Thierry Lefèvre

Bio: Thierry Lefèvre is an academic researcher from University of Montpellier. The author has contributed to research in topics: Stent & Angioplasty. The author has an hindex of 46, co-authored 286 publications receiving 7877 citations. Previous affiliations of Thierry Lefèvre include Emory University & Institut de recherche pour le développement.

Stenting of bifurcation lesions: classification, treatments, and results.

Abstract: Percutaneous transluminal balloon coronary angioplasty (PTCA) of coronary bifurcations is associated with a low success rate, high rate of complications, and high incidence of target vessel revascularization (TVR). The strategy of systematic coronary stenting in bifurcation lesions involving a side branch >/= 2.2 mm in diameter was prospectively evaluated in a single-center observational study during a 35-month inclusion period. All patients meeting these criteria were consecutively included. Bifurcation lesions and treatment were predefined in the study. The study included 366 patients (12.1% of PTCA) with 373 bifurcation lesions, mean age 63.7 +/- 11.6 years, 79.2% male, 46.7% with unstable angina, and 8.3% acute MI. The left anterior descending/diagonal bifurcation was involved in 55.2% of cases, circumflex/marginal 22. 2%, PDA/PLA 10.4%, left main bifurcation in 6.8%, and others 5.4%. The main branch (2.78 +/- 0.42 mm reference diameter) was stented in 96.3% of cases and the side branch (2.44 +/- 0.43 mm) in 63.2% (the two branches were stented in 59.5% of cases). Procedural success was obtained in 96.3% in both branches and 99.4% in the main branch. At1-month follow-up, The major cardiac event rate (MACE) was 4.8% (death 1.1%, emergency CABG 0.6%, Q-wave MI 0.9%, acute or subacute closure 1.4%, repeat PTCA 1.1%, and non-Q-wave MI 2.3%). At 7-month follow-up, the total MACCE rate was 21.6%, including a TVR rate of 17.2%. Analysis of the 7-month outcome according to two study periods (period I, 1 January 1996 to 31 August 1997, 182 patients; period II, 1 September 1997 to 30 June 1998, 127 patients) showed that the TVR rate decreased from 20.6% to 13.8% (P = 0.04) and the MACE rate from 29.2% to 17.1% (P < 0.01) in period I and II, respectively. This was associated by univariate analysis with an increasing use of tubular stents deployed in the main branch (94.2% vs. 59.1%, P < 0.001) and kissing balloon inflation after coronary stenting (75.4% vs. 18.1%, P < 0.001). Bifurcation lesions are frequent. Procedural success of coronary stenting is high with a low rate of in-hospital MACE. TVR rate at follow-up is relatively low. In-hospital and follow-up results are influenced not only by the learning curve but also by the use of tubular stents in the main branch and final kissing balloon inflation.

Intracoronary Stent Implantation Without Ultrasound Guidance and With Replacement of Conventional Anticoagulation by Antiplatelet Therapy 30-Day Clinical Outcome of the French Multicenter Registry

Abstract: Background Stenting reduces both acute complications of coronary angioplasty and restenosis rates but increases subacute thrombosis rates and hemorrhagic complications when used with coumadin anticoagulation Methods and Results To simplify postcoronary stenting treatment and to reduce these drawbacks, we evaluated the 1-month outcome of a prospective registry of 2900 patients in whom successful coronary artery stenting was performed without coumadin anticoagulation Patients received 100 mg/d aspirin and 250 mg/d ticlopidine for 1 month Low-molecular-weight heparin (LMWH) treatment was progressively reduced in four consecutive stages, from 1-month treatment to none Event-free outcome at 1 month was achieved in 2816 patients (971%) Major stent-related cardiac events were subacute closure in 51 patients (18%), including death in 12 (05%), acute myocardial infarction in 17 (06%), and coronary artery bypass graft surgery in 9 (03%) Stent thrombosis was more frequent with balloon size of <30 mm (≤2

European perspective in the recanalisation of Chronic Total Occlusions (CTO): consensus document from the EuroCTO Club.

