Short term results of percutaneous transluminal coronary angioplasty with the monorail technique: experience in the first 1000 patients

The monorail technique allows monitoring of all steps of the coronary angioplasty procedure by high quality coronary angiography; easy, rapid, and safe recrossing and redilatation of the lesion if necessary; and stepwise dilatation of a stenosis with sequential increase of size of balloons. Transstenotic pressure differences cannot, however, be measured through the narrow shaft of the standard monorail balloon catheter. The monorail technique was used in 1014 patients (820 men, 194 women; mean age 57.8 years (range 24 to 84]. The indication for coronary angioplasty was stable angina in 52%, unstable angina in 40%, and acute myocardial infarction in 8%. Single vessel coronary angioplasty was attempted in 78%, multilesion coronary angioplasty in 11%, and multivessel coronary angioplasty in 11%. Angiographic success (reduction of stenosis to less than 50% of the luminal diameter) of all attempted lesions was achieved in 93%. The technique was clinically successful--that is, angiographic success of all attempted lesions, no occurrence of a major complication (death, myocardial infarction, acute bypass surgery), and improvement of symptoms--in 92% and partially successful in 1.3%. The clinical success rates were similar for stable angina (91%) and unstable angina (94%), but were somewhat lower for acute myocardial infarction (88%). Failure without major complication occurred in 3.4% of the patients. Failure with a major complication occurred in 3.3% (death 0.3%, myocardial infarction 2.4%, and acute bypass surgery 2.3%). The total major complication rate was higher in unstable angina (4.2%) than in stable angina (3.0%). These results indicate that the monorail technique can be applied safely and effectively for coronary angioplasty of patients with stable angina, unstable angina, and acute myocardial infarction.     

Short term results of percutaneous transluminal coronary angioplasty with the monorail technique: experience in the first 1000 patients.

The monorail technique allows monitoring of all steps of the coronary angioplasty procedure by high quality coronary angiography; easy, rapid, and safe recrossing and redilatation of the lesion if necessary; and stepwise dilatation of a stenosis with sequential increase of size of balloons. Transstenotic pressure differences cannot, however, be measured through the narrow shaft of the standard monorail balloon catheter. The monorail technique was used in 1014 patients (820 men, 194 women; mean age 57.8 years (range 24 to 84]. The indication for coronary angioplasty was stable angina in 52%, unstable angina in 40%, and acute myocardial infarction in 8%. Single vessel coronary angioplasty was attempted in 78%, multilesion coronary angioplasty in 11%, and multivessel coronary angioplasty in 11%. Angiographic success (reduction of stenosis to less than 50% of the luminal diameter) of all attempted lesions was achieved in 93%. The technique was clinically successful--that is, angiographic success of all attempted lesions, no occurrence of a major complication (death, myocardial infarction, acute bypass surgery), and improvement of symptoms--in 92% and partially successful in 1.3%. The clinical success rates were similar for stable angina (91%) and unstable angina (94%), but were somewhat lower for acute myocardial infarction (88%). Failure without major complication occurred in 3.4% of the patients. Failure with a major complication occurred in 3.3% (death 0.3%, myocardial infarction 2.4%, and acute bypass surgery 2.3%). The total major complication rate was higher in unstable angina (4.2%) than in stable angina (3.0%). These results indicate that the monorail technique can be applied safely and effectively for coronary angioplasty of patients with stable angina, unstable angina, and acute myocardial infarction.     

