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)     

应用5F引导导管经桡动脉行冠状动脉介入治疗

目的 评价应用5F引导导管经桡动脉行冠状动脉(冠脉)介入治疗(PCI)的可行性、安全性及优越性，探讨其应用策略。方法 应用5F引导导管经桡动脉对120例患者的166处病变进行PCI，桡动脉穿刺成功后动脉鞘内注入维拉帕米5mg，根据造影显示冠脉起始段和病变近端的情况选择合适引导导管，按常规进行PCI操作；术后立刻拔出鞘管，加压包扎穿刺处，4h后解除加压包扎；术后仅限制患者穿刺侧上肢活动。结果 右冠脉(RC)病变43例中有67．4％应用Judkins RC导管(JR)，32．6％应用Amplatz导管。92例患者的121处左冠脉(LC)病变，66．3％应用Judkins LC导管，18．5％应用EBU导管，15．2％应用Amplatz LC导管。2例静脉旁路病变均应用JR。PCI成功率97％；5处(3％)仅行经皮冠脉成形术未成功；并发症仅有1例(0．8％)桡动脉闭塞，但不影响手部供血。结论 应用5F引导导管经桡动脉行PCI具有可行性，由于导管细软，大大降低冠脉和穿刺部位的并发症，具有很高的安全性和优越性；但操作难度较大，需掌握导管的选用策略，以增加导管的支持力和同轴性，提高成功率。     

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 balloon angioplasty through diagnostic 6 French catheters

We investigated the use of ultralow profile balloon catheters (Scimed ACE, USCI Probe, Cordis, Orion) for coronary angioplasty through 6 French diagnostic catheters (Schneider, Cordis). Contrast injection was assisted with a Hercules pump (Cordis) in all cases. During 21 procedures, angioplasty of 27 lesions in 20 selected patients was attempted (1.3 lesion/procedure). Twelve lesions were in the right, 10 in the left anterior descending, and 5 in the left circumflex coronary artery. Balloon size varied between 2.5 and 3.5 mm. Twenty lesions could be successfully dilated (74%) through the 6 French catheter and 7 lesions required an exchange to a 7 French angioplasty guiding catheter. For 5 cases, another balloon was also necessary to complete the procedure. The final overall success rate was 100% per patient and per lesion and there were no major complications. Despite the small internal catheter lumen (1.22 mm) coronary visualization was adequate, and mechanical support was good. Failures of 6 French catheters were attributed to insufficient torque control and excessive friction when the balloon crossed the tapered end of the diagnostic catheter. Coronary angioplasty through a diagnostic 6 French catheter is feasible and may represent a reasonable alternative for simple cases that are done during the same session as the diagnostic angiography. Once available, 6 French high flow angioplasty guiding catheters without a tapered tip should improve success while retaining the advantage of a small femoral puncture site.     

Double loop guiding catheter: A primary catheter for angioplasty of the right coronary artery

Double loop guiding catheters have been used for percutaneous transluminal coronary angioplasty (PTCA) of the right coronary artery (RCA) in 42 consecutive cases. A catheter with a 90- degree primary curve was used when the proximal RCA had horizontal or inferior orientation. When the proximal segment of the RCA was oriented superiorly (shepherd's crook), the catheter with a 75-degree primary curve was used. Catheters were fabricated with short (1.5 cm) or long (2.3 cm) (USCI, C.R. Bard, Inc., Billerica, MA) distal tips. Short-tip catheters were satisfactory in the majority of cases. When the RCA had a complex course and more backup was necessary or when the ascending aorta was wide, long-tip catheters were found to be the best choice. Angioplasty of 49 lesions was attempted in 42 consecutive patients. In 39 patients successful dilatation was achieved (93%). In three patients the procedure was unsuccessful. In one patient, the lesion could not be crossed with the guidewire despite an excellent backup. In another patient, two of three stenoses were dilated successfully; the distal lesion was crossed with a guidewire but could not be crossed with the balloon catheter in spite of a good backup. The lack of a satisfactory engagement and inadequate backup were responsible for the failure in only one patient. There were no complications related to these guiding catheters. We conclude that double loop guiding catheters are safe and can be the primary choice in all right coronary angioplasties. These catheters provide an excellent backup with consequent high success rate.     

