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Dive into the research topics where Paul R. Cipriano is active.

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Featured researches published by Paul R. Cipriano.


American Journal of Cardiology | 1979

Altered Adrenergic Activity in Coronary Arterial Spasm: Insight Into Mechanism Based on Study of Coronary Hemodynamics and the Electrocardiogram

Donald R. Ricci; Arthur E. Orlick; Paul R. Cipriano; Diana F. Guthaner; Donald C. Harrison

To elucidate the pathophysiologic mechanism of coronary arterial spasm, the hypothesis was examined that underlying alterations in sympathetic activity may account for this syndrome in some patients. Observations were directed to alterations in coronary arterial hemodynamics and the electrocardiogram. Spasm of the left anterior descending coronary artery produced a mean increase in coronary vascular resistance of 107 percent (P less than 0.05) in four patients in whom coronary sinus blood flow was measured with the thermodilution technique. The alpha adrenergic blocking agent phentolamine, given intravenously, acutely reversed coronary spasm and its clinical manifestations in eight patients and reduced coronary resistance. In four patients, administration of the long-acting oral alpha blocking agent phenoxybenzamine (20 to 80 mg/day) caused disappearance of symptoms during a follow-up period of 3 to 12 months. Transient prolongation of the corrected Q-T interval preceded spontaneous or ergonovine maleate-provoked coronary spasm in 11 patients with variant angina pectoris, whereas no significant change in the Q-T interval followed ergonovine administration in 27 control patients with atypical chest pain who did not have coronary spasm. T wave inversions in the resting electrocardiogram were normalized by isoproterenol infusion in one patient and by long-term phenoxybenzamine treatment in four patients with variant angina pectoris. These Q-T and T wave changes are analogous to those described with unilateral or asymmetric stellate ganglion stimulation in animals. These observations suggest that alterations in the sympathetic nervous system that are consistent with asymmetric stellate ganglion activity and transient alpha adrenergic receptor stimulation can presage the development of coronary arterial spasm in some patients with variant angina pectoris.


American Journal of Cardiology | 1977

Coronary arterial narrowing in Takayasu's aortitis

Paul R. Cipriano; James F. Silverman; Mark G. Perlroth; Griepp Rb; Lewis Wexler

A patient with Takayasus aortitis and angina pectoris due to severe narrowing of the right and left coronary arterial ostia is described. Takayasus arteritis produces a panaortitis, with thickening of the adventitia predominating, and an inflammatory cell infiltrate involving the adventitia, outer media and vasa vasorum. Narrowing of the coronary arteries in this disease is due to extension into these arteries of the processes of proliferation of the intima and contraction of the fibrotic media and adventitia that occur in the aorta. The distal coronary arteries usually do not manifest arteritis and are normal in caliber. Angina pectoris may be the first symptom of the disease if the coronary arteries are the initial site of severe arterial narrowing. The coronary arterial bypass graft operation is effective therapy for treating coronary arterial narrowing due to Takayasus arteritis.


The American Journal of Medicine | 1981

Coronary artery spasm in the denervated transplanted human heart: A clue to underlying mechanisms

Andrew J. Buda; Robert E. Fowles; John S. Schroeder; Sharon A. Hunt; Paul R. Cipriano; Edward B. Stinson; Donald C. Harrison

The mechanism of coronary artery spasm has been poorly understood but there has been some suggestion that cardiac autonomic innervation may play an important role. We report coronary artery spasm in a 43 year old man two years after he had received a transplant. Provocative pharmacologic testing suggested functional denervation of the patients heart. Thus, coronary artery spasm can occur in the transplanted, denervated human heart. Autonomic innervation of the heart is not essential in all cases of coronary spasm, and circulating catecholamines and/or metabolic of hormonal products may play an important role.


Journal of Endovascular Therapy | 2002

The First 150 Endovascular AAA Repairs at a Single Institution: How Steep Is the Learning Curve?