Increase of Initial Success and Safety of Single-Vessel Percutaneous Transluminal Coronary Angioplasty in 1371 Patients: A Seven-Year Experience

Three successive time periods were compared to study the impact of evolving techniques and new equipment on the immediate results of single-vessel percutaneous transluminal coronary angioplasty (PTCA), the initial success rate and major complication rate (death, myocardial infarction, and urgent surgery). The three periods were selected on the basis of a significant advance in either PTCA technique or equipment. In period I from 1980 to 1983 a nonsteerable catheter system was used. In period II from 1983 to 1986 a steer-able catheter was used. In period HI from 1986 to 1987 the long guidewire technique and/or monorail system was used. A total of 1,371 successive patients underwent single-vessel dilatation for stable angina (848 patients) or for unstable angina (523 patients). Initial success was defined as a reduction of the stenosis to less than 50% with no major complications (myocardial infarction or death, or the necessity of proceeding to coronary artery bypass surgery). The initial success rate increased from 68% (period I) to 88% (period II) and to 91% (period III) for all attempts. When attempts of dilatation of totally occluded vessels were excluded these figures were 71%, 91%, and 95%, respectively. The overall major complication rate decreased from 16% (period I) to 8% (period II) to 3.5% (period III). Thus, increase in investigator experience, technical improvements of balloon catheter systems, and introduction of new PTCA techniques have resulted in an increase in success and safety of PTCA procedures. (J Inter-ven Cardiol 1988:1:1)     

Initial experience with the Europass™: A new ultra-low profile monorail balloon catheter

One of the causes for percutaneous transluminal coronary angioplasty (PTCA) failure is the inability to cross the lesion with the balloon catheter after guidewire positioning. The Europass? coronary angioplasty catheter is a monorail Duralyn? balloon catheter developed to enhance lesion crossability and to overcome this limitation. This system was evaluated in 50 patients in which target lesions were chronic total coronary occlusions (12 cases) or stenoses that could not be reached or crossed by other new monorail balloon catheters. Overall procedural success was obtained in 49/50 patients (98%), using a single Europass? balloon catheter in 46/50 patients (92%), with no in-hospital complications. Its low profile, small distal shaft, and excellent trackability allowed successful angioplasty in cases where other catheters failed. This balloon catheter represents a significant advance in angioplasty technology and can be considered as a first-choice device for a safe and expeditious single-operator procedure. © Wiley-Liss, Inc.     

A new catheter system for coronary angioplasty

A new catheter system has been designed for percutaneous transluminal coronary angioplasty. An independently movable, flexible-tipped guide wire within the balloon dilation catheter facilitates selection of the involved vessel. This guide wire can be passed slowly and carefully beyond the coronary stenosis, permitting safe advancement of the balloon catheter. After testing in animal and cadaver hearts, this system was used in 53 patients (56 stenoses) with single vessel coronary artery disease, with an overall primary success rate of 64 percent. In the last 41 of these 56 cases, use of a balloon catheter with a smaller deflated diameter increased the success rate to 73 percent. In patients with lesions of the left anterior descending coronary artery, the success rate was 89 percent. Three (6 percent) of the 53 patients had complications during coronary arterial dilation that necessitated emergency coronary arterial bypass graft surgery. There were no procedure-related or late cardiac deaths. During the mean follow-up period of 8 months (range 1 to 21), there were one late death (of noncardiac causes) and no late myocardial infarctions. Clinical status was persistently improved in 31 of the 36 patients who had successful dilation. The remaining five patients experienced restenosis at the angioplasty site and return of angina pectoris within 3 months of dilation. Two of these patients had repeat coronary angioplasty with restoration of asymptomatic status, and three had elective coronary bypass graft surgery.     

Coronary angioplasty with a rotary atherotome]

Several new coronary dilatation systems, including those using laser energy, atherectomy devices and stent implantation, are being developed as alternative or complementary procedures to coronary artery balloon angioplasty. We report our initial experience performing coronary angioplasty with a new rotational atherectomy device, the transluminal extraction catheter, which simultaneously cut and aspirate fragments from the atherosclerotic plaque. The components of the whole system are a special guidewire to cross the stenosis, the atherectomy catheter and the conduction-control unit. This unit, connected when the atherectomy catheter is positioned across the lesion, produces rotation of the conical bladder located in the catheter distal tip and simultaneous aspiration of residual particles. The procedure was performed in 11 patients in whom 13 lesions were dilated. All patients were male (mean age 55 +/- 23 years, range 45-77). The reason for the angioplasty was stable angina in 2 patients and unstable angina in the remaining seven. Initial success (residual stenosis less than 50% of vessel diameter) was obtained in 10 of 13 lesions. In two, conventional balloon angioplasty was required to improve atherectomy result. The only unsuccessful procedure was in a proximal right coronary artery venous graft, in which a large dissection occurred. Patient had angina but no myocardial infarction. Pathologic examination of aspirated material revealed fibrous tissue in 12 cases and cholesterol crystals in four. We conclude, with the limitation of a preliminary study, that rotational atherectomy with the transluminal extraction catheter is a useful procedure to relief coronary stenosis of the coronary arteries.     