Efficacy of a new angioplasty catheter for severely narrowed coronary lesions

Conventional over the wire dilation catheters may be unsuccessful in crossing coronary lesions that are severely narrowed. Hence, a new, extremely low profile coronary angioplasty catheter specifically designed to dilate such lesions was investigated. The catheter features a 2.0, 2.5 or 3.0 mm (inflated diameter) balloon mounted on a guide wire. The deflated profile of the 2.0 mm balloon measures 0.020 +/- 0.001 in. (0.51 +/- 0.03 mm). The catheter can be used in conjunction with 7F angiographic or 8F guide catheters. The catheter was used in 61 patients, aged 43 to 86 years, with predominantly Canadian Cardiovascular Society class III-IV angina. Dilation was attempted in 77 lesions. Lesion length averaged 5.7 +/- 3.1 mm (mean +/- 1 SD), minimal diameter 0.51 +/- 0.25 mm and internal vessel diameter 2.27 +/- 0.43 mm. Sixty lesions (78%) were successfully dilated to less than 50% residual stenosis with this catheter alone; nine lesions were further dilated with a larger balloon catheter. The new catheter was unable to cross 13 lesions (17%); only 2 of these lesions were subsequently crossed with a conventional over the wire system. On the other hand, the catheter was used after failure of conventional dilating catheters in 21 lesions and was successful in 16. The new catheter was particularly valuable for distal lesions and those demonstrating 90 to 99% diameter reduction. For all lesions crossed, stenosis decreased from 76 +/- 11 to 29 +/- 12% after 2.9 +/- 2.7 inflations and peak inflation pressure of 8.0 +/- 2.9 bar. Complications were rare; coronary occlusion occurred in two lesions (3%) and dissection in three lesions (4%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Bailout techniques for failed coronary angioplasty using 6 french guiding catheters

Coronary angioplasty (PTCA) through 6 French (F) guiding catheters is feasible, although acute or threatened closure following coronary artery dissections may occur. This report describes our experience with the treatment of suboptimal results in 13 patients from a population of 144 patients who had PTCA through 6F guiding catheters. Patients were treated with a new low profile autoperfusion catheter (ACS®, Flowtrack40?) or with Palmaz Schatz stents, advanced through 6F guiding catheters. PTCA was performed via the radial artery in 11 pts (85%) or via the femoral artery in two patients (15%). In two patients, (15%) PTCA was complicated by an dissection associated with complete loss of flow (TIMI 0) and a dissection was considered to lead to abrupt closure in the remaining 11 patients (85%), despite the presence of normal flow. A Flow-track40? perfusion catheter was successfully applied in three of four patients. In one patient a persisting dissection after restoration of flow by a perfusion catheter was treated with three Palmaz Schatz stents. Implantation of Palmaz Schatz stents was attempted as primary technique in nine patients. In one patient the stent could not cross a dissection in the proximal LAD via the radial artery. With an 8F system via the femoral artery, two stents could successfully be deployed with the stent delivery system. In another patient the stent could not be advanced across a subtotal residual stenosis in a tortuous left anterior descending coronary artery. Despite normal antegrade flow and emergency bypass surgery, this patient developed a non-Q-myocardial infarction. In the remaining patients, the clinical course was uncomplicated. With the limitations of the bare stent technique kept in mind, applying bailout techniques such as perfusion balloons and implantation of bare Palmaz Schatz coronary stents should be considered for improvement of suboptimal angioplasty results in a selected group of patients after PTCA with 6F guiding catheters. © 1994 Wiley-Liss,Inc..     

Probe, a balloon wire: initial experience

Coronary angioplasty is unsuccessful in less than 3-5% of cases because the balloon catheter fails to follow a guidewire that has traversed a lesion. Between June 1986 and August 1987, 31 lesions were unable to be crossed with at least two standard angioplasty catheters. Finally, a 2.0-mm-diameter Hartzler LPS (ACS) was utilized and successfully crossed and dilated 16 out of 31 lesions (52%). In the remaining 15 lesions, the Probe (USCI) 2.0 mm diameter x 1.5 cm long balloon wire was able to cross the lesions in 13 (82%) and successfully dilated 12. In one case, lesion rigidity prevented the balloon from expanding at 14 atm. A right coronary artery lesion was attempted in 11 cases, and a left anterior descending and circumflex artery lesion in two patients each. No complications were encountered. In seven out of 12 successful Probe cases, a larger balloon catheter was used to further dilate the artery. This new balloon wire has increased our success rate in severe stenoses and in tortuous vessels with severe distal lesions, in which presently available angioplasty equipment has failed.     

