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See detail18fdg-Pet for the Assessment of Primary Head and Neck Tumors: Clinical, Computed Tomography, and Histopathological Correlation in 38 Patients
Paulus, Patrick; Sambon, A.; Vivegnis, Danielle et al

in Laryngoscope (1998), 108(10), 1578-83

OBJECTIVES: To evaluate the clinical usefulness of FDG-PET (fluoro-2-deoxy-glucose-positron emission tomography) in the detection of lymph node involvement and recurrences in patients with head and neck ... [more ▼]

OBJECTIVES: To evaluate the clinical usefulness of FDG-PET (fluoro-2-deoxy-glucose-positron emission tomography) in the detection of lymph node involvement and recurrences in patients with head and neck cancer. STUDY DESIGN: Retrospective review of 38 patients with biopsy-proven head and neck cancers who underwent clinical, computed tomography (CT), and FDG-PET examinations. Twenty-five patients were studied prior to therapy and 13 patients were evaluated for disease recurrence. METHODS: All patients were operated and clinical data, CT, and FDG-PET results were correlated with histopathological findings. RESULTS: All primary tumors in 25 patients were detected, with the exception of one small superficial localization of the epiglottis. Histopathological examination showed lymph node involvement in 10 patients; PET detected lymph node involvement in five. FDG-PET found one case of nodal disease not identified by clinical and CT examination. With so few cases, this could be anecdotal. Five false-negative results (microscopic lymph node involvement) and two false positives were noted. Twelve of 13 patients with recurrent disease were correctly identified with FDG-PET. FDG-PET was the only imaging technique to identify local recurrence in two patients and lymph node involvement in two others. One false-positive result occurred in a patient with a foreign body granuloma. CONCLUSIONS: FDG-PET is a useful diagnostic modality for the detection of recurrent tumors and, in selected cases, precise lymph node involvement. The best way to further investigate the utility of clinical FDG-PET is in the follow-up of treated patients. [less ▲]

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See detailFluorine-18 deoxyglucose positron emission tomography for the detection of bone metastases in patients with non-small cell lung cancer
Bury, Thierry ULg; BARRETO, A.; Daenen, Frédéric ULg et al

in European Journal of Nuclear Medicine (1998), 9

Despite advances in morphological imaging, some patients with lung cancer are found to have non resectable disease at surgery or die of recurrence within a year of surgery. At present, metastatic bone ... [more ▼]

Despite advances in morphological imaging, some patients with lung cancer are found to have non resectable disease at surgery or die of recurrence within a year of surgery. At present, metastatic bone involvement is usually assessed using bone scintigraphy, which has a high sensitivity but a poor specificity. We have attempted to evaluate the utility of the fluorine-18 deoxyglucose positron emission tomography (FDG PET) for the detection of bone metastasis. One hundred and ten consecutive patients with histological diagnosis of non-small cell lung cancer (NSCLC) who underwent both FDG PET and bone scintigraphy were selected for this review. In this group, there were 43 patients with metastatic disease (stage IV). Among these. 21 (19% of total group) had one or several bone metastases confirmed by biopsy (n = 8) or radiographic techniques (n = 13). Radionuclide bone scanning correctly identified 54 out of 89 cases without osseous involvement and 19 out of 21 osseous involvements. On the other hand, FDG PET correctly identified the absence of osseous involvement in 87 out of 89 patients and the presence of bone metastasis in 19 out of 21 patients. Thus using PET there were two false-negative and two false-positive cases. PET and bone scanning had, respectively, an accuracy of 96% and 66% in the evaluation of osseous involvement in patients with NSCLC. In conclusion, our data suggest that whole-body FDG PET may be useful in detecting bone metastases in patients with known NSCLC. [less ▲]

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See detailMalignant Melanoma Staging Using Whole-Body Positron Emission Tomography
Paquet, Philippe ULg; Hustinx, Roland ULg; Rigo, Pierre ULg et al

in Melanoma Research (1998), 8(1), 59-62

The correct staging of potentially metastatic melanoma is essential for an appropriate therapeutic attitude. Current methods include computed tomography, magnetic resonance imaging, ultrasonography and ... [more ▼]