Triple vessel coronary angioplasty: acute outcome and long-term results

Triple vessel coronary angioplasty, defined as angioplasty of one or more lesions in each of the three major coronary arteries (left anterior descending, left circumflex, right coronary artery) was performed in 50 (11%) of 469 patients who had angioplasty of multiple vessels. There were 32 men and 18 women with a mean age of 56 years. All 50 patients had severe three vessel coronary disease and represent approximately 5% of patients with three vessel disease who had revascularization in this institution; 8 (16%) had previous coronary bypass surgery, and 23 (46%) had previous myocardial infarction. Unstable angina was present in 33 patients (66%) and 96% had Canadian Heart Association class III or IV angina; mean left ventricular ejection fraction was 57 +/- 11%. Angioplasty was performed in 176 vessels (3.5 vessels per patient, range 3 to 6) and in 250 lesions (5 lesions per patient, range 3 to 9); angiographic success was achieved in 240 lesions (96%) and 166 vessels (94%). Success in all vessels attempted was achieved in 40 (80%) of the 50 patients. Clinical success (angiographic success associated with clinical improvement) was obtained in all 50 patients in whom triple vessel angioplasty was performed; none of them required urgent bypass surgery and 5 patients (10%) had a non-Q wave myocardial infarction. In four other patients triple vessel angioplasty was planned but not performed because of failure to dilate the primary vessel; urgent bypass surgery was required in one of these, who developed a Q wave infarction. Thus, overall clinical success in 54 patients was 93%; the incidence rate of myocardial infarction was 11%, and that of urgent surgery 1.8%.(ABSTRACT TRUNCATED AT 250 WORDS)     

Coronary angioplasty of anomalous coronary arteries: notes on technical aspects

Five patients with significant atherosclerotic lesions of anomalous coronary arteries underwent coronary angioplasty of the anomalous vessel. Four patients had anomalous circumflex artery and 1 had an anomalous right coronary artery. Angiographic and clinical success was achieved in all 5 patients. To ensure adequate equipment selection special consideration should be given to angiographic characteristics of these vessels, such as the orifice configuration, exit angulation, the route the artery traverses and the location of the stenotic lesions. Major determinants for successful angioplasty in these patients are guiding catheter selection and advancement of the balloon catheter to the very proximal portion of the anomalous vessel to subsequently facilitate guide wire advancement. This data indicates that balloon angioplasty can be successfully utilized in patients with significant atherosclerotic disease of anomalous coronary arteries.     

Percutaneous transluminal angioplasty of a large septal artery

A severely stenotic, large-caliber, first septal artery was successfully dilated in a patient with refractory angina and nonsurgical, multivessel coronary artery disease. The success of this dilatation was related to favorable coronary anatomy and to the availability of a guidewire-directed dilatation catheter. Septal artery stenosis with or without surgically accessible stenoses in other coronary vessels represents a potential indication for percutaneous transluminal coronary angioplasty.     