New balloon catheter for prolonged percutaneous transluminal coronary angioplasty and bypass flow in occluded vessels

A new balloon catheter was developed for continuous perfusion of coronary arteries during angioplasty (CPC catheter). Steerable Grüntzig balloon catheters (3.7 mm) with two lumina were formed. The first lumen was used for balloon inflation. Side holes to the second lumen proximally and distally to the balloon were created for coronary perfusion even during inflation phase. At a perfusion pressure of 120 mmHg, a flow rate of 63 +/- 3 ml/min with 0.9% saline and 43 +/- 1 ml/min with plasma expander were measured. In experiments on five dogs, dilation time until appearance of signs of ischemia could be prolonged in three of five dogs from 30 to 40 s, 120 to 203 s, and 180 to 420 s comparing conventional and CPC balloon catheters. In 11 patients with proximal lesions, dilation time could be increased from 39.5 +/- 23.9 s to 81.1 +/- 36.3 s (p less than 0.01) until appearance of angina pectoris. ST segment changes were observed in 10/11 patients using conventional catheters. Using CPC catheters, no ST segment changes were observed in four patients; time until appearance of ST segment changes was delayed in the other seven patients. The CPC catheter seems to be an alternative catheter in proximal lesions of the left and right coronary artery, allowing the possibility of prolonged dilation and increased safety to the patient. In case of dissection or perforation, the CPC catheter can be used for perfusion of the distal part of the coronary vessel until emergency bypass surgery.     

Two-dimensional echocardiography during percutaneous transluminal coronary angioplasty

In order to study myocardial and clinical events during transient coronary occlusion in humans, two-dimensional echocardiography was continuously performed in 15 patients undergoing 49 balloon inflations during percutaneous transluminal coronary angioplasty (PTCA). Transient segmental asynergy developed in all patients 8 +/- 3 seconds after balloon inflation and returned to baseline 19 +/- 8 seconds after balloon deflation. Segmental dyskinesis was seen in only 8 of 11 patients undergoing PTCA of the left anterior descending artery (LAD). A wall motion score, based on degree of asynergy of 13 segments of the left ventricle, was significantly higher during LAD than during right coronary artery inflation (7.9 +/- 1.3 vs 4.0 +/- 1.4, p less than 0.01). Left ventricular size index increased significantly during balloon inflation, from 179 +/- 9 to 196 +/- 10 mm (p less than 0.01). Four patients developed transient ST segment changes in the extremity leads of the ECG and five patients had angina pectoris. The very first sign of ischemia in three patients, who developed all of these symptoms together, was consistently asynergy, followed by ECG changes, and last, angina pectoris. Thus during PTCA, transient asynergy and left ventricular dilatation develop, which are often clinically silent.     

Coronary artery angioplasty with a helical autoperfusion balloon catheter

The initial in-hospital and long-term clinical experience with a helical autoperfusion balloon catheter in the treatment of coronary artery disease is reported. This new catheter design allows blood to flow passively around the inflated balloon through a protected helical channel molded into the balloon surface. Twelve consecutive patients underwent PTCA. Continuous ST monitoring, heart rate, average peak distal coronary blood flow velocity (APV), coronary blood flow (CBF), dP/dt and systemic and pulmonary arterial pressures were determined during PTCA. During balloon inflation there were no hemodynamic changes, TIMI flow was 1.7 ± 0.8, and APV was 39% of baseline. Luminal diameter stenosis improved from 61 ± 17 to 29 ± 13% (P < 0.05) following PTCA. Mean continuous inflation duration was 385 ± 215 sec and 6/12 patients had ≥ 7.5-min inflations. There were no in-hospital adverse cardiac events. One patient developed recurrent angina during 8 mo of follow-up and underwent successful PTCA of a restenotic lesion. We conclude that human plaques can be successfully dilated with a helical balloon catheter that provides autoperfusion and the ability to perform prolonged inflations with hemodynamic stability. A comparison of this PTCA catheter with standard balloon catheters is warranted. Cathet. Cardiovasc. Diagn. 40:179–185, 1997. © 1997 Wiley-Liss, Inc.     