Abstract: © Europa Edition 2007. All rights reserved. Introduction Within the cardiology community there continues to be confusion regarding the indications for percutaneous coronary interventions (PCI) in patients with chronic total occlusion (CTO) and scepticism with regard to the ultimate impact revascularisation has on patient outcomes. It is not surprising, therefore, that most interventional cardiologists try to avoid these potentially long procedures that can be costly and expose the operator to higher radiation doses1,2 and, with success rates remained unchanged in the last years, perceived as insufficient to justify the effort involved. The procedural complexity of CTO angioplasty and the lack of familiarity with new equipment and techniques often prompts half-hearted and prematurely aborted attempts at PCI, leading to physician and patient frustration. A recent analysis from a NHLBI database even showed a decrease of attempted PCIs in CTOs from 9.4 to 5.7% between 1997 to 20043. Consequently, patients with single vessel disease and chronically occluded vessels are often managed medically regardless of the severity of symptoms and extent of ischaemia, and those with multivessel disease with a CTO are referred for bypass graft surgery even if the other lesions are ideal suited for PCI4-7. As a reaction to this prevailing attitude, experienced European interventionists have recently established the EuroCTO Club, modelled on similar initiatives in Japan and the USA, whereby members share their experience both within the group and with the interventional and general cardiology communities at large. The aim of the EuroCTO Club is to promote clinical excellence through training and quality control as well as fostering research and technical development in the field of CTO recanalisation. The current paper is an essential part of this strategy: we do not wish to challenge or overcome other recent comprehensive reviews of this broad subject8-12, but rather, our aim is to highlight misconceptions in clinical indication, outdated technical choices, inadequacies in operator training and centre qualifications and equipment which limit a more widespread application of percutaneous techniques for recanalisation of CTO in Europe and impair the consistent achievement of the high success rates possible with contemporary techniques. European perspective in the recanalisation of Chronic Total Occlusions (CTO): consensus document from the EuroCTO Club Carlo Di Mario1*, MD, PhD, FRCP, FESC; Gerald S. Werner2, MD, PhD, FESC; Georgios Sianos3, MD, PhD, FESC; Alfredo R. Galassi4, MD, FESC; Joachim Büttner5, MD, PhD, FESC; Dariusz Dudek6, MD, PhD, FESC; Bernard Chevalier7, MD; Thierry Lefevre8, MD, FESC; Joachim Schofer9, MD, PhD; Jacques Koolen10, MD, PhD, FESC; Horst Sievert11, MD, PhD, FESC; Bernhard Reimers12, MD, FESC; Jean Fajadet13, MD, FESC; Antonio Colombo14, MD, FESC; Anthony Gershlick15, MD, FRCP, FESC; Patrick W. Serruys3, MD, PhD, FESC; Nicolaus Reifart16, MD, PhD, FESC for the EuroCTO Club

Six-month outcome of emergency percutaneous coronary intervention in resuscitated patients after cardiac arrest complicating ST-elevation myocardial infarction

Abstract: Background— The outcome of resuscitated patients after cardiac arrest complicating acute myocardial infarction remains poor, primarily because of the relatively low success rates of cardiopulmonary...

Coronary angiography through the radial or the femoral approach: The CARAFE study

Abstract: In a previous study, the radial approach for coronary angiography was shown to be associated with a lower success rate and longer procedural and X-ray times compared to the femoral approach. However, this approach is associated with a steep learning curve. A series of 210 consecutive nonselected patients were randomized to femoral versus right radial approach or femoral versus left radial approach by two experienced operators. Clinical characteristics were similar in the three groups. Technical failure occurred in one patient in the right radial group with subsequent crossover to left radial artery. The number of coronary catheters used was lower in the right radial group (1.4 ± 0.7 vs. 2.1 ± 0.4 for the two other groups). The procedural duration was longer with left radial (14.2 ± 3.3 min; P < 0.05) approach than with right radial (12.4 ± 5.8 min) and femoral (11.2 ± 3.3 min) without significant differences between femoral and right radial. X-ray exposure was shorter in the femoral group (3.1 ± 1.7 min) than in both radial groups (right: 3.8 ± 2.2 min; left: 4.2 ± 1.7 min). The angiographic quality was not different between the three groups for RCA, but was less good for LCA through right radial approach. Bed rest and hospital stay were shorter in the two radial groups. The comfort was judged better with the transradial approach. An ad hoc PTCA was performed in 45.7% of femoral patients, 41.4% of right radial, and 44.3% of left radial with immediate sheath withdrawal (closure device for femoral group). There were no severe complications in the three groups, but two patients from the femoral group were discharged later because of vascular complications. The total cost of coronary angiography was higher in the femoral group. In conclusion, after the learning period, transradial coronary angiography can be performed with a high success rate, low rate of complication, and good angiographic quality. It is associated with a slight increase in procedural (LR) and fluoroscopy times, but permits earlier ambulation and discharge, improves patient comfort, and reduces the cost. Cathet Cardiovasc Intervent 2001;52:181–187. © 2001 Wiley-Liss, Inc.

ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation

Abstract: ACE : angiotensin-converting enzyme ACS : acute coronary syndrome ADP : adenosine diphosphate AF : atrial fibrillation AMI : acute myocardial infarction AV : atrioventricular AIDA-4 : Abciximab Intracoronary vs. intravenously Drug Application APACHE II : Acute Physiology Aand Chronic

2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).

Abstract: 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)

“Bioinformatics” 특집을 내면서

Abstract: BIOE 402. Medical Technology Assessment. 2 or 3 hours. Bioentrepreneur course. Assessment of medical technology in the context of commercialization. Objectives, competition, market share, funding, pricing, manufacturing, growth, and intellectual property; many issues unique to biomedical products. Course Information: 2 undergraduate hours. 3 graduate hours. Prerequisite(s): Junior standing or above and consent of the instructor.