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JACC. Cardiovascular Interventions Apr 2012Coronary chronic total occlusions (CTOs) are frequently identified during coronary angiography and remain the most challenging lesion group to treat. Patients with CTOs... (Review)
Review
Coronary chronic total occlusions (CTOs) are frequently identified during coronary angiography and remain the most challenging lesion group to treat. Patients with CTOs are frequently left unrevascularized due to perceptions of high failure rates and technical complexity even if they have symptoms of coronary disease or ischemia. In this review, the authors describe a North American contemporary approach for percutaneous coronary interventions for CTO. Two guide catheters are placed to facilitate seamless transition between antegrade wire-based, antegrade dissection re-entry-based, and retrograde (wire or dissection re-entry) techniques, the "hybrid" interventional strategy. After dual coronary injection is performed, 4 angiographic parameters are assessed: 1) clear understanding of location of the proximal cap using angiography or intravascular ultrasonography; 2) lesion length; 3) presence of branches, as well as size and quality of the target vessel at the distal cap; and 4) suitability of collaterals for retrograde techniques. On the basis of these 4 characteristics, an initial strategy and rank order hierarchy for technical approaches is established. Radiation exposure, contrast utilization, and procedure time are monitored throughout the procedure, and thresholds are established for intraprocedural strategy conversion to maximize safety, efficiency, and effectiveness.
Topics: Algorithms; Angioplasty, Balloon, Coronary; Catheters; Chronic Disease; Clinical Competence; Coronary Angiography; Coronary Occlusion; Decision Support Techniques; Equipment Design; Humans; Learning Curve; Patient Selection; Predictive Value of Tests; Treatment Outcome; Ultrasonography, Interventional
PubMed: 22516392
DOI: 10.1016/j.jcin.2012.02.006 -
Journal of the American College of... Dec 1999
Review
Topics: Angioplasty, Balloon, Coronary; Blood Flow Velocity; Blood Vessel Prosthesis Implantation; Coronary Circulation; Coronary Disease; Coronary Vessels; Cost-Benefit Analysis; Echocardiography, Doppler; Humans; Secondary Prevention; Stents; Treatment Outcome; Ultrasonography, Interventional
PubMed: 10588202
DOI: 10.1016/s0735-1097(99)00458-1 -
Journal of the American College of... Nov 2018
Topics: Angioplasty, Balloon, Coronary; Animals; Cardiology; Cardiovascular Diseases; Forecasting; Humans; Intersectoral Collaboration; Radiology
PubMed: 30442296
DOI: 10.1016/j.jacc.2018.10.004 -
EuroIntervention : Journal of EuroPCR... May 2017
Topics: Angioplasty, Balloon, Coronary; Cardiac Surgical Procedures; Heart; History, 20th Century; History, 21st Century; Humans; Myocardial Revascularization
PubMed: 28504214
DOI: 10.4244/EIJV13I1A2 -
JACC. Cardiovascular Interventions Mar 2021
Topics: Angioplasty, Balloon; Angioplasty, Balloon, Coronary; Humans; Stents; Treatment Outcome
PubMed: 33736779
DOI: 10.1016/j.jcin.2021.01.020 -
Journal of the American College of... May 1994Percutaneous intracoronary angioscopy was used to study the morphologic changes occurring in coronary arteries after balloon or laser angioplasty. (Comparative Study)
Comparative Study
OBJECTIVES
Percutaneous intracoronary angioscopy was used to study the morphologic changes occurring in coronary arteries after balloon or laser angioplasty.
BACKGROUND
Angioscopy is thought to provide details of the coronary vessel lumen and the inner wall.
METHODS
Coronary lesions were studied in 44 patients with a 4.5F Imagecath angioscope before and after each interventional procedure. Balloon and laser angioplasty were performed in 21 (group I) and 23 patients (group II), respectively. There was no difference in age, gender or angiographic lesion appearance before the procedure between the two groups.
RESULTS
Circumferential visualization of the target lesion was successfully completed in 17 group I and 19 group II patients. A larger lumen than that observed at baseline was seen in all 17 group I and in 13 of the 19 group II patients. Tissue remnants were observed in all group I and II patients. Laser irradiation resulted in characteristic sharp-edged craters. Dissection was identified in 2 of 19 patients before versus 9 of 19 patients after balloon angioplasty (p < 0.05) and in 0 of 23 patients before versus 4 of 23 patients after laser angioplasty (p = NS). Subintimal hemorrhage was observed in 3 of 19 patients before versus 11 of 19 patients after balloon angioplasty (p < 0.05) and in 2 of 23 patients before versus 4 of 23 patients after laser angioplasty (p = NS). The frequency of hemorrhage was higher in group I than in group II (11 of 19 vs. 4 of 23, respectively, p < 0.02).
CONCLUSIONS
Angioscopy provides valuable information on lesion morphology after coronary interventions. Balloon dilation results in a high rate of dissection and subintimal hemorrhage. Laser angioplasty is able to ablate obstructing tissue and results in a lower rate of subintimal hemorrhage than balloon dilation.