经桡动脉行复杂冠状动脉病变的介入治疗

目的探讨经桡动脉行复杂冠状动脉病变介入治疗的可行性。方法将178例左主干开口病变、分叉病变、慢性闭塞病变、长度≥30mm的长病变、纡曲成角病变及严重钙化病变等复杂冠状动脉病变患者经桡动脉途径进行PCI。结果经桡动脉PCI完成率97.2%。因导引导管支撑力不够,采用双导丝技术18例,采用子母导管技术5例,微导管技术6例,锚技术3例。左主干开口病变8处即刻全部成功。左主干分叉病变双支架置入17例,单支架置入9例。其他分叉病变67处,单支架置入47处,双支架置入20处。双支架置入后对吻球囊扩张成功率100%。34处慢性闭塞病变PCI成功27处。长度≥30mm的长病变91处、纡曲成角病变23处、严重钙化病变27处全部PCI成功。术中支架内血栓2例,住院期间亚急性血栓形成2例。死亡1例。穿刺处并发症:桡动脉闭塞8例,前臂肿胀4例,无血肿及神经损伤。结论经桡动脉途径进行冠状动脉复杂病变的PCI有较高的成功率。     

Transluminal coronary angioplasty. Experience apropos of 155 procedures

The authors report their experience of transluminal coronary angioplasty (TCA) from February 1980 to November 1983. 140 patients underwent TCA and 155 procedures were performed. The mean age was 55 years (range 33 to 74 years). Clinically, the patients presented with Stage I angina in 26 cases (18 p. 100), Stage II in 18 cases (13 p. 100), Stage III in 24 cases (17 p. 100) and Stage IV in 72 cases (52 p. 100), according to the NYHA Classification. 23 patients (16.5 p. 100) underwent combined thrombolysis - TCA. The coronary artery disease was limited to a single vessel in 135 cases (96 p. 100) and involved 2 vessels in 5 cases (4 p. 100). The overall results showed a 71 p. 100 primary success rate. There were no fatalities. The incidence of myocardial infarction was 3 p. 100 (5 patients) and emergency coronary bypass surgery was necessary in 16 patients (10 p. 100). The results in two groups of patients were compared: Group A: 69 patients treated with a conventional balloon catheter. Group B: 86 patients treated with a balloon catheter with a guide wire. The coronary stenosis was catheterised in 73 p. 100 of patients in Group A, and 90 p. 100 of patients in Group B (p less than 0.01). The primary success rate was 56 p. 100 in Group A and 83 p. 100 in Group B. The use of this new material improves the primary success rate and also makes more distal, anatomically atypical lesions, accessible.     

Coronary angioplasty with 7F guiding catheters

The performance of 7F guiding catheters for percutaneous transluminal coronary angioplasty (PTCA) was investigated in 300 patients. A total of 233 patients had single-vessel PTCA and 67 had multivessel PTCA. Angioplasty was attempted for 371 lesions (141 [38%] in the left anterior descending, 124 [33%] in the right coronary artery, and 95 [26%] in the left circumflex coronary artery or their branches; 10 [3%] in a bypass graft, and one in the left main stem). The mean degree of stenosis was 86 +/- 11% (range 60% to 100%). The monorail technique was used in 83%, and balloon-on-a-wire devices were used in 6% of cases. The balloon sizes varied between 2.0 and 4.25 mm. There was a 98% technical success rate for the 325 nontotal lesions. Five could not be crossed with the wire. Exchange to an 8F guiding catheter was done in four cases (1.2%) and yielded success in two of them. In 46 occlusions the success rate was 72%. Nine were failures due to an inability to cross the wire, another two were balloon failures, and in two cases the residual stenosis was greater than 50%. The mean residual stenosis of successful cases was 24 +/- 18%. Overall, the primary success rate was 95%. The complications were: in-hospital death in five patients (1.7%); infarction in 12 (4%); emergency bypass surgery in one; and significant inguinal hematoma in five (1.7%). Coronary angioplasty through 7F guiding catheters yields a high success rate with less coronary wedging and a smaller puncture hole.     