Percutaneous Transluminal Coronary Angioplasty Through 5 French Diagnostic Catheters

In 130 patients, coronary angioplasty (PTCA) with fixed wire balloons through 5 French (F) diagnostic catheters was performed immediately following diagnostic coronary angiography. Patients with complex lesions or in whom the need for alternative devices was likely such as stents were excluded. A total of 151 lesions were attempted. Primary success with 5F systems was achieved in 92% of lesions. In 7 cases, the 5F system failed to cross the stenosis and a change to a larger guiding catheter was necessary. Of these 7 cases, 6 could be dilated successfully with 6 or 7F systems. In one patient in whom the fixed wire balloon was not able to cross a subtotal stenosis of an obtuse marginal branch through the 5F catheter, a Monorail system through a 6F guiding catheter failed as well. The overall technical success rate was 96%. Cardiac complications occurred in 2% of patients (3 patients with Q-wave myocardial infarction). Two other patients (1.5%) with suboptimal PTCA results underwent bypass surgery. PTCA through small diagnostic catheters is a valid alternative technique in selected patients. It is safe and leads to high success rates. Advantages of this technique include 1) less peripheral and coronary trauma; 2) enhanced patient comfort; 3) economical advantages.     

The Falconª Eccentric Coronary Balloon Angioplasty Catheter: A Randomized Safety and Efficacy Study

Percutaneous coronary angioplasty (PTCA) is usually performed using concentric shaped balloon catheters with the guidewire passing through the center of the shaft. The Falcona balloon catheter features a guide wire lumen on the outside of the balloon so that an eccentric balloon catheter profile is obtained concentrating the dilating force on the wire supported side, allowing lower inflation pressures and potentially causing less vessel injury. The aim of this study was to evaluate the safety and efficacy of this new balloon catheter in patients with stable and unstable angina. In 95 prospectively randomized patients, 57 lesions were dilated with a concentric balloon and 51 with the eccentric balloon. Technical success in the two groups was similar (73.3% vs. 74.5% control vs. Falcon respectively). Procedural success was 96.5% vs. 96.1% in the control and Falcon groups respectively. The mean increase in minimum luminal diameter (MLD) was 1.01 +/- 0.41 mm in the control vs 0.85 +/- 0.45 mm in Falcon (p = 0.053). There was an increase in type A dissections in the Falcon group 18 (36.75%) vs. 10 (19.23%) in the control group (p = 0.07) with no difference in stent implantation, myocardial infarction, CABG or death between the two groups. All patients with a technically successful PTCA were followed up. Seventeen (43.6%) in the control and 11 (32.4%) in the Falcon had repeat coronary angiography (p = 0.38), 12 (30.8%) vs. 7 (20.6%) had repeat PTCA (p = 0.37) and time to PTCA was 116 +/- 70 days vs. 154 +/- 103 days respectively (p = 0.36). The Falcon performed technically as well as the concentric balloons. Despite a smaller MLD and increase in Type A dissections there was no associated increase in complications or reintervention for restenosis. Further investigation is required to evaluate the role of this mechanism of dilatation in restenosis.     

Identifying patients at high risk for restenosis after percutaneous transluminal coronary angioplasty for unstable angina pectoris

