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Clinical Cardiology Sep 1993The success of percutaneous transluminal coronary angioplasty is limited by acute occlusion and late restenosis. In 25 patients (20 men, 5 women, age range 36-81 years)...
The success of percutaneous transluminal coronary angioplasty is limited by acute occlusion and late restenosis. In 25 patients (20 men, 5 women, age range 36-81 years) coronary angioplasty was performed using a new cutting balloon into which 3-4 longitudinally orientated blades are incorporated so as to reduce the rate of severe dissections. In 12 patients stenoses were reduced from 83.9 +/- 7.8% to 28.4 +/- 10.7% (mean +/- SD) by the cutting balloon alone, using predilatation with a small conventional balloon in two cases. Thirteen other patients were additionally dilated with a conventional balloon because of a residual stenosis > 50% after cutting balloon angioplasty. Here the stenoses could be reduced from 78.1 +/- 8.7% to 29.1 +/- 11.3%. Six months follow-up angiography in 14 patients showed > 50% restenosis in two of seven patients dilated with a conventional balloon in addition to the cutting balloon, and in one of seven patients dilated with the cutting balloon alone but predilated with a small conventional balloon. These results show that coronary angioplasty by the new cutting balloon results in a stenosis reduction comparable with conventional balloons at a low complication rate. Available 6 months follow-up data show three restenoses in patients either pre- or postdilated by a conventional balloon and none in stand-alone cutting balloon cases.
Topics: Adult; Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; Coronary Disease; Female; Follow-Up Studies; Humans; Male; Middle Aged; Recurrence; Time Factors
PubMed: 8242910
DOI: 10.1002/clc.4960160907 -
EuroIntervention : Journal of EuroPCR... Aug 2017Four decades after its introduction into clinical practice, coronary balloon angioplasty is still used during most coronary interventions. Conventional balloon...
Four decades after its introduction into clinical practice, coronary balloon angioplasty is still used during most coronary interventions. Conventional balloon angioplasty is frequently used to predilate complex or severe lesions and remains of major value to optimise the results of stent implantation. Plain balloon angioplasty is still used alone in some anatomic scenarios where stent implantation is not desirable (very small vessels or diffuse lesions, large resistant thrombus burden, side branches of bifurcations). However, this technique is hampered by a relatively high restenosis risk. Recently, drug-coated balloons (DCB) have been shown to provide an attractive new tool for the "leave nothing behind" strategy. Many studies have demonstrated that DCB are indeed safe and effective. Evidence of the value of DCB in patients with ISR is overwhelming. DCB are attractive for selected de novo coronary lesions (small vessels, diffuse disease, side branches). DCB have also gained major evidence supporting their clinical efficacy in the peripheral arterial territory. Further studies are required to elucidate the relative value of DCB compared with alternative strategies (namely new-generation drug-eluting stents) in different clinical and anatomic scenarios.
Topics: Angioplasty, Balloon; Angioplasty, Balloon, Coronary; Coronary Angiography; Coronary Restenosis; Coronary Vessels; Drug-Eluting Stents; Humans
PubMed: 28844030
DOI: 10.4244/EIJ-D-17-00494 -
BMC Cardiovascular Disorders Jan 2019Percutaneous coronary interventions (PCI) of bifurcation lesions is technically challenging and associated with lower success rates and higher frequency of adverse...
BACKGROUND
Percutaneous coronary interventions (PCI) of bifurcation lesions is technically challenging and associated with lower success rates and higher frequency of adverse outcomes. In the present study, we aimed to evaluate the immediate and long-term treatment effect and adverse events of a new modified jailed-balloon technique on side branch (SB) during PCI on coronary bifurcation lesions.
METHODS
This was a prospective study of 60 patients (49 males, 11 females, mean age 66 ± 10 years) with coronary bifurcation lesions treated at the Beijing Hospital between September 2014 and October 2015. They underwent main vessel (MV) stenting and modified jailed-balloon technique on the SB. All patients were followed with hospital visits at 9 months. Angiographic success, major adverse cardiac events (MACE), SB occlusion, and angina were evaluated.
RESULTS
The majority of the patients had acute coronary syndrome (91.7%) and Medina 1.1.1. bifurcation lesions (71.7%). After MV stenting, thrombolysis in myocardial infarction (TIMI) 3 flow was established 100% of MV and 93.3% of SB. No SB occlusion occurred. The jailed SB balloon and wire could be successfully removed in all patients without damage or entrapment. The majority (91.7%) of patients achieved Canadian Cardiovascular Society I stage. There was no MACE during in-hospital stay and 9-month follow-up.
CONCLUSION
The modified JBT provided high rate of procedural success, excellent SB protection during MV stenting, and excellent immediate and long-term clinical outcomes.