Coronary angioplasty of 'complex lesions' in patients with unstable angina

Out of 55 patients subjected to coronary angioplasty over the past 12 months, there were 33 (60%) who had unstable angina. Amongst these, 22 patients had coronary lesions classified as 'complex' on coronary angiography. These included tandem lesions, branch stenoses, distal lesions, total occlusions, vein graft stenoses, lesions with ulceration and intraluminal clot and associated with valvular lesions. We describe our experience of coronary angioplasty in these 22 patients of unstable angina having 'complex lesions'. All were males with a mean age of 48.7 +/- 13 years. Fourteen patients had single vessel and 8 multivessel disease. A total of 35 lesions were subjected to dilatation. The angiographic primary success was achieved in 85.7% of the lesions attempted. Except total occlusions and very distal lesions, all other types of 'complex lesions' could be dilated with a success rate of greater than 75%. There were 4 (11.4%) failures because of inability to cross the lesion with the guidewire or balloon catheter. One patient developed non-Q wave inferior wall infarction. There were no deaths. We conclude that coronary angioplasty of various types of 'complex lesions' can be performed with a good primary success and negligible complications in our setting.     

FX MiniRAIL catheter usage for treatment of de novo complex coronary lesions: results from the "OFFAR"

INTRODUCTION: Gradual prolonged balloon angioplasty may cause less arterial trauma, higher success rates, and fewer complications than conventional angioplasty (POBA). The OFFAR aimed to determine the safety and effectiveness of the FX MiniRAIL (FX) catheter, used with a slow, stepwise inflation protocol. METHODS AND RESULTS: From June to December 2003, 181 consecutive patients (age 61.9 +/- 10.6 years) with de novo coronary artery lesions (n = 217) were treated by FX and stent implantation in 11 European centers. Fifty-one patients (28.2%) had diabetes, and 70 (38.7%) had prior MI; 73 patients (40.3%) presented with stable angina and 85 (47.0%) with unstable angina. Fifty-five lesions (25.3%) were in small vessels (<2.5 mm), 40 (18.6%) were highly calcific, and 133 (62%) were long lesions (>18 mm). Stenosis resolution pressure was 7.17 +/- 4.2 atm; inflation time was 116.5 +/- 54.6 seconds. FX technical success (residual stenosis <50% post-FX) was obtained in 191 lesions (88.0%), and FX optimal success (residual stenosis <20% post-FX) in 117 (54.9%). Dissection was observed in 34 lesions (15.9%), 27 (79.3%) of which were type A or B. No coronary ruptures occurred. Nine (5.0%) in-hospital events occurred, all non-Q-wave MI. During 6-month follow-up, major adverse clinical events occurred in 14.4% of cases (n = 26; 3 cardiac deaths, 1 Q-wave MI, 2 non-Q-wave MI, 3 CABG, and 17 re-PTCA). CONCLUSION: The results of the OFFAR suggest that FX utilization for treatment of de novo complex coronary lesions is safe and effective.     

Percutaneous transluminal coronary angioplasty in unstable and stable angina pectoris: a comparison of immediate success and complications.

To determine the success rate and the safety of percutaneous transluminal coronary angioplasty in patients with unstable angina pectoris (group 1) versus stable angina (group 2), we studied 299 consecutive patients who underwent coronary angioplasty of 373 consecutive lesions. Of these patients, 149 had unstable angina pectoris and dilation of 188 arteries. The success rate was high and similar in both groups (95 and 93%, respectively). The groups did not differ in regard to the lesion characteristics, vessels and number of sites dilated except for an increase in the presence of thrombus in the unstable angina group (p < 0.03). Although there was a higher incidence of coronary thrombus and more acute myocardial infarction in group 1, the major complication rate did not differ from that of group 2 and was low in both of them (3 and 2%, respectively). No deaths occurred. Six patients (3 in each group) needed urgent coronary artery bypass grafting while 3 additional patients developed acute Q-wave myocardial infarction (all of them in group 1). Thus, percutaneous transluminal coronary angioplasty is a safe and successful procedure in patients with unstable angina as well as in patients with stable angina pectoris.     