The correct staging of potentially metastatic melanoma is essential for an appropriate therapeutic attitude. Current methods include computed tomography, magnetic resonance imaging, ultrasonography and scintigraphy. Another tool is whole-body positron tomography using the radiopharmaceutical 2-fluorine-18-fluoro-2-deoxy-D-glucose as an emitter because it accumulates inside neoplasms, especially melanoma. We report two cases of malignant melanoma in which computed tomography and magnetic resonance imaging suggested visceral metastatic spread. In contrast, whole-body positron emission tomography indicated the absence of metastases, and this was confirmed by histological examination of the organs where metastases were suspected. Whole-body positron emission tomography appears to have high specificity and sensitivity for clinical melanoma staging. [less ▲]

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See detailClinical evaluation of whole-body 18F-fluorodeoxyglucose positron emission tomography in the detection of liver metastases.
Hustinx, Roland ULg; Paulus, Patrick; Jacquet, Nicolas et al

in Annals of Oncology (1998), 9(4), 397-401

BACKGROUND: Assessment of metastatic involvement of the liver remains a diagnostic challenge. The objective of this study was to evaluate the potential role of FDG PET in the detection of liver metastases ... [more ▼]

BACKGROUND: Assessment of metastatic involvement of the liver remains a diagnostic challenge. The objective of this study was to evaluate the potential role of FDG PET in the detection of liver metastases. PATIENTS AND METHODS: Sixty-four patients with malignancy and possible liver involvement were included. Liver metastases were present in 31 cases, demonstrated by histopathological analysis in 15 cases and by follow-up in 16 cases. The negative cases were confirmed by pathology in four cases, peroperative ultrasonography in 12 cases, and follow-up in 17 cases. Whole-body FDG PET was compared to CT (n = 53) and US (n = 43). RESULTS: PET demonstrated a 97% sensitivity, an 88% specificity and a 92% accuracy, compared to 93%, 75% and 85%, respectively, for CT (P = NS). Concordant results were obtained in 44 of 64 patients (69%: 19 TP. 25 TN). PET provided new and accurate information in 15 of 64 patients (23.4%). PET demonstrated liver metastases in 11 patients in whom conventional methods yielded negative (two cases) or doubtful (nine cases) results. Four patients free of liver involvement were correctly staged with PET, while CT/US were equivocal. PET was erroneous in five of 64 cases (7.8%, four FP, one FN). CONCLUSIONS: FDG PET allows an accurate screening of liver involvement in patients with malignancy. Combined with CT, it provides additional diagnostic information that could directly affect the management of these patients. [less ▲]

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See detailWhole-Body 18fdg Positron Emission Tomography in the Staging of Non-Small Cell Lung Cancer
Bury, Thierry ULg; Dowlati, A.; Paulus, Patrick et al

in European Respiratory Journal (1997), 10(11), 2529-34

Despite advances in morphological imaging, some patients with lung cancer are found to have nonresectable disease at surgery or die of recurrence within yr of surgery. We performed a prospective study in ... [more ▼]

Despite advances in morphological imaging, some patients with lung cancer are found to have nonresectable disease at surgery or die of recurrence within yr of surgery. We performed a prospective study in 109 patients to compare the accuracy of whole-body positron emission tomography (PET) using fluorine-18 deoxyglucose (18FDG) and conventional imaging (CI) methods for the staging of non-small cell lung cancer (NSCLC). When CI or PET study suggested metastatic disease, confirmation was obtained by biopsy or follow-up information. As compared to CI, 18FDG-PET correctly changed the N stage in 22 patients (33%) and the M stage in 15 patients (14%). For the detection of distant metastases, PET study showed five false-positive sites and no false-negative cases. Currently, the accuracy of PET in the detection of M stage is 96%. Our study shows that visual interpretation of whole-body fluorine-18 deoxyglucose-positron emission tomography images can improve the diagnostic accuracy in the staging of non-small cell lung cancer. Further experience is needed to establish if metabolic imaging would be a cost-effective tool in the future management of lung cancer. [less ▲]

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See detailCardiac Risk Assessment before Vascular Surgery: A Prospective Study Comparing Clinical Evaluation, Dobutamine Stress Echocardiography, and Dobutamine Tc-99m Sestamibi Tomoscintigraphy
VAN DAMME, Hendrik ULg; Pierard, Luc ULg; Gillain, Daniel ULg et al

in Cardiovascular Surgery (1997), 5(1), 54-64

Preoperative evaluation for cardiac risk assessment before peripheral vascular surgery remains controversial. Between January and June 1994, a prospective open study was carried out in 156 patients ... [more ▼]