Topics: Acute Coronary Syndrome; Aged; Angioplasty, Balloon, Coronary; Coronary Artery Disease; Female; Humans; Male; Middle Aged; Prospective Studies; Stents; Time Factors; Treatment Outcome
PubMed: 30630420
DOI: 10.1186/s12872-018-0995-x -
Journal of the American College of... Jan 1993The purpose of this study was to measure elastic recoil from sequential angiograms after balloon angioplasty and after implantation of a balloon-expandable Palmaz-Schatz... (Comparative Study)
Comparative Study
OBJECTIVES
The purpose of this study was to measure elastic recoil from sequential angiograms after balloon angioplasty and after implantation of a balloon-expandable Palmaz-Schatz stent in the same patient, and to compare the results with the late angiographic outcome.
BACKGROUND
The immediate result of coronary balloon angioplasty is influenced by plastic deformation, primarily of the atherosclerotic plaque, and by elastic recoil, primarily of the less or nondiseased vessel circumference.
METHODS
The extent of elastic recoil was measured quantitatively as the difference between maximal balloon size and the resulting vessel diameter or cross-sectional area.
RESULTS
Analysis was performed in 60 patients who received a single stent for late restenosis after initially successful coronary balloon angioplasty. Minimal lumen diameter (minimal cross-sectional area) was 0.98 +/- 0.43 mm (0.97 +/- 0.67 mm2) before balloon angioplasty, 2.06 +/- 0.36 mm (3.68 +/- 1.17 mm2) after angioplasty (both p < 0.001 vs. values before angioplasty) and 2.98 +/- 0.26 mm (7.12 +/- 1.28 mm2) after stenting (both p < 0.001 vs. postangioplasty results). No significant changes in vessel reference diameters or areas were measured. Mean balloon/artery ratios were similar in both procedures, ranging from 0.93 to 0.96. The calculated mean elastic recoil was 0.98 +/- 0.50 mm in diameter (31%) and 3.67 +/- 2.05 mm2 in area (48%) after balloon angioplasty compared with 0.10 +/- 0.07 mm (3.5%) and 0.38 +/- 0.36 mm2 (5.1%) after stenting. Increasing balloon sizes induced increased vessel stretch, which was followed by increased elastic recoil in the angioplasty group in contrast to the stenting group. Short, noncalcified and eccentric lesions tend to be associated with increased recoil after balloon angioplasty. Overdilation or underdilation in one of the procedures, changes in postprocedural vasomotion or postprocedural thrombus formation was not responsible for this outcome. After 6 months mean minimal lumen diameter was 2.39 +/- 0.58 mm, suggesting a mean hyperplasia of 0.59 +/- 0.51 mm. Twelve patients (20%) had a follow-up diameter that was equal to or less than the mean postangioplasty result and eight patients (14%) had a diameter stenosis of > 50%.
CONCLUSIONS
The implantation of a Palmaz-Schatz stent almost completely eliminates the decrease in vessel dimensions caused by elastic recoil and therefore diminishes the impact of hyperplasia and reduces the rate of restenosis.
Topics: Adult; Aged; Analysis of Variance; Angioplasty, Balloon, Coronary; Coronary Angiography; Coronary Disease; Elasticity; Equipment Design; Female; Follow-Up Studies; Humans; Male; Middle Aged; Recurrence; Stents
PubMed: 8417068
DOI: 10.1016/0735-1097(93)90713-b -
Circulation Mar 1995
Topics: Angioplasty, Balloon, Coronary; Coronary Disease; Humans; Stents
PubMed: 7882502
DOI: 10.1161/01.cir.91.6.1891 -
Journal of the American College of... Mar 1996Coronary angioplasty is being increasingly used as the primary treatment for patients with acute myocardial infarction, but controversy remains over its potential... (Comparative Study)
Comparative Study Review
Coronary angioplasty is being increasingly used as the primary treatment for patients with acute myocardial infarction, but controversy remains over its potential adoption in preference to thrombolysis as standard care. This report summarizes the published evidence on health outcomes after primary angioplasty compared with thrombolysis or no intervention for patients with acute myocardial infarction. The data tables presented provide the scientific groundwork to assist physicians and other policy-makers in deciding which interventions to provide for broad populations of patients.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Angioplasty, Balloon, Coronary; Clinical Trials as Topic; Decision Support Techniques; Hospital Mortality; Humans; Male; Middle Aged; Myocardial Infarction; Survival Analysis; Thrombolytic Therapy; Time Factors; Treatment Outcome
PubMed: 8606291
DOI: 10.1016/0735-1097(95)00572-2 -
Turk Kardiyoloji Dernegi Arsivi : Turk... Jun 2011Periprocedural bleeding and vascular complications after percutaneous coronary intervention (PCI) are associated with worse clinical outcomes and increased short- and... (Review)
Review
Periprocedural bleeding and vascular complications after percutaneous coronary intervention (PCI) are associated with worse clinical outcomes and increased short- and long-term mortality. Vascular access-related bleeding accounts for more than 80% of all major bleeding events in PCI performed by the transfemoral approach. Transradial approach (TRA), on the other hand, virtually eliminates access site bleeding and vascular complications. Although clinical trials have mostly evaluated different pharmacological strategies for reducing bleeding risk, adoption of a radial rather than a femoral access may allow greater reductions in bleeding complications than pharmacological strategies alone. High-risk patients such as those with acute coronary syndrome and ST-segment elevation myocardial infarction, women, obese patients, and elderly subjects who are at increased risk for vascular complications and bleeding might particularly benefit from the radial approach. Besides increased patient safety, the TRA is associated with improved patient satisfaction, reduced cost, and length of hospital stay, thus allowing outpatient performance of uncomplicated PCI.