Usefulness of morphologic parameters in predicting the outcome of coronary excimer laser angioplasty

The treatment of complex coronary lesions with conventional balloon angioplasty is associated with a reduced success rate and an increased incidence of complications. To evaluate the influence of lesion morphology on the outcome of coronary excimer laser angioplasty, morphologic parameters of 148 target lesions in 147 consecutive patients were determined. Morphologic analysis included target vessel, involved vessel segment, vessel diameter, minimal lumen diameter, length of the lesion, single discrete (concentric/eccentric) or complex lesions (occlusions, bifurcational, tandem or long segmental lesions), American College of Cardiology/American Heart Association Task Force classification, lesion location in curved or straight vessel segments, prestenotic vessel tortuosity and the direction of the laser approach in curved vessels with eccentric lesions. Failure of laser angioplasty occurred in 17 patients because of failed guidewire placement (n = 8), catheter placement (n = 6), or inability to pass the lesion with the laser catheter (n = 3). Successful stand-alone laser angioplasty was achieved in 68 procedures. In 63 interventions additional balloon angioplasty was necessary (n = 60) or stand-alone laser angioplasty was not successful (n = 3). The frequency of complex lesions, particularly total occlusions (p less than 0.001) and prestenotic vessel tortuosity (p = 0.002) was significantly increased in the group with failed laser attempts. Statistical analysis of the morphologic parameters in successful stand-alone laser interventions compared with combined or unsuccessful interventions revealed no significant difference. These data suggest that failure of laser angioplasty occurs because of low catheter flexibility and the need for guidewire support in treating totally occluded vessels.(ABSTRACT TRUNCATED AT 250 WORDS)     

Percutaneous transluminal coronary angioplasty through six French catheters

We present the results of 221 coronary angioplasty (PTCA) procedures in which a 6 French diagnostic catheter was chosen as a guiding catheter. A total of 218 were done through a femoral and 3 through an axillary approach. Total occlusion PTCA was done in 9 (4%) and multivessel PTCA in 19 procedures (9%). In 191 (86%) procedures a fixed-wire system was used (ACE Scimed, Probe USCI, Orion Cordis), and in 30 (14%) a monorail system (Speedy Schneider, Express Scimed). The mean nominal inflated balloon diameter was 2.9+/-0.3 mm (range 2.0-4.0), and the catheter internal lumen varied between 0.041 and 0.055 inch. In 186 procedures (84%) all targeted lesions could be successfully dilated through the 6 French catheter. In 30 (14%) patients, the guiding catheter was changed to a 7 or 8 French, for an overall success rate of 95%. Results with 6 French catheters were significantly better in our late experience (success rate of 92% for the last 110 procedures compared to 77% for the first 111 procedures) (p less than 0.01). There were no new Q-wave myocardial infarctions, but 6 patients (2.7%) had moderate CK elevation, 1 required emergent bypass surgery, 1 underwent emergent coronary stenting, and there was 1 in-hospital death. The overall major complication rate was 3.2%. In selected patients, PTCA can be safely and effectively done through a diagnostic 6 French guiding catheter.(ABSTRACT TRUNCATED AT 250 WORDS)     

Laser angioplasty of restenosed coronary stents: results of a multicenter surveillance trial. The Laser Angioplasty of Restenosed Stents (LARS) Investigators.

OBJECTIVES: This study evaluated safety and efficacy of excimer laser angioplasty for treatment of restenosed or occluded coronary stents. BACKGROUND: Balloon angioplasty of in-stent restenosis is limited by a high recurrence rate. Debulking by laser angioplasty is a novel concept to treat in-stent restenosis. METHODS: A total of 440 patients with restenoses or occlusions in 527 stents were enrolled for treatment with concentric or eccentric laser catheters and adjunctive balloon angioplasty. RESULTS: Laser angioplasty success (< or =50% diameter stenosis after laser treatment or successful passage with a 2.0-mm or 1.7-mm eccentric laser catheter) was achieved in 92% of patients. Adjunctive balloon angioplasty was performed in 99%. Procedural success (laser angioplasty success followed by < or =30% stenosis with or without balloon angioplasty) was 91%. There was neither a significant difference in success with respect to lesion length, nor were there differences between small and large vessels or native vessels and vein grafts. Success was higher and residual stenosis lower using large or eccentric catheters. Serious adverse events included death (1.6%, not directly laser catheter related), Q-wave myocardial infarction (0.5%), non-Q-wave infarction (2.7%), cardiac tamponade (0.5%) and stent damage (0.5%). Perforations after laser treatment occurred in 0.9% of patients and after balloon angioplasty in 0.2%. Dissections were visible in 4.8% of patients after laser treatment and in 9.3% after balloon angioplasty. Reinterventions during hospitalization were necessary in 0.9% of patients; bypass surgery was performed in 0.2%. CONCLUSIONS: Excimer laser angioplasty with adjunctive balloon angioplasty is a safe and efficient technology to treat in-stent restenoses. These data justify a randomized comparison with balloon angioplasty.     