Preoperative evaluation for cardiac risk assessment before peripheral vascular surgery remains controversial. Between January and June 1994, a prospective open study was carried out in 156 patients scheduled for elective vascular procedures (63 carotid endarterectomies, 34 abdominal aortic aneurysms, 29 aortoiliac and 30 infrainguinal reconstructions) to compare the ability of clinical data, dobutamine stress echocardiography, and dobutamine Tc-99m sestamibi tomoscintigraphy to predict postoperative cardiac events. Pharmacological stress testing consisted of incremental dobutamine infusion (+/-1 mg atropine to achieve 85% of age-predicted maximal heart rate, with continuous echocardiographic monitoring, and injection of Tc-99m sestamibi after dobutamine infusion). Dobutamine echocardiography was abnormal in 36 patients (worsening resting wall motion abnormality in 11; new induced wall motion abnormality in 25). Dobutamine Tc-99m sestamibi tomoscintigraphy revealed a reversible perfusion defect in 34 patients, indicating the presence of myocardial ischaemia. As a result, eight patients underwent myocardial revascularization (n = 5) or the proposed operation was cancelled (n = 3). In the remaining 142 vascular procedures, there were eight (5.6%) adverse cardiac events: three myocardial infarctions (two fatal), three prolonged myocardial ischaemia, one acute congestive heart failure and one sustained ventricular arrhythmia in the post operative period. Univariate analysis selected unstable angina (relative risk (RR) 11.6), previous congestive heart failure (RR 6.4), Detsky's score of > or = 15 (RR 3.0), positive dobutamine stress echocardiography (RR 3.7), and positive dobutamine tomoscintigraphy (RR 7.4) as significant predictors of postoperative cardiac events. In patients without clinical markers of coronary artery disease (n = 66), non-invasive cardiac testing did not predict cardiac complications (n = 2; one prolonged myocardial ischaemia; one infarction). In the subset of 76 patients with definite clinical or electrocardiographic evidence of ischaemic heart disease, dobutamine stress testing provided additional information, and optimized risk stratification: five of six patients who suffered a cardiac complication had a pathologic dobutamine stress test. Furthermore, a negative dobutamine stress test was characterized by a high negative predictive value (0.96 for echocardiography; 0.97 for tomoscintigraphy). The study further demonstrated that the cardiac response (ischaemic versus non-ischaemic) to dobutamine stress was concordantly classified by echocardiographic and tomoscintigraphic techniques in 96% of cases. It is concluded that complementary non-invasive cardiac stress testing by dobutamine is indicated only in patients with clinically apparent coronary artery disease. [less ▲]

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See detailClinical PET in Oncology
Rigo, Pierre ULg; Paulus, Patrick; Bury, Thierry ULg et al

in Bergmann, H.; Kroiss, A.; Sinzinger H (Eds.) Radioactive Isotopes in Clinical Medicine and Research (1997)

18-FDG is accumulated in cancer cells. It has been proven useful to image a variety of tumors in conjunction with whole-body positron emission tomography. This review details somes of the indications of ... [more ▼]

18-FDG is accumulated in cancer cells. It has been proven useful to image a variety of tumors in conjunction with whole-body positron emission tomography. This review details somes of the indications of PET at various stages of the cancerous process : differential diagnosis, preoperative staging, diagnosis of residual or recurrent disease as well as follow-up of therapy. Consideration of several potential improvements in clinical PET and of the need for careful patients selection conclude this review. [less ▲]

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See detailUsefulness of 18fdg Positron Emission Tomography in Detection and Follow-up of Digestive Cancers
Paulus, P.; Hustinx, Roland ULg; Daenen, Frédéric ULg et al

in Acta Gastro-Enterologica Belgica (1997), 60(4, Oct-Dec), 278-80

PET is a diagnostic method that creates high resolution, 3 dimensional tomographic images of the distribution of positron emitting radionuclides in the human body. Recent technological developments allow ... [more ▼]

