.
Jacc-cardiovascular Interventions | 2011
Rasha Al-Lamee; Alfonso Ielasi; Azeem Latib; Cosmo Godino; Massimo Ferraro; Marco Mussardo; Francesco Arioli; Mauro Carlino; Matteo Montorfano; Alaide Chieffo; Antonio Colombo
OBJECTIVES The aim of this study was to evaluate the incidence, predictors, management, and clinical outcomes in patients with grade III coronary perforation during percutaneous coronary intervention. BACKGROUND Grade III coronary perforation is a rare but recognized complication associated with high morbidity and mortality. METHODS From 24,465 patients undergoing percutaneous coronary intervention from May 1993 to December 2009, 56 patients had grade III coronary perforation. RESULTS Most lesions were complex: 44.6% type B2, 51.8% type C, and 28.6% chronic total occlusions, and within a small vessel (≤ 2.5 mm) in 32.1%. Glycoprotein IIb/IIIa inhibitors were administered in 17.9% of patients. The device causing perforation was intracoronary balloon in 50%: 53.6% compliant, 46.4% noncompliant; intracoronary guidewire in 17.9%; rotablation in 3.6%; and directional atherectomy in 3.6%. Following perforation, immediate treatment and success rates, respectively, were prolonged balloon inflation 58.9%, 54.5%; covered stent implantation 46.4%, 84.6%; coronary artery bypass graft surgery (CABG) and surgical repair 16.0%, 44.4%; and coil embolization 1.8%, 100%. Multiple methods were required in 39.3%. During the procedure (n = 56), 19.6% required cardiopulmonary resuscitation and 3.6% died. In-hospital (n = 54), 3.7% required CABG, 14.8% died. The combined procedural and in-hospital myocardial infarction rate was 42.9%, and major adverse cardiac event rate was 55.4%. At clinical follow-up (n = 46) (median: 38.1 months, range 7.6 to 122.8), 4.3% had a myocardial infarction, 4.3% required CABG, and 15.2% died. The target lesion revascularization rate was 13%, with target vessel revascularization in 19.6%, and major adverse cardiac events in 41.3%. CONCLUSIONS Grade III coronary perforation is associated with complex lesions and high acute and long-term major adverse cardiac event rates.
Journal of the American College of Cardiology | 1996
Antonio Colombo; Massimo Ferraro; Akira Itoh; Giovanni Martini; Simonetta Blengino; Leo Finci
OBJECTIVES This study attempted to analyze immediate and long-term angiographic and clinical results of coronary stent implantation for restenosis in a consecutive group of patients. BACKGROUND The rate of stent utilization in patients with coronary artery disease has increased exponentially in recent years. There are many unanswered questions about the use of stenting in patients with restenosis, particularly with respect to late clinical and angiographic results. METHODS A total of 159 stents were implanted in 128 consecutive patients with 139 lesions (mean 1.3 stents/patient). A technique of optimal stent expansion was used in all patients, and intravascular ultrasound guidance with no subsequent anticoagulation was performed in 41 patients. RESULTS Stent implantation was successful in 126 patients (98%). Four patients (3.1%) had complications (in two after successful stenting): death in one, emergency bypass surgery operation in two and subacute stent thrombosis in one. Stents were implanted with a final balloon size (mean +/- SD) of 3.5 +/- 0.5 mm and a mean maximal pressure of 11 +/- 4 atm (range 8 to 20). Angiographic restenosis occurred in 27 patients (25%). Regression analysis on clinical and angiographic variables for prediction of restenosis showed no statistical significance for any variable. Late events occurred in 23 patients (19%). The actuarial survival rate was 98% at 1 year and at 3 years, and the event-free survival rate including freedom from repeat angioplasty for restenosis was 95% and 76%, respectively. CONCLUSIONS The late angiographic outcome, restenosis rate and total clinical events are favorable for selected patients undergoing stent implantation for the indication of restenosis.
American Journal of Cardiology | 2010
Rasha Al-Lamee; Alfonso Ielasi; Azeem Latib; Cosmo Godino; Massimo Ferraro; Francesco Arioli; Marco Mussardo; Daniela Piraino; Filippo Figini; Mauro Carlino; Matteo Montorfano; Alaide Chieffo; Antonio Colombo
Poor long-term outcomes after percutaneous coronary intervention (PCI) in chronic total occlusion (CTO) of saphenous vein grafts (SVGs) have been reported. However, limited data are available evaluating the use of modern techniques in this group. The aim of the present study was to assess the efficacy and long-term outcomes of PCI in SVG CTO with the routine use of embolic protection devices and drug-eluting stents. A retrospective cohort analysis was conducted of all consecutive patients undergoing PCI to SVG CTO from May 2002 to July 2009 at 2 centers. The indication for PCI was the presence of angina or silent ischemia with evidence of inducible ischemia after functional testing in the territory supplied by the SVG, despite optimal medical therapy. We identified 34 patients with SVG CTO. Of the 34 patients, 23 (68%) underwent successful SVG recanalization with stent implantation. An embolic protection device was used in 78% and 95% of stents implanted were drug-eluting stents. No in-hospital major adverse cardiac events occurred in the successful PCI group; one myocardial infarction occurred in the unsuccessful group. At follow-up (median 18.0 months, interquartile range 10.4 to 48.3), 1 case of myocardial infarction had occurred in the successful group. The in-stent restenosis rate was 68% (n = 13), of which 77% were focal, with target vessel revascularization in 61%. In conclusion, despite the relatively low procedural success rates, the clinical outcomes after successful PCI to SVG CTO with modern techniques were favorable. The repeat revascularization rates were high; however, graft patency was achievable in most after reintervention.
