Papers by Enrique Hernández
American Journal of Cardiology, 2001
1. The GUSTO Investigators. An interventional randomized trial comparing four thrombolytic strate... more 1. The GUSTO Investigators. An interventional randomized trial comparing four thrombolytic strategies for acute myocardial infarction. N Engl J Med 1993;328: 673-682. 2. Lee KL, Woodlief LH, Weaver WD, Betriu A, Simons M, Aylward P, Van de Werf F, Califf RM, for the GUSTO-I Investigators. Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction: results from an international trial of 41021 patients. Circulation 1995;91:1659 -1668. 3. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17187 cases of suspected acute myocardial infarction: ISIS-2. Lancet 1988;2:349 -402. 4. Gibbons RJ, Holmes DR, Reeder GS, Leon MB, Rothbaum DA, Cummins FE, Goldenberg T, Bresnanan JF. Immediate angioplasty compared with the administration of a thrombolytic agent followed by conservative treatment for myocardial infarction. N Engl J Med 1993;328:685-691. 5. Grines CL, Browne KF, Marco J, Rothbaum D, Stone GW, O'Keefe J, Overlie P, Donohue B, Chelliah N, Timmis GC. A comparison of immediate coronary angioplasty with intravenous streptokinase for acute myocardial infarction. N Engl J Med 1993;328:673-679. 6. Zijlstra F, De Boer MJ, Hoorntje JCA, Reiffers S, Reiber JH, Suryapranata H. A comparison of immediate coronary angioplasty with intravenous streptokinase in acute myocardial infarction. N Engl J Med 1993;328:680 -684. 7. Chesebro JH, Knatterud G, Roberts R, Borer J, Cohen LS, Dodge HT, Francis CK, Hillis D, Ludbrook P. Thrombolysis in myocardial infarction (TIMI) trial, phase I: a comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Circulation 1987;76:142-154. 8. Kaplan BM, Larkin T, Safian RD, O'Niell WW, Kramer B, Hoffmann M, Schreiber T, Grines CL. Prospective study of extraction atherectomy in patients with acute myocardial infarction. Am J Cardiol 1996;78:383-388. 9. Nagakawa Y, Matsuo S, Kimura T, Yokoi H, Tamura T, Hamasaki N, Nosaka H, Nobbuyoshi M. Thrombectomy with the AngioJet catheter in native coronary arteries for patients with acute or recent myocardial infarction. Am J Cardiol 1999;83:994 -999. 10. van Ommen GV, van den Bos AA, Pieper M, den Heyer P, Thomas MR, Ozbeck S, Bär FW, Wellens HJ. Removal of thrombus from aortocoronary bypass grafts and coronary arteries using the 6Fr Hydrolyser. Am J Cardiol 1997;79:1012-1016. 11. Rosenschein U, Roth A, Rassin T, Basan S, Miller HI. Analysis of coronary ultrasound thrombolysis endpoints in myocardial infarction (Acute Trial). Results of the feasibility phase. Circulation 1997;95:1411-1416. 12. Hamm C, Steffen W, Terres W, de Scheerder I, Reimers J, Cumberland D, Siegel RJ, Meinertz T. Intravascular ultrasound thrombolysis in acute myocardial infarction. Am J Cardiol 1997;80:200 -204. 13. Reisman M, Dewhurst TA, DeVore LJ. A new percutaneous thrombectomy catheter: an investigational report.
American Journal of Cardiology, 1997
Two hundred twenty-eight patients with successful coronary stent implantation were randomized eit... more Two hundred twenty-eight patients with successful coronary stent implantation were randomized either to protamine administration and femoral sheath removal (group I, n = 117) or no heparin neutralization and delayed sheath removal (group II, n = 111). The hospital stay after treatment was shorter in patients receiving protamine; therefore, protamine use for neutralizing circulating heparin may be safely administered immediately after stent implantation.