W. Anthony Lee; Yehuda G. Wolf; Bradley B. Hill; Paul R. Cipriano; Thomas J. Fogarty; Christopher K. Zarins

Purpose: To determine whether increasing experience with endovascular abdominal aortic aneurysm (AAA) repair in a single institution will result in improved outcome. Methods: A retrospective review was undertaken of 150 consecutive cases of endovascular AAA repairs performed using the AneuRx device between October 1996 and April 2000 in a university-based medical center. The population was divided into early and late groups of 75 patients each. Endpoints included technical success; complications; early (≤30-day) morbidity, mortality and rupture; endoleak at discharge and at 1 month; early secondary intervention; proximal neck and iliac tortuosity; extender cuff placement; femoral reconstructions beyond primary repair; total fluoroscopy time; and contrast load. Results: Baseline patient and aneurysm characteristics were similar between the 2 groups. Technical success was 98.7%; 2 cases were converted intraprocedurally owing to difficult iliac access (early group) and a severely angulated proximal neck (late group). There was a tendency toward more frequent use of intraoperative proximal extender cuffs in the early group (12% versus 4% in the late group, p=0.13). Femoral reconstructions were more frequent in the early group (36% versus 19%, p<0.025). While total contrast volume was similar (111 ± 56 versus 105 ± 45 mL, p=NS), total fluoroscopy time was significantly reduced (p<0.05) between the early and late groups. Conclusions: With attention to detail and careful patient selection, successful endovascular AAA repair can be achieved with very few conversions and low perioperative mortality even during the centers early experience. Evidence indicates, however, that a learning curve definitely exists, as shown by fewer access site problems, more accurate device deployments, and decreased fluoroscopy times as proficiency is attained.


American Journal of Cardiology | 1979

Acute retrograde dissection of the ascending thoracic aorta

Paul R. Cipriano; Griepp Rb

Abstract The clinical, aortographic and pathologic features of six patients with acute retrograde dissection of the ascending thoracic aorta are presented and appropriate guidelines for surgical treatment are proposed. Although acute dissection of the aorta was the clinical diagnosis in these patients, clinical features were not helpful in identifying the pattern or extent of dissection. Aortography demonstrated that the site or sites of intimal tear occurred adjacent to the origin of the innominate artery (three patients) or left subclavian artery (two patients); an intimal tear was not seen in one patient. Five of the six patients also had acute or chronic (or both) antegrade dissection of the descending thoracic aorta. Retrograde dissection of the ascending aorta occurred in the outer portion of the media. The primary histologic changes were fragmentation of elastic fibers and fibrosis of the media. Three patients died, including two of the five patients who were treated surgically; the other three patients survived. Immediate replacement of the ascending aorta with a Dacron graft is recommended to prevent lethal complications due to extension of retrograde dissection, even though dissection may involve both the ascending and descending aorta and the site of intimai disruption may not be resected. The aortic arch or descending thoracic aorta, or both, can be replaced later, utilizing total body hypothermia and temporary circulatory arrest, if further dis-section or enlargement of the aorta occurs after emergency operation on the ascending aorta.


American Heart Journal | 1981

Clinical course of patients following the demonstration of coronary artery spasm by angiography

Paul R. Cipriano; Francis H. Koch; Steven J Rosenthal; John S. Schroeder

The clinical course of 25 patients was determined during an average of 2.7 years following the angiographic demonstration of coronary artery spasm (CAS). Seventeen patients received medical treatment after the demonstration of coronary spasm and six patients had cardiac surgery. Twenty-three patients were living and two patients had died at the time of follow-up. Twenty-one of the 23 surviving patients has either no chest pain or markedly reduced symptoms. However, the demonstration of CAS by angiography was associated with a high incidence of subsequent cardiac complications, which included myocardial infarct (four patients), cardiac arrest (four patients), and death (two patients). We concluded from this study that after the demonstration of CAS by angiography: (1) the clinical course was variable, with most patients (21 of 25 patients, 84%) having improvement of symptoms at the time of follow-up; (2) major cardiac complications were frequent (11 out of 25 patients, 44%) and; (3) although clinical and coronary angiographic features were of limited use in predicting major cardiac complications, most of the patients who had an uncomplicated course (11 of 14 patients, 79%) had either less than 50% fixed coronary artery luminal diameter narrowing (CAN) or coronary artery bypass graft operations, the majority of patients with less than 50% CAN (8 of 11 patients, 73%) had no major cardiac complications, and myocardial infarction or death usually occurred during periods of increased angina pectoris.


American Heart Journal | 1983

Myocardial infarction in patients with coronary artery spasm demonstrated by angiography

Paul R. Cipriano; Francis H. Koch; Steven J Rosenthal; Donald S. Baim; Robert Ginsburg; John S. Schroeder

Twelve cases of myocardial infarction (MI) were documented in 11 of 39 patients who had coronary artery spasm (CAS) that was observed by angiography either before MI (3 patients), after MI (5 patients), or both before and after MI (3 patients). MI corresponded in location to sites of ECG changes of myocardial ischemia during spontaneous angina pectoris in 7 of 7 patients and to the region of myocardium supplied by the vessel in which CAS was observed by angiography in each patient. MI occurred in the distribution of the right coronary artery in 8 patients and of the left coronary artery in 4 patients. Of 12 vessels that supplied infarcted regions of myocardium, 7 vessels had greater than or equal to 50% diameter fixed coronary artery narrowing (CAN), but the remaining 5 vessels had minimal (10%) or no fixed CAN. In those patients who were studied after MI, coronary angiography demonstrated that only 3 of 9 vessels in the distribution of infarcted regions of myocardium were completely occluded. Clinical follow-up for an average of 1.3 years after MI showed that 7 patients continued to have chest pain, 2 patients were asymptomatic, and 2 patients died suddenly 9 weeks and 1 year, respectively, after MI. Therefore, among our patients with CAS demonstrated by angiography, MIs (1) were frequent (28%), (2) occurred in the distribution of observed coronary spasm, (3) were frequently (5 of 12 arteries) in the distribution of vessels having minimal or no fixed narrowing, and (4) were often (6 of 9 arteries) in the distribution of vessels that were demonstrated to be patient after MI.