To study the determinants of late restenosis after percutaneous transluminal coronary angioplasty (PTCA) performed in patients with unstable angina pectoris, a prospective study was undertaken in 90 patients. Primary PTCA success was achieved in 84 (93%) patients, dilating 116 of 118 coronary narrowings (1.4/patient), while major complications during PTCA occurred in only 1 patient (1 death). Eighty-two patients (114 dilated arteries) were followed for 25 +/- 11 months: 68 (83%) were in New York Heart Association functional class I or II, 11 (13%) in class III, and there were 3 deaths. Late restenosis was found in 16 (25%) of 65 lesions (29% of 49 patients) studied by angiography 9 +/- 7 months after PTCA. Restenosis was more frequent in left anterior descending coronary artery lesions (p = 0.07) and in those which at the time of PTCA had multiple irregularities (67 vs 14%, odds ratio 12.5, p = 0.002), decreased coronary perfusion (Thrombolysis in Myocardial Infarction grade less than 3) (50 vs 15%, odds ratio 5.7, p = 0.02) or intraluminal thrombus (67 vs 19%, odds ratio 8.7, difference not significant). Multiple irregularities (p = 0.003) and decreased flow (p = 0.02) remained independent predictors of restenosis (goodness of fit 0.88) after adjustment for 12 pre- and peri-PTCA clinical and angiographic variables by logistic regression analysis. These data underline the feasibility of early revascularization by PTCA in patients with unstable angina pectoris. Careful follow-up should be instituted in patients with multiple irregular lesions, decreased coronary perfusion or intraluminal thrombus at the time of PTCA. In such patients, late restenosis may be the rule rather than the exception.     

Decreasing length of stay in the hospital by coronary angiography with 5-French catheters

The use of 5-French (F) coronary angiography catheters as opposed to 7-F may reduce arterial injury at the puncture site. Therefore, a decrease in time to recuperation after coronary angiography with the Judkins technique seems possible. In 199 patients undergoing coronary angiography with 5-F catheters, management, imaging, and complications were investigated. In 18 patients the diagnosis of a valvular defect was confirmed; in 128 patients coronary artery disease (lesions greater than 70%) was found. Three patients had idiopathic dilative cardiomyopathy. Coronary lesions of less than 70% with normal left ventricular function were found in 50 patients ("normals"). After coronary angiography with 5-F catheters bedrest was recommended for 4 h, as compared to 24 h after a 7-F catheter procedure. Successful coronary artery imaging with 5-F catheters was achieved in 168 patients (84%). In 31 patients (27 coronary artery disease, 1 aortic stenosis, 3 normals) selective imaging was not achieved, and the 5-F catheter had to be replaced by a 7-F catheter. Aortic (systolic 147 +/- 24 vs 132 +/- 20 mm Hg, p = 0.002; diastolic 74 +/- 13 vs 70 +/- 11, p = 0.05) and left ventricular pressures (systolic 149 +/- 26 vs 131 +/- 20 mm Hg, p = 0.001; enddiastolic 18 +/- 8 vs 14 +/- 8 mm Hg, p = 0.035) were higher in this group, whereas no relations to age, sex, and diagnosis emerged.(ABSTRACT TRUNCATED AT 250 WORDS)     

Effectiveness of the Arani double-loop guiding catheters in angioplasty of aorto-coronary vein grafts

Double-loop guiding catheters have been used for angioplasty of aorto-coronary vein grafts (VG) or grafted arteries through the VG in 31 cases. A catheter with a 90 degrees primary curve was usually the best choice for angioplasty of the VG to the right coronary artery (RCA). For angioplasty of the VG to the left coronary artery branches (LCA), a 90 degrees primary curve was used when the proximal segment of the VG was oriented horizontally and a 75 degrees (USCI, C.R. Bard, Inc., Billerica, MA) was used when the proximal segment was directed superiorly. Angioplasty of 32 lesions was attempted in 31 patients. These catheters provided good "back-up" in angioplasty of 30 lesions (94%). The lesions were crossed with balloon catheters in 29 cases (91%). There was one acute VG occlusion requiring coronary artery bypass graft (CABG) surgery, a complication not attributed to the guiding catheter. We conclude that Arani guiding catheters provide strong back-up, are helpful in angioplasty of the vein grafts, and could be used as the primary choice for VG angioplasties.     