PET is a diagnostic method that creates high resolution, 3 dimensional tomographic images of the distribution of positron emitting radionuclides in the human body. Recent technological developments allow the use of whole-body PET devices in clinical oncology. 18FDG is a glucose analog transported and competitively used with glucose reflecting the increased glucose metabolism into malignant cells. Differential diagnosis between chronic pancreatitis and pancreatic cancer is already a well-documented indication. For initial staging of gastro-esophageal and colorectal tumours, results are preliminary but the clinical impact seems to be rather limited. At present, the major indication of FDG-PET is the detection and staging of colorectal cancer recurrences. FDG-PET allows the differentiation between scared tissue and tumour when structural imaging is often confusing. In the same time, the whole-body imaging capability provides unique information that can modify loco-regional and liver staging. Overall, FDG-PET affects the clinical management of 30 to 40% of these patients. Quantitative assessment of therapeutic response to chemotherapy regimen appears to be one of the most promising applications of FDG-PET. Since the most effective therapy of colorectal cancer are often surgical, the role of chemotherapy in colorectal cancer remains limited to adjuvant therapy and in advanced disease. However, FDG-PET could be of great value in assessing the response of oesophageal carcinomas to chemo-radio therapy, before surgery. In our experience, FDG-PET appears to be the first line diagnostic method in the detection and staging of colorectal recurrence and differential diagnosis of pancreatic tumour versus chronic pancreatitis. [less ▲]

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See detailStaging of the Mediastinum: Value of Positron Emission Tomography Imaging in Non-Small Cell Lung Cancer
Bury, Thierry ULg; Paulus, P.; Dowlati, A. et al

in European Respiratory Journal : Official Journal of the European Society for Clinical Respiratory Physiology (1996), 9(12), 2560-4

Recent studies have shown limitations of morphological imaging in staging mediastinal lymph node involvement in lung cancer. In contrast to computed tomography (CT), which depends primarily on anatomical ... [more ▼]

Recent studies have shown limitations of morphological imaging in staging mediastinal lymph node involvement in lung cancer. In contrast to computed tomography (CT), which depends primarily on anatomical imaging features, positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) depends mainly on the metabolic characteristics of a tissue for the diagnosis of disease. We have performed a prospective study comparing FDG-PET and CT of the thorax in the presurgical assessment of the mediastinum in 50 patients with newly diagnosed non-small cell lung cancer (NSCLC). CT and PET scans were interpreted separately, and results were compared to pathological staging obtained during thoracotomy. Hilar or mediastinal lymph node involvement was present in 58%. In staging for lymph node involvement, CT had a sensitivity of 72% and specificity of 81%, whereas PET had a sensitivity and specificity of 90% and 86%, respectively. When the PET study was compared to histological results, there were four cases showing more advanced mediastinal involvement with PET and four cases showing less involvement with PET. From our preliminary results, we conclude that positron emission tomography with 18-fluorodeoxyglucose is significantly more accurate than computed tomography in the mediastinal staging of non-small cell lung cancer. [less ▲]

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See detailOncological Applications of Positron Emission Tomography with Fluorine-18 Fluorodeoxyglucose
Rigo, Pierre ULg; Paulus, Patrick; Kaschten, Bruno et al

in European Journal of Nuclear Medicine (1996), 23(12), 1641-74

Positron emission tomography (PET) is now primarily used in oncological indication owing to the successful application of fluorine-18 fluorodeoxyglucose (FDG) in an increasing number of clinical ... [more ▼]

Positron emission tomography (PET) is now primarily used in oncological indication owing to the successful application of fluorine-18 fluorodeoxyglucose (FDG) in an increasing number of clinical indications at different stages of diagnosis, and for staging and follow-up. This review first considers the biological characteristics of FDG and then discusses methodological considerations regarding its use. Clinical indications are considered, and the results achieved in respect of various organs and tumour types are reviewed in depth. The review concludes with a brief consideration of the ways in which clinical PET might be improved. [less ▲]

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See detailComment j'explore ... une suspicion de cancer broncho-pulmonaire par tomographie a émission de positrons
Bury, Thierry ULg; Paulus, Patrick; Weber, Thierry et al

in Revue Médicale de Liège (1996), 51(4), 317-9

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See detailStaging of Non-Small-Cell Lung Cancer by Whole-Body Fluorine-18 Deoxyglucose Positron Emission Tomography
Bury, Thierry ULg; Dowlati, A.; Paulus, Patrick et al

in European Journal of Nuclear Medicine (1996), 23(2), 204-6

Positron emission tomography (PET) using fluorine-18 deoxyglucose (FDG), showing increased FDG uptake and retention in malignant cells, has been proven useful to differentiate malignant from benign tissue ... [more ▼]