Topics: Aged; Angioplasty, Balloon, Coronary; Angioplasty, Balloon, Laser-Assisted; Angioscopes; Angioscopy; Chi-Square Distribution; Coronary Disease; Coronary Vessels; Female; Humans; Male; Middle Aged; Postoperative Complications
PubMed: 8176089
DOI: 10.1016/0735-1097(94)90373-5 -
Journal of Interventional Cardiology 2019To assess the expansion pattern of coronary stents by using different balloon inflation times and pressures.
OBJECTIVES
To assess the expansion pattern of coronary stents by using different balloon inflation times and pressures.
BACKGROUND
The selection of coronary stent size and its proper deployment is crucial in coronary artery interventions, having an impact on the success of the procedure and further therapy.
METHODS
Ten pairs of different stents were deployed under nominal pressure using sequential (5, 5, 10, and 10 seconds of repeated inflations, thus 30 seconds of summarized time) and continuous (30 seconds) deployment pattern. After each given time-point, intraluminal stent measurements were performed by optical coherence tomography (OCT) and intravascular ultrasound (IVUS).
RESULTS
Both in-stent diameters and cross-section areas (CSA) of paired stents measured by OCT at all sequential time-points were significantly smaller compared to given manufacturers charts' values (90% to 94% for diameters and 81% to 88% for CSA, p<0.05). Significant increase of in-stent diameter and CSA was observed across the step-by-step deployment pattern. In-stent lumen measurements were significantly larger when sequential deployment pattern was applied compared to continuous deployment. Additional measurements were also done for overlapping segments of stents, showing smaller in-stent measurements of the latter compared to nonoverlapping segments. Validation of OCT and IVUS measurements using a phantom metallic tube showed perfect reproducibility with OCT and overestimation with IVUS (8% for diameters and 16% for CSA).
CONCLUSIONS
Stent diameter after deployment is time-dependent and not only pressure-dependent. Different stent expansion behavior, depending on the applied deployment pattern (sequential and nonsequential), was observed.
Topics: Angioplasty, Balloon, Coronary; Coronary Angiography; Equipment Design; Humans; Materials Testing; Stents; Time Factors; Tomography, Optical Coherence; Ultrasonography, Interventional
PubMed: 31772543
DOI: 10.1155/2019/6945372 -
EuroIntervention : Journal of EuroPCR... Nov 2011
Topics: Angioplasty, Balloon, Coronary; Diffusion of Innovation; Drug-Eluting Stents; Health Care Sector; History, 20th Century; History, 21st Century; Humans; Prosthesis Design
PubMed: 22082572
DOI: 10.4244/EIJV7I7A121 -
Texas Heart Institute Journal 2009Medical, percutaneous, and surgical therapies for coronary atherosclerotic disease are developing rapidly, with many recent breakthroughs in metabolic control,... (Review)
Review
Medical, percutaneous, and surgical therapies for coronary atherosclerotic disease are developing rapidly, with many recent breakthroughs in metabolic control, improvements in catheter and stent engineering, and advances in surgical technique. Treatment guidelines are still in their infancy and do not take into account several of these recent innovations. Consequently, determining the most appropriate treatment for many patients remains challenging. In this review, we examine the most recent revascularization guidelines, discuss important new data and trials comparing contemporary stent technology and coronary artery bypass surgery, and conclude with updated revascularization recommendations.
Topics: Angioplasty, Balloon, Coronary; Comorbidity; Coronary Artery Bypass; Coronary Artery Disease; Drug-Eluting Stents; Evidence-Based Medicine; History, 20th Century; History, 21st Century; Humans; Patient Selection; Practice Guidelines as Topic; Risk Assessment; Risk Factors; Stents; Treatment Outcome
PubMed: 19876412
DOI: No ID Found -
PloS One 2020The experimental quantification and modeling of the multiaxial mechanical response of polymer membranes of coronary balloon catheters have not yet been carried out. Due...
The experimental quantification and modeling of the multiaxial mechanical response of polymer membranes of coronary balloon catheters have not yet been carried out. Due to the lack of insights, it is not shown whether isotropic material models can describe the material response of balloon catheter membranes expanded with nominal or higher, supra-nominal pressures. Therefore, for the first time, specimens of commercial polyamide-12 balloon catheters membranes were investigated during uniaxial and biaxial loading scenarios. Furthermore, the influence of kinematic effects on the material response was observed by comparing results from quasi-static and dynamic biaxial extension tests. Novel clamping techniques are described, which allow to test even tiny specimens taken from the balloon membranes. The results of this study reveal the semi-compliant, nonlinear, and viscoelastic character of polyamide-12 balloon catheter membranes. Above nominal pressure, the membranes show a pronounced anisotropic mechanical behavior with a stiffer response in the circumferential direction. The anisotropic feature intensifies with an increasing strain-rate. A modified polynomial model was applied to represent the realistic mechanical response of the balloon catheter membranes during dynamic biaxial extension tests. This study also includes a compact set of constitutive model parameters for the use of the proposed model in future finite element analyses to perform more accurate simulations of expanding balloon catheters.
Topics: Angioplasty, Balloon, Coronary; Anisotropy; Biomechanical Phenomena; Cardiac Catheters; Finite Element Analysis; Heart; Membranes; Models, Biological; Myocardium; Nylons; Stress, Mechanical; Tensile Strength
PubMed: 32579587
DOI: 10.1371/journal.pone.0234340