Probe™, a balloon wire: Initial experience

Coronary angioplasty is unsuccessful in <3–5% of cases because the balloon catheter fails to follow a guidewire that has traversed a lesion. Between June 1986 and August 1987, 31 lesions were unable to be crossed with at least two standard angioplasty catheters. Finally, a 2.0-mm-diameter Hartzler LPS (ACS) was utilized and successfully crossed and dilated 16 out of 31 lesions (52%). In the remaining 15 lesions, the Probe^TM (USCI) 2.0 mm diameter × 1.5 cm long balloon wire was able to cross the lesions in 13 (82%) and successfully dilated 12. In one case, lesion rigidity prevented the balloon from expanding at 14 atm. A right coronary artery lesion was attempted in 11 cases, and a left anterior descending and circumflex artery lesion in two patients each. No complications were encountered. In seven out of 12 successful Probe^TM cases, a larger balloon catheter was used to further dilate the artery. This new balloon wire has increased our success rate in severe stenoses and in tortuous vessels with severe distal lesions, in which presently available angioplasty equipment has failed.     

复杂冠状动脉病变的腔内成形术

本文报道5例不同类型复杂冠状动脉病变腔内成形术。对于位于血管分叉处的病变,采用了双导丝技术;对于引起急性心肌梗塞的高度狭窄血管采用自灌注球囊扩张;对于完全闭塞且病变较长的血管,采用较硬的标准直头导引钢丝导入尔后逐段扩张的办法;对于术中出现的内膜剥离,采用了自灌注球囊导管行长时间低压修补。术后血管再通,残余狭窄为0～10％。因此,认为只要针对不同情况,采用不同方法,PTCA成功率可望提高。     

Distal coronary artery perfusion during percutaneous transluminal coronary angioplasty

Perfusion of the coronary artery distal to an occluding angioplasty balloon was performed in 34 patients undergoing coronary angioplasty (PTCA). A randomized crossover study was employed using two exogenous substances as perfusates: lactated Ringer's solution (LR) and a fluorocarbon emulsion (FL), Fluosol-DA 20%. Both substances are electrolyte solutions, but the FL will dissolve more oxygen than the LR. During two attempted coronary artery occlusions of 90 seconds each, we perfused through the central lumen (guidewire channel) of the PTCA catheter at 60 ml/min. With FL perfusion the mean time to onset of angina after occlusion was delayed (41 +/- 21 vs 33 +/- 16 seconds, mean +/- SD; p less than 0.05), the mean duration of angina was shortened (77 +/- 58 vs 92 +/- 70 seconds, p less than 0.05), and the rise in the ST segment of the ECG was reduced (0.15 +/- 0.24 vs 0.2 +/- 0.23 mV, p less than 0.001) when compared to LR perfusion. Balloon occlusion time was able to be extended with FL perfusion (71 +/- 22 vs 59 +/- 22 seconds p less than 0.001). These results indicate that perfusion of the distal coronary artery is possible during PTCA and can reduce ischemia during a prolonged balloon occlusion time.     

Percutaneous transluminal coronary angioplasty after previous coronary artery bypass surgery

To improve symptomatic status and avoid repeat coronary artery bypass graft surgery (CABG), 115 lesions were approached for transluminal coronary angioplasty (PTCA) in 94 patients (82 men, 12 women) with angina pectoris and prior CABG at a mean of 60 months (range 4 to 192) after CABG. Fifteen patients were in Canadian Cardiovascular Society functional class I, 32 were in class II, 31 were in class III, and 16 were in class IV. Patients were 37 to 76 years old (mean 57). PTCA was successful (at least a 40% reduction in stenosis diameter and improvement in symptomatic status) in 83 patients (88%) and 103 (90%) lesions. Mean stenosis was reduced from 80 +/- 14% to 20 +/- 16% (mean +/- standard deviation) and mean pressure gradient from 41 +/- 7 mm Hg to 14 +/- 6 mm Hg. Seven patients had lesions that could not be crossed for technical reasons and these patients underwent non-emergency CABG. Four patients required emergency CABG after PTCA; 1 patient subsequently died and 2 survived acute myocardial infarction. One patient had a femoral artery laceration, which required surgical repair. At a mean follow-up of 8 +/- 4 months, 63 patients (76%) with initially successful results were free of angina or in improved condition. Of the remaining 20 patients, 18 consented to repeat coronary angiography. Four patients did not have restenosis. Of the 14 patients with documented restenosis, 5 underwent successful repeat PTCA, 5 had repeat CABG, and 4 were treated medically. Thus, when coronary anatomy is suitable, PTCA is an effective alternative to reoperation in symptomatic patients with prior CABG.