American Heart Journal | 1978

Organized left atrial mural thrombus demonstrated by coronary angiography

Paul R. Cipriano; Diana F. Guthaner

Small coronary artery fistulas terminating at the site of adherent, organized mural thrombi in the left atrial appendage were observed during selective coronary angiography in patients with mitral stenosis. The angiographic features of this abnormality can be distinguished from those of cardiac tumors, vascular malformations, and coronary artery fistulas that are not associated with organized thrombus. This coronary angiographic abnormality may indicate the presence of left atrial thrombus that is not revealed by echocardiography and is not manifest clinically by systemic emboli. The size of the collection of radiographic contrast material in the left atrium is not proportional to the size of the thrombus.


Journal of Endovascular Therapy | 2001

Increased Flexibility of AneuRx Stent-Graft Reduces Need for Secondary Intervention Following Endovascular Aneurysm Repair

Frank R. Arko; W. Anthony Lee; Bradley B. Hill; Paul R. Cipriano; Thomas J. Fogarty; Christopher K. Zarins

Purpose: To evaluate the impact of a change in the manufacturing of the AneuRx stent-graft on the long-term results of endovascular abdominal aortic aneurysm (AAA) repair. Methods: The first 70 AAA patients treated with the AneuRx stent-graft between October 1996 and December 1998 were reviewed. The early stiff bifurcated design (STIFF) was used in 23 patients (mean age 71.7 ± 9.3 years, range 45–87) and the current flexible bifurcated design (FLEX) in 47 mean age 75.0 ± 7.3 years, range 61–96). Data on patient demographics, aneurysm morphology, technical success, complications, secondary procedures, and outcomes were compared using Kaplan-Meier estimates to evaluate patient survival and freedom from surgical conversion, rupture, and secondary interventions at 6, 12, and 24 months. Results: The 2 groups were equally matched with regard to age, preoperative comorbidities, proximal neck dimensions, and aneurysm diameter. Mean follow-up times were 22.42 ± 11.72 months (range 1–46) for the STIFF cohort and 18.08 ± 6.14 months (range 1–30) for the FLEX (p = 0.057). Eleven (48%) of 23 STIFF patients required secondary interventions versus 6 (13%) of 47 FLEX patients (p < 0.05). There were no ruptures. At the 24-month interval, survival estimates were 86% for STIFF and 76% for FLEX (p = NS); freedom from surgical conversion was 100% for STIFF and 97% for FLEX (p = NS) and freedom from secondary interventions was 18% for STIFF and 90% for FLEX (p < 0.05) at 24 months. Conclusions: The AneuRx stent-graft was effective in achieving the primary objective of preventing aneurysm rupture in all patients. However, increasing the flexibility of the bifurcated module significantly improved the primary success rate by reducing the need for subsequent secondary interventions.


Journal of Endovascular Therapy | 2003

Treatment of Axillosubclavian Vein Thrombosis: A Novel Technique for Rapid Removal of Clot Using Low-Dose Thrombolysis

Frank R. Arko; Paul R. Cipriano; Eugene Lee; Konstantinos Filis; Christopher K. Zarins; Thomas J. Fogarty

PURPOSE To report successful combined percutaneous mechanical thrombectomy and pharmacological lysis for axillosubclavian vein thrombosis, with rapid clot removal at a single setting using low-dose thrombolysis. CASE REPORTS Two consecutive patients presented with arm swelling; the diagnosis of axillosubclavian vein thrombosis was confirmed with duplex ultrasound. Both patients were treated percutaneously with the Solera mechanical thrombectomy device, after which 5 mg of tissue plasminogen activator were delivered within approximately 10 minutes via the Trellis infusion catheter to remove any residual thrombus. Completion venography and serial duplex ultrasound scans in follow-up demonstrated widely patent axillosubclavian veins with no residual thrombus in both cases. CONCLUSIONS Standard treatment of axillosubclavian vein thrombosis may require 12 to 36 hours, with multiple trips to the angiography suite. The novel technique combining mechanical thrombectomy and pharmacological lysis can be performed safely and successfully at a single setting with a small dose of the lytic drug.

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Frank R. Arko

University of Texas Southwestern Medical Center

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