Percutaneous coronary excimer laser angioplasty in patients with stable and unstable angina pectoris. Acute results and incidence of restenosis during 6-month follow-up

A clinical study was conducted to evaluate the efficacy and safety of percutaneous coronary excimer laser angioplasty in 60 patients with coronary artery disease. Forty-nine patients had stable exertional angina, and 11 patients had unstable angina despite medical therapy. A novel 1.4-mm diameter catheter with 20 quartz fibers of 100-microns diameter each arranged concentrically around a central lumen suitable for a 0.014-in. flexible guide wire was coupled to an excimer laser. A commercial excimer laser emitting energy at a wavelength of 308 nm with a pulse duration of 60 nsec was used. The laser was operated at 20 Hz. Mean energy transmission was 30 +/- 5 mJ/mm2. In five of the 60 patients, laser angioplasty was not attempted. In 23 patients with laser ablation alone, percent stenosis decreased from 76 +/- 14% before to 27 +/- 17% after ablation and was 34 +/- 15% at the early follow-up angiogram. In 32 patients, additional balloon angioplasty was performed because of vessel closure after laser ablation in 11 and an insufficient qualitative result in 21 patients. Of the 11 patients with unstable angina, one patient died due to vessel closure 3 hours after intervention, and two patients developed a myocardial infarction. In 22 of 47 patients with late follow-up angiography, restenosis within the 6-month follow-up period occurred. Rate of restenosis was higher in patients treated with laser ablation and balloon angioplasty (16 of 28) than in patients treated with laser ablation alone (six of 19). These results suggest that coronary excimer laser angioplasty for ablation of obstructive lesions is feasible and safe in patients with stable angina. However, development of new catheter systems is necessary for an improved success rate.     

Minimally invasive angioplasty: acute and long term results of low pressure dilatation with a non-compliant balloon during percutaneous transluminal coronary angioplasty

Despite technological advances in angioplasty equipment and increased operator experience, the incidence of dissection and abrupt closure remains unchanged. To test the hypothesis that a different balloon inflation strategy may influence the degree of arterial trauma, and therefore reduce the incidence of major complications, the success rate, acute complications and incidence of restenosis were analyzed in 110 consecutive patients using a non-compliant dilatation catheter. The term "minimally invasive angioplasty" has been coined to describe a strategy of minimizing arterial trauma by using the lowest possible inflation pressures during percutaneous transluminal coronary angioplasty (PTCA). Lesion analysis using a modified American College of Cardiology/American Heart Association Classification showed that 37% of lesions were Type A, 40% were Type B, and 23% were Type C. Overall, PTCA success was achieved in 98% of lesions. Major dissection and abrupt closure occurred in 1%. No patient required emergency coronary bypass surgery and there were no deaths. The mean coronary stenosis was reduced from 85% to 18.4%. In 75% of lesions, inflation pressures of 5 atmospheres (atm) or less were used. Angiographic follow-up was available in 80 (73%) of the patients and restenosis occurred in 19 (24%). Thus, minimally invasive angioplasty, a technique which may reduce arterial trauma, results in a high primary success rate; low residual stenosis; and very low incidence of abrupt closure, major dissection and perhaps lower restenosis. These data suggest the need for further study of PTCA techniques designed to minimize arterial trauma.