Positron emission tomography (PET) using fluorine-18 deoxyglucose (FDG), showing increased FDG uptake and retention in malignant cells, has been proven useful to differentiate malignant from benign tissue. We undertook a prospective study in 61 patients to compare the accuracy of whole-body FDG PET and conventional imaging (CI) methods for the staging of non-small-cell lung cancer (NSCLC). CI included chest and abdomen computed tomographic scanning and bone scintigraphy. When CI or PET study suggested metastatic disease, confirmation was obtained by biopsy or clinical or radiological follow-up. As compared to CI, PET correctly changed the N stage in 13 patients (21%) and the M stage in six patients (10%). There were three false-positive and no false-negative distant PET findings. Our preliminary results show that whole-body FDG PET can improve the diagnostic accuracy in the staging of NSCLC. [less ▲]

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See detailClinical PET in Oncology
Hustinx, Roland ULg; Paulus, Danusia ULg; Rigo, Pierre ULg et al

Book published by GE Medical Systems (1996)

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See detailDifferential diagnosis of Alzheimer's disease with PET.
Salmon, Eric ULg; Sadzot, Bernard ULg; Maquet, Pierre ULg et al

in Journal of Nuclear Medicine : Official Publication, Society of Nuclear Medicine (1994), 35(3), 391-8

PET studies have demonstrated bilateral temporo-parietal hypoperfusion and hypometabolism in probable and definite Alzheimer's disease (AD), a pattern that may help differentiate AD from other dementias ... [more ▼]

PET studies have demonstrated bilateral temporo-parietal hypoperfusion and hypometabolism in probable and definite Alzheimer's disease (AD), a pattern that may help differentiate AD from other dementias. METHODS: To evaluate the diagnostic power of cerebral metabolic distribution patterns for "cortical" degenerative dementias, PET scans obtained from 129 patients referred for differential diagnosis of dementia were analyzed visually. RESULTS: Sixty-five patients had a final clinical diagnosis of probable AD. Ninety-seven percent (97%) of those had abnormal metabolic scans and 94% showed a suggestive pattern of bilateral or unilateral temporo-parietal hypometabolism (with or without frontal involvement). Hypometabolism was unilateral in 23% of patients. Five subjects with a neuropathologically proven diagnosis of Alzheimer's disease had a suggestive metabolic pattern. One of those was an early case with frontal hypometabolism exceeding temporo-parietal involvement. Two patients with Alzheimer's-type dementia had isolated bilateral frontal hypometabolism. CONCLUSIONS: This alternative metabolic pattern may correspond to a non-Alzheimer pathology occurring in 10%-20% of patients suffering from clinically probable Alzheimer's disease. Most of the patients with possible but atypical Alzheimer's-type dementia showed isolated bilateral frontal involvement. This metabolic pattern probably corresponds to different diseases, such as Pick's disease, frontal lobe dementia or progressive subcortical gliosis. [less ▲]

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See detailEffect of Spinal Cord Stimulation on Regional Myocardial Perfusion Assessed by Positron Emission Tomography
de Landsheere, Christian ULg; Mannheimer, C.; Habets, A. et al

in American Journal of Cardiology (1992), 69(14), 1143-9

Spinal cord stimulation (SCS) can relieve symptoms in patients with severe angina pectoris refractory to conventional medical or surgical therapy. This symptomatic improvement may result from decreased ... [more ▼]

Spinal cord stimulation (SCS) can relieve symptoms in patients with severe angina pectoris refractory to conventional medical or surgical therapy. This symptomatic improvement may result from decreased myocardial ischemia. To test this hypothesis, positron emission tomography (PET) and potassium-38 as a flow tracer were used in 8 patients for the quantitative evaluation of regional myocardial perfusion at rest and after exercise, before and during SCS. Potassium uptake was evaluated as myocardial clearance (flow times net extraction) in ml/min/100 g. Tomographic segments were categorized as nonaffected and affected on the basis of the absence or presence of arterial stenosis on coronary angiography and on the basis of thallium scintigraphic data. In nonaffected segments, before SCS, regional myocardial clearance significantly increased from rest (28 +/- 4) to exercise (47 +/- 13 clearance units; p less than 0.004). A similar increase occurred after SCS. In affected segments, before SCS, regional myocardial clearance barely increased (p = 0.065) from rest (26 +/- 6) to exercise (33 less than or equal to 12). In comparison, after SCS, the resting regional myocardial clearance was slightly elevated (29 +/- 8) reflecting an increased double product, but did not increase (p = 0.192) with exercise (34 +/- 12). However, the magnitude and duration of ST-segment depression decreased during treatment with SCS. Anginal pain occurred in all patients during control exercise, but was attenuated in all but one with SCS. These results indicate that SCS improves exercise-induced angina and electrocardiographic signs of ischemia but this influence does not appear to be mediated by changes in regional myocardial perfusion. [less ▲]

