Percutaneous transluminal angioplasty with stenting in extended supra-aortic artery dissection

A 51-year-old man underwent two percutaneous transluminal angioplasties with stenting for a dissection that extended from the right brachiocephalic trunk into the proximal part of the internal carotid artery. The patient presented with transient dysphasia one month after surgical treatment of a type A dissecting aortic aneurysm. Initially, he was managed with conservative treatment, with no effect on the dissected arteries. Two stents were then successfully placed over the site of dissection to prevent further embolization. At follow-up 29 months after stent implantation, the patient was asymptomatic and ultrasound examination demonstrated no recurrence of dissection at the stented segment. This case suggests that stenting could be a successful treatment of cervical artery dissection.     

Percutaneous transluminal coronary angioplasty without thrombolytic therapy in acute myocardial infarction

Percutaneous transluminal coronary angioplasty (PTCA) in acute myocardial infarction (AMI) was performed in 42 patients (37 males, 5 females, average age 53 years). Recanalization of the stenosed or occluded infarction-related coronary artery was achieved within the first 14 to 50 min from the start of catheterization in 95% of cases. Three patients were transferred for emergency coronary bypass graft surgery (CABG) because of major multiple coronary lesions, immediately after angiographically successful PTCA. One of the patients died in cardiogenic shock. Four patients died between days 5 to 15 of hospitalization. Repeat coronary angiography was done in 27 of the 37 survivors at a mean interval of 2.5 months after AMI. Total reocclusion was found in 6 patients. The recanalized coronary artery had prevented its patency in 78% of the cases; restenosis was found in 5 patients, and was successfully dealt with renewed angioplasty in 3 patients. While the ejection fraction (EF) had remained largely unchanged, there was some improving tendency of left ventricular segmental kinetics, particularly in case of anterior wall infarction. PTCA without thrombolytic therapy seems to provide an effective and relatively prompt recanalizing procedure in the complex management of AMI.     

Dissecting aneurysm of a coronary artery due to percutaneous transluminal balloon angioplasty

Percutaneous transluminal balloon angioplasty (PTCA) is utilized successfully to dilate stenotic coronary arteries. The procedure is a frequent nonsurgical method to restore coronary artery blood flow to ischemic myocardium. In this paper, we report a case of intimal tear and medial dissection of the right coronary artery leading to a dissecting aneurysm and occlusion of the coronary artery. The patient died following coronary artery bypass grafts, and the autopsy demonstrated the dissecting aneurysm of the coronary artery.     

Coronary artery restenosis following transluminal coronary angioplasty

Morphological changes are described in a case of coronary restenosis occurring three and ten months after transluminal coronary angioplasty. The lesions consisted of severe narrowing of the previously mechanically dilated coronary segments. This narrowing was produced by fibrocellular intimal hyperplasia associated with rupture of the media whereas the atheromatous plaque was not involved. This suggests that medial injury associated with healing intimal hyperplasia could be the major factor resulting in late coronary restenosis.     

Percutaneous transluminal coronary angioplasty of focal coronary lesions after cardiac transplantation

Summary Transplant coronary artery disease is the greatest impediment to long-term survival beyond the first year after cardiac transplantation. Transplant coronary artery disease shows a heterogeneous angiographic appearance, but focal stenoses can occur alone or at least predominate. Based on an angiographic indication 35 critical focal lesions causing narrowing by 75% or more were treated by PTCA during 23 procedures in seven patients 18–84 months after cardiac transplantation. Three patients each underwent only one procedure and four underwent repeated procedures [2, 3, 4 and 11, respectively]. Primary success was achieved without any complication in 35 of 35 lesions (100%). The mean degree of stenosis was reduced from 86±9% to 28±17% (P<0.001). The rate of restenosis was 18/29 (62%) at a mean of 4 months after angioplasty. Four patients are alive and free of adverse effects (symptoms, myocardial infarction, repeated percutaneous transluminal coronary angioplasty, retransplantation) 16±10 months after their last angioplasty. One patient underwent a successful second heart transplantation 26 months after the first angioplasty. Two patients died, 1 and 31 months after the last angioplasty. In conclusion, percutaneous transluminal coronary angioplasty can be performed safely with an excellent primary success rate in critical focal transplant coronary artery disease. The rate of restenosis is higher than in native coronary artery disease. Long-term follow-up depends on the individually variable accelerated nature of graft atherosclerosis.Abbreviations PTCA percutaneous transluminal coronary angioplasty - TxCAD transplant coronary artery disease - HTX heart transplantation - LAD left anterior decending artery - CFX circumflex artery - RCA right coronary artery     

Percutaneous transluminal coronary angioplasty: morphological findings in 3 patients

Little morphologic information is available on the status of the major epicardial coronary arteries in patients dying after percutaneous transluminal coronary angioplasty. We studied hearts from 3 men (aged 60, 45 and 47 years) dying 3 days, 1 month and 7 months after balloon--dilatation of obstructed coronary artery segments. Twice the left anterior, once the left main coronary artery have been desobliterated. In one patient the procedure has not been successful and a venous bypass graft had to be implanted. Histologically the site of dilatation is clearly recognisable after 7 months. The characteristic findings are intimal tears in the segment opposite to the obstructing plaque. The intimal gaps are filled after 7 months by a neointima. In the dilated left main coronary we find 1 month after angioplasty an extensive proliferation of smooth muscle cells resulting in restenosis. Two patients died suddenly after an interval without angina. In the third patient--ome hours after bypass grafting--spasm of the non-involved right coronary artery occurred resulting in inferior infarction; this patient died 3 days after dilatation.     

Percutaneous transluminal coronary angioplasty in a child with Kawasaki disease.

A successful attempt at percutaneous transluminanl coronary angioplasty (PTCA) to relieve stenosis of the mid-portion of the left anterior descending artery was achieved in a 6-year 9-month old boy who had multiple coronary aneurysms and stenosis due to Kawasaki disease. Despite the progression of coronary stenosis he had been well except for the perfusion defect of the anterior wall of myocardium on 99mTc-MIBI SPECT with dipyridamole infusion until PTCA was carried out after 4-year 4-months of the onset of illness. The area of stenosis was 70% before PTCA and 20% after PTCA. No restenosis at the site of PTCA was observed on follow-up angiography at