Catheterization and Cardiovascular Diagnosis, 1992
The Palmaz-Schatz stent can be successfully deployed in most patients. However, in a small percen... more The Palmaz-Schatz stent can be successfully deployed in most patients. However, in a small percentage of instances a systemic embolism of the stent has been reported. In the present article we describe an easy and fast method of stent capture when detachment from the balloon has happened (pulling back the stent-loaded balloon into the guiding catheter or femoral sheath). In this situation we propose the use of the coronary guide-wire “as a guide” to capture coaxially the lost stent. This method allows for continuing the procedure without removal of the femoral sheath.
American Heart Journal, 2004
Conventional bare stents have been used to treat unprotected left main (LM) coronary artery steno... more Conventional bare stents have been used to treat unprotected left main (LM) coronary artery stenosis. However, restenosis remains the main limitation. Since rapamycin-eluting stents (RES) appear to inhibit neointimal proliferation, their application to this specific site seems promising.Since May 2002, we have studied a series of 52 patients with LM lesions treated with RES. Forty-seven patients presented with de novo stenoses, and 5 had in-stent restenosis; 19 patients required combined stent treatment for other remote lesions in the coronary tree, 6 of them at the level of proximal right coronary artery. The RES was implanted directly at the LM in 39 patients; 13 others needed predilation. Once deployed, the RES was overexpanded with short balloons adjusted to the LM length in 44 patients. Quantitative coronary angiograms were analyzed in the same view before and immediately after treatment and at follow-up. Patients were followed-up closely and new cardiac catheterization was scheduled at 6-month evaluation or earlier in the presence of symptoms. At follow-up study, quantitative coronary angiography and motorized intravascular ultrasound analyses were performed in 35 (67%) patients.Primary success was obtained in 50 patients (96%). Two patients (4%) developed a non-Q–wave myocardial infarction. All patients were symptom-free at discharge. After a mean follow-up of 12 ± 4 months, 50 patients (96%) remain asymptomatic. No late death or acute thrombosis have been recorded. Two patients became symptomatic 2 and 4 months after treatment, respectively. One had restenosis at a remote site, while the other had in-segment restenosis. None of the remaining 33 angiographically evaluated patients developed restenosis at any site. Target lesion revascularization was 1/52 (2%).Although longer-term follow-up studies are needed, the tailored treatment of coronary lesions located at the LM by overexpanded RES is feasible and safe. Midterm results seem promising, which might help to shift the orientation of patient management from surgical to percutaneous revascularization.
American Heart Journal, 1995
To assess the risk of late side branch occlusion after Palmaz-Schatz stent deployment, we analyze... more To assess the risk of late side branch occlusion after Palmaz-Schatz stent deployment, we analyzed the angiographic evolution of 62 patients treated by successful stent implantation who had a total of 85 side branches starting from the stented segment. Side branches were considered minor (n = 39) when the diameter was <1 mm and intermediate (n = 46) when the vessel had >--1 mm diameter. One angiographic follow-up study was available in all patients at 8 +_ 5 months. Eight minor branches presented some degree of stenosis at origin before stent deployment (4 totally occluded). After stent deployment, 32 82%) of 39 remained unchanged and 3 became occluded. Late progression at origin occurred in 4 of 34 (3 occluded). Before stent deployment, 48% of the intermediate branches had some compromise degree at their starting point (1 totally occluded). Eight of 45 intermediate branches became occluded after stent implantation. Late progression at origin happened in 5 of 32 branches (2 occluded). Some degree of follow-up stenosis regression at the origin was observed in 22 (26%) of 85 arteries. Neither clinical nor angiographic factors could be identified as predictors of late side branch occlusion or stenosis progression at its origin. Later occlusion or progression at origin of a side branch covered by a Palmaz-Schatz stent seems to be an uncommon occurrence (7% and 12% respectively) that cannot be predicted by angiographic or clinical factors. On the contrary, regression at follow-up of a side branch-origin stenosis can also come about. (AM HEART J 1995;129:436-40.)