Topics: Angioplasty, Balloon, Coronary; Femoral Artery; Hemorrhage; Humans; Postoperative Complications; Radial Artery; Ulnar Artery
PubMed: 21646838
DOI: 10.5543/tkda.2011.01533 -
Journal of the American College of... Feb 1994The purpose of this study was to evaluate the effects of thermal balloon percutaneous transluminal coronary angioplasty using radiofrequency energy in the treatment of...
OBJECTIVES
The purpose of this study was to evaluate the effects of thermal balloon percutaneous transluminal coronary angioplasty using radiofrequency energy in the treatment of patients with failed coronary angioplasty and complex lesions. In addition, we evaluated restenosis after radiofrequency thermal balloon applications.
BACKGROUND
The efficacy of coronary angioplasty is limited by the relatively low success rate in complex lesions and the high frequency of restenosis. Few reports have studied the combined effects of pressure and laser thermal energy. This study describes a new device for coronary angioplasty using radiofrequency thermal energy.
METHODS
Thirty-two patients with failed conventional coronary angioplasty or complex lesions were treated with radiofrequency thermal balloon coronary angioplasty. Radiofrequency energy was delivered up to 11 times in exposures ranging from 30 to 60 s in duration. This combined effect allowed the vascular wall to be heated to temperatures ranging from 60 to 70 degrees C. Follow-up coronary angiography was performed, on average, 6 months after the procedure.
RESULTS
Successful radiofrequency coronary angioplasty was achieved in 28 (82%) of 34 lesions. There was one abrupt coronary artery occlusion (3%) and no death, perforation or dissection. Angiographic restenosis occurred in 14 (56%) of 25 lesions.
CONCLUSIONS
In patients with failed coronary angioplasty and difficult complex lesions, radiofrequency coronary angioplasty could potentially improve angioplasty success rates and may have important implications for bailout cases with abrupt occlusion. However, restenosis remains a significant problem.
Topics: Angioplasty, Balloon, Coronary; Coronary Angiography; Coronary Disease; Equipment Design; Female; Follow-Up Studies; Humans; Male; Middle Aged; Radio Waves; Recurrence; Time Factors; Treatment Outcome
PubMed: 8294683
DOI: 10.1016/0735-1097(94)90416-2 -
Journal of Interventional Cardiology Oct 2011
Topics: Acute Coronary Syndrome; Angioplasty, Balloon, Coronary; Catheters, Indwelling; Humans; Radial Artery
PubMed: 21919957
DOI: 10.1111/j.1540-8183.2011.00678.x -
Journal of the American College of... Nov 1994This study was designed to determine the effectiveness, safety and costs associated with reuse of angioplasty catheters and to compare these results with those of a...
OBJECTIVES
This study was designed to determine the effectiveness, safety and costs associated with reuse of angioplasty catheters and to compare these results with those of a contemporary center that employed a single-use strategy.
BACKGROUND
Coronary angioplasty is an important but expensive procedure. To overcome the financial constraints of the Canadian health care system, reuse of angioplasty catheters is routinely practiced in some institutions.
METHODS
In a prospective observational study, data forms were completed after each angioplasty procedure and before patient discharge over a 10-month period.
RESULTS
A total of 693 patients underwent coronary angioplasty in the two centers. Clinical and lesion characteristics were similar except for a higher incidence of unstable angina at the reuse center (p < 0.005). The angiographic success rate was identical (88%) at both centers. The reuse center utilized more balloon catheters/lesion (mean +/- SD 2.4 +/- 1.5 vs. 1.2 +/- 0.5, p < 0.00001) and had a higher incidence of initial balloon failure (10.2% vs. 3.3%, p < 0.0001). Significant prolongation of the procedure time (81 +/- 41 vs. 68 +/- 32 min, p < 0.0001) and increased volume of contrast medium (201 +/- 86 vs. 165 +/- 61 ml, p < 0.0001) were seen in the reuse center. A higher rate of adverse clinical events (7.8% vs. 3.8%, p < 0.025) was observed in the reuse center, especially in patients with unstable angina.
CONCLUSIONS
The reuse strategy was associated with a higher rate of adverse events, prolonged procedure time and increased use of contrast medium, especially in lesions that were not crossed by the initial balloon and in patients with unstable angina. Whether these differences are related to the reuse strategy or to differences in patient groups cannot be ascertained by this observational study. A multicenter randomized trial is required to further assess the safety and the cost/benefit ratio of this strategy.
Topics: Aged; Angioplasty, Balloon, Coronary; Cost Savings; Equipment Reuse; Female; Humans; Male; Middle Aged; Prospective Studies; Treatment Outcome
PubMed: 7930278
DOI: 10.1016/0735-1097(94)90142-2