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See detailAutomated Production of Potassium-38 for the Study of Myocardial Perfusion Using Positron Emission Tomography
Guillaume, Marcel; de Landsheere, Christian ULg; Rigo, Pierre ULg et al

in International Journal of Radiation Applications and Instrumentation. Part A : Applied Radiation and Isotopes (1988), 39(2), 97-107

The 35Cl(alpha, n)38K nuclear reaction was developed for the routine cyclotron production of repeated multimillicurie batches of 38K for dynamic studies of regional tissue perfusion with positron emission ... [more ▼]

The 35Cl(alpha, n)38K nuclear reaction was developed for the routine cyclotron production of repeated multimillicurie batches of 38K for dynamic studies of regional tissue perfusion with positron emission tomography. The objective is to make this isotope available as an alternative to the use of [13N]NH3 and 82Rb for the investigation of flow in experimental and clinical use. A sodium chloride powder target mounted on a water-cooled nickel backing is bombarded with 26 MeV helium-4 ions at a maximum beam current of 25 microA. The target is remotely disconnected from the bombardment port, transported to a hot cell and entirely processed by a computer-controlled system within a total time of less than 4 min. The final pyrogen-free isotonic and sterile solution of 38K has a radionuclidic purity of more than 99.99%. A typical yield of 19 +/- 2 mCi of 38K is obtained at the end of a 30 min bombardment at 10 microA. The production rate at saturation can therefore be estimated to 2.05 +/- 0.2 mCi/microA. [less ▲]

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See detailUsefulness of Thromboendarterectomy in Association with Coronary Artery Bypass Grafting
Larock, Marie-Paule; Burguet, Willy; Grenade, Thierry et al

in American Journal of Cardiology (1987), 60(13), 1025-9

Thromboendarterectomy is sometimes performed in association with coronary artery bypass graft surgery (CABG). Right coronary arteries and severely narrowed coronary arteries mainly undergo ... [more ▼]

Thromboendarterectomy is sometimes performed in association with coronary artery bypass graft surgery (CABG). Right coronary arteries and severely narrowed coronary arteries mainly undergo thromboendarterectomy, but perioperative acute myocardial infarctions (AMI) are possible complications. One hundred seventy-six consecutive patients with rest and stress thallium-201 scintigraphy and angiography were studied before and after surgery. To compare patients with and without thromboendarterectomy, 48 patients who had undergone thromboendarterectomy and whose characteristics matched closely those of patients who had not were selected. Twenty patients had previous AMI before CABG in each group. Analysis accounted for the severity of vessel lesion (complete or incomplete) and for the patency of the graft and of the native coronary artery. In these 96 patients, graft patency was lower than in the overall group and similar among patients with and without thromboendarterectomy among the 56 patients without previous AMI. In patients with previous AMI and thromboendarterectomy, however, reperfusion was achieved more often through the native vessel than through the graft. New AMI or residual ischemia occurred in 32% of the areas undergoing thromboendarterectomy and in only 5% of the standard grafts (p less than 0.001). Best results were obtained in patients with incomplete occlusion after AMI. Patients without previous AMI had worse results. Thus, thromboendarterectomy can yield 64 to 75% good results in selected subgroups when CABG is otherwise impossible, but should be avoided in mildly or moderately stenotic arteries perfusing noninfarcted myocardium. [less ▲]

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See detailPrevention of Aorta-Coronary Bypass Graft Occlusion. Beneficial Effect of Ticlopidine on Early and Late Patency Rates of Venous Coronary Bypass Grafts: A Double-Blind Study
Limet, Raymond ULg; David, Jean-Louis ULg; Magotteaux, Paul ULg et al

in Journal of Thoracic and Cardiovascular Surgery (The) (1987), 94(5), 773-83

The efficacy of coronary bypass grafting obviously being linked to graft patency, it is compulsory to look for any innovation that could improve the patency rate. Ticlopidine, an antiplatelet drug, was ... [more ▼]