Journal of The American College of Cardiology, 1993
O&ectives. This sandy WPF conducted to csw the reMions ResuuS. E&ga6c plnque bad a higher cdlrgen... more O&ectives. This sandy WPF conducted to csw the reMions ResuuS. E&ga6c plnque bad a higher cdlrgen and &urn iuncq bltracoroocry Id-nd, aq#ogMphic and II-content, rheress cd¢ plpqurs bed an incrcascd tcvcl of data obtatncd from pattcnti ntth corenary artery dkasc sum fibrin, m&i and tipida. TJtllrsouad plaque reduction aflcr fully treated by directiansl cxxonary ~~berectom~ In addition, it atbwectomy 1~~6 greater by ccbolocmt Q6 + 21%) than ia was desigocd to ctuddotc wbctber some qccte of b~trovw_uler nhogmkpInqws6u+18%;p~O.osJ.llutKduetiouultrawuod or pathologic tklioga Dodd prcdb!t o pmpcnslty to latedwith tbc wel@,bt oftbc rewctca matcrw (r = 0.62; p i 0.01). -.
American Journal of Cardiology, 1993
Mitral balloon valvulotomy (MBV) has proved to be an effective method in the treatment of pa tlen... more Mitral balloon valvulotomy (MBV) has proved to be an effective method in the treatment of pa tlents with mitral stenosis. Although several W tors determlning an optimal immediate result have been desdbed, there is little information * garding long-term folloWp, as well as factors irr fluenclng late success after MBV. This study analyzes 350 patients (mean age 46 + 12 years) treated by MBV who W~IU clinically followed up between6monthsand6years.Atleastlec~ Doppler followup study was obtained in 298 pa tlents 28 f 14 months after MBV; hemodynamic reevaluations were performed in 66 patients after 23 -c 8 months. Late success was cmsldered If the patlent was in functional class I to II and free of nu@r events (death, restenosis and valve su~c gery). Restenosis was defined as a 50% loss of initial gain with regard to valve area by echocar-dlo@aphy, which was confirmed hemodynamically. After a mean follo~fup of 38 + 15 months, 296 patients (84%) remained in functional class I to II, wlthout surgery or the need for an increase in medical treatment. The &year KaplanMeier survival rate was 94 -c l%, whereas restenosis, valve surgery and mJor evenWee probability were 90 -c 3%, 91 f 2% and 85 -c 2%, respectively. Multi vsviate study (Cox regression model) identiied the presence of sinus mhrn (p <O.OOl) and the absence of calcium at fluoroscopy (p *0.003) as the only independent factors of late success. Thus, the best results at 5 years after MBV were observed In patlents with a noncalcified valve and sinus rhythm (estimated mqjor eve&free probzk blllty 96%). On the conWuy,'the presence of atrial fibrillation zmd valve calciiication before treatment determined an eve&free probabllii of 60%.
American Journal of Cardiology, 1999
Coronary lesions located in major bifurcations constitute a challenge for the use of stents. Alth... more Coronary lesions located in major bifurcations constitute a challenge for the use of stents. Although the occlusion of a side branch covered by a stent is infrequent, the maintenance of a patent, stenosis-free bifurcation may result in a complex procedure. Between September 1994 and April 1998, 70 patients were treated by stent implantation for coronary bifurcation stenosis. The side branch always had a diameter >2 mm. The pairs of treated arteries were: left anterior descending (LAD)/diagonal artery in 32 patients, circumflex/obtuse marginal in 26, right coronary/posterior descending artery in 5, and LAD/circumflex in 7. We applied 2 different techniques of stent implantation: (l) deployment of 1 stent in the parent vessel covering the takeoff of the side branch and subsequent angioplasty of the side branch across the metallic structure (group A, n = 47 patients), and (2) implantation of 1 stent at the ostium of the side branch and complete reconstruction of the entire bifurcation with additional implantation of 1 or 2 stents at the parent vessel (group B, n = 23 patients). There were no significant differences between groups at baseline variables. Procedural success was similar in both groups: 42 (89%) in group A versus 21 (91%) in group B. However, major cardiac events at 18 months follow-up were higher in group B (event-free probability 44% vs 75%, p <0.05). Selected patients with coronary stenosis at major bifurcations can be treated with an acceptable rate of primary and late success. Complex techniques providing radical stent reconstruction of the bifurcation seems to provide no advantages over the simpler stent jail followed by ostial side branch balloon dilation.