Catheterization and Cardiovascular Interventions | 2005
Ioannis Iakovou; Giuseppe Sangiorgi; Goran Stankovic; Nicola Corvaja; Giancarlo Vitrella; Massimo Ferraro; Antonio Colombo
The aim of this study was to assess the safety and effectiveness of ≥4 sirolimus‐eluting stent (SES; Cypher, Cordis, Johnson and Johnson) implantation. The safety of implantation of ≥4 SESs in the same patient and setting has not been established. Furthermore, it has been hypothesized that sirolimus administration with the use of multiple stents may diminish the platelet inhibitory effects of clopidogrel and may trigger drug‐drug interactions. We identified 96 consecutive patients (96 procedures) who underwent implantation of ≥4 SESs in 365 lesions (438 stents) during the same procedure. All patients received aspirin indefinitely and clopidogrel or ticlopidine for at least 1 year postprocedure; 57% and 47% of the patients were on calcium channel blocker and statin therapy, respectively. All stents were successfully deployed and glycoprotein IIb/IIIa inhibitors were used in 50% of the procedures. There were no in‐hospital deaths, Q‐wave myocardial infarction (MI), urgent bypass surgery, or repeat percutaneous coronary intervention; 18 patients (19%) suffered non‐Q‐wave MI (defined as CK‐MB elevation >3 times the upper limit of normal). At 30‐day follow‐up, there was one (1%) subacute thrombosis resulting in target lesion revascularization. At mean follow‐up time of 15.4 ± 6.2 months, the frequency of target lesion revascularization, target vessel revascularization, and major adverse cardiac event rates were 12%, 16%, and 18%, respectively. No other notable clinical events that might have been attributed to the possible drug‐drug interactions or discontinuation of concomitant antithrombotic, statin, or calcium channel blocker therapy were reported. Multiple (≥4) SES implantation appears safe with no increase in major adverse cardiac events. Catheter Cardiovasc Interv 2005;64:436–439.
International Journal of Cardiology | 2013
Kensuke Takagi; Joanne Shannon; Sandeep Basavarajaiah; Azeem Latib; Rasha Al-Lamee; Tasuku Hasegawa; Cosmo Godino; Massimo Ferraro; Filippo Figini; Mauro Carlino; Matteo Montorfano; Alaide Chieffo; Antonio Colombo
BACKGROUND/OBJECTIVES Quantitative coronary analysis (QCA) of the coronary artery and stent size may be influenced by anatomical location in relation to both calibration point and the X-ray tube. The impact of this phenomenon on lesion assessment is undetermined. METHODS In total, 427 consecutive patients who underwent PCI with intravascular ultrasound (IVUS)-guidance were enrolled. The minimum stent diameter (MSD) was measured using QCA (MSDQCA) and IVUS (MSDIVUS) analysis. We used reference objects positioned at a different height from the X-ray source to validate our approach. RESULTS A statistically positive moderate correlation was observed between MSDQCA and MSDIVUS (r=0.649, p=0.001). The mean MSDQCA and MSDIVUS were 3.04±0.49 mm and 2.68±0.47 mm respectively. The difference between MSDQCA and MSDIVUS of >0.75 mm was more frequently observed in the LCx rather than in the LAD (7.4% in the LAD vs. 24.3% in the LCx, p=0.001). The discrepancy between the MSDQCA and MSDIVUS for the LCx was larger than for the LAD, and tended to be larger than for the RCA (13.3% vs. 18.5%, p=0.05 and 18.5% vs. 14.5%, p=0.17). A discrepancy >20% was more frequently observed in the small (≤2.5 mm) than in the large MSDIVUS group (52.7% vs. 25.1%, p=0.001). This discrepancy was more common in the LCx than in the LAD or RCA (48.6% vs. 30.9% vs. 31.2%, p=0.03). CONCLUSIONS Assessment of the MSDQCA is more likely to overestimate in the LCx than in the LAD, particularly when the MSDIVUS is <2.5 mm. Therefore, we should be less aggressive in oversizing balloons and stents based on QCA for the LCx or small vessel intervention.