The efficacy of coronary bypass grafting obviously being linked to graft patency, it is compulsory to look for any innovation that could improve the patency rate. Ticlopidine, an antiplatelet drug, was tested against placebo in a double-blind trial: 173 patients (475 grafts) subjected to venous coronary artery bypass grafting were randomly treated with ticlopidine (250 mg twice daily) or placebo from the second postoperative day for 12 months. Graft patency was assessed by digital angiography on days 10 (99.4% of the patients), 180 (98.2%), and 360 (91.7%). The effect of treatment on platelet aggregation and bleeding time were measured concomitantly; a clear-cut effect was demonstrated at each interval. Intention-to-treat graft-by-graft analysis shows that ticlopidine significantly reduced the graft occlusion rate on day 10 (7.1% versus 13.4%, p less than 0.05), day 180 (15.0% versus 24.0%, p less than 0.02), and day 360 (15.9% versus 26.1%, p less than 0.01). Sequential grafts to the left anterior descending coronary artery, with side-to-side anastomosis to diagonal branch(es), are less frequently occluded than individual grafts. On the contrary, grafts to endarterectomized vessels occlude more frequently. Individual patient-by-patient analysis shows that patency of all grafts at each study time, is more frequent in the ticlopidine group. The difference is significant when one considers patients without sequential or endarterectomized grafts. The difference is also present at each study time: day 10 (84.4% versus 66.7%, p less than 0.05), day 180 (74.4% versus 52.3%, p less than 0.05) and day 360 (75.0% versus 52.5%, p less than 0.05). Results are even more impressive if one excludes from analysis the four patients in the ticlopidine group in whom administration of the drug was delayed. This supports previous suggestions that early therapy is necessary. These results show that graft occlusion occurs mainly in the first 6 postoperative months. The incidence of occlusion is significantly reduced by ticlopidine therapy. [less ▲]

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See detailThrombolysis in anterior myocardial-infarction-effect onregionnal viability studied with positron emission tomography
Delandsheere, C. M.; Raets, D.; Pierard, Luc ULg et al

in Circulation (1987), 76(4), 5

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See detailComplementary role of thallium-201 scintigraphy to predischarge exercise electrocardiography for patients stratification after a first myocardial infarction.
Legrand, Victor ULg; Albert, Adelin ULg; Rigo, Pierre ULg et al

in European Heart Journal (1986), 7(8), 644-53726

The value of a predischarge exercise test combined with thallium-201 myocardial scintigraphy in detecting patients with severe multivessel disease (MVD) was studied in 58 consecutive patients discharged ... [more ▼]

The value of a predischarge exercise test combined with thallium-201 myocardial scintigraphy in detecting patients with severe multivessel disease (MVD) was studied in 58 consecutive patients discharged after a first acute myocardial infarction. Twelve electrocardiographic, clinical and scintigraphic variables were analysed. Angiography at one month revealed MVD (greater than 70% narrowing in vessels unrelated to infarction) in 26 patients (45%). ST segment depression of 1mm or greater, thallium defects in multiple vascular distributions (MVTL), and reversible thallium defects in a vascular distribution different from the infarct related vessel predicted patients at risk for MVD (predictive value respectively of 68%, 65% and 75%). The other variables were not significantly associated with the presence of MVD. Only ST segment depression and thallium defects in multiple vascular distributions emerged as independent predictors of MVD. Their combination yielded a 77% sensitivity and a 59% specificity for MVD. Combination of thallium imaging with the predischarge exercise ECG significantly improved the stratification provided by the exercise test alone (P less than 0.05). A positive thallium scan (MVTl defects) associated with a positive ECG (ST depression) carried a risk for MVD of 80% in the population studied. When both tests were negative, MVD was infrequent (risk 22%). Because improvement in the stratification of patients is not as clear as expected from studies performed at a later stage, it appears that exercise thallium scintigraphy at a submaximal level one or two weeks after infarction does not provide optimal information. Predischarge exercise thallium-201 scintigraphy, however, is superior to an exercise tolerance test alone in separating patients into those with high and low risk of MVD. [less ▲]

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