American Heart Journal, 1996
This study compared two consecutive antithrombotic strategies after Palmaz-Schatz stent implantat... more This study compared two consecutive antithrombotic strategies after Palmaz-Schatz stent implantation and involved 918 patients. Patients treated between May 1991 and May 1994 (group 1; n = 379) received aspirin, dipyridamole, and intravenous unfractionated heparin until oral anticoagulation was effective. Between June 1994 and August 1995, 539 patients (group 2) were treated for 1 month with subcutaneous low-molecular-weight heparin (Fragmin), ticlopidine, and aspirin. There were no differences between the groups in terms of sex, clinical condition, vessel diameter, and severity and location of stenosis. Patients in group 1 were younger than those in group 2 (4% were >70 years old compared with 12%, respectively; p < 0.01). Group I patients had more frequent unplanned stenting (48% vs 18%, respectively; p < 0.01) and fewer endoprostheses in the same artery than those in group 2 (1.1 ± 0.5 vs 1.2 ± 0.5, respectively; p < 0.01). Among group 2 patients, there was a significant reduction in thrombotic and hemorrhagic complications compared with group 1 patients. No subacute thrombosis occurred in patients in group 2 in contrast with a 5.8% incidence in patients in group 1 (p < 0.01). in addition, a lower incidence of groin and systemic bleeding was observed in patients in group 2 compared with patients in group I (2.6% vs 15%, respectively; p < 0.01). The association of low-molecular-weight heparin and antiplatelets provides a simpler antithrombotic strategy in patients treated with intracoronary stents and reduces the incidence of stent thrombosis and hemorrhagic complications. Our findings suggest that this antithrombotic regimen may prevent or completely avoid stent thrombosis. (Am Heart J 1996;132:1119-26.)
American Heart Journal, 1995
Experimental studies have shown that stents implanted at the aorta become incorporated within the... more Experimental studies have shown that stents implanted at the aorta become incorporated within the aortic wall and can be further expanded in growing animals. This study evaluates the feasibility and immediate results of balloon-expandable stent implantation in 10 patients with severe coarctation of aorta. The ages of the patients ranged from 1 month to 43 years; 1 was an infant, 8 were children (mean age 5.3 +/- 4 years), and 1 was an adult. All had an unfavorable anatomy for balloon angioplasty; 9 had isthmus hypoplasia. Balloon predilation was first performed and its immediate effect evaluated. Then a balloon-expandable stent that was 30 mm long and covered the isthmus and coarctation levels was deployed, and it was further expanded to the preselected final diameter (12 +/- 4 mm). A final hemodynamic and angiographic evaluation was then obtained. Full deployment of an incompletely expanded and distally displaced stent in the infant led to aortic disruption that was controlled by a second stent covering the disrupted zone and the isthmus. After balloon angioplasty alone was done, the mean gradient (43 +/- 12 vs 31 +/- 10 mm Hg) and the percentage stenosis (72% +/- 11% vs 54% +/- 11%) had an insufficient decrease. However, after stent implantation was done, the gradient almost disappeared (mean 2 +/- 3 mm Hg). The angiographic stenosis disappeared in 7 patients and was markedly reduced in 3. The ratio of isthmus/descending aorta changed from 0.65 +/- 0.14 to 1 +/- 0.08 (p &amp;amp;lt; 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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Papers by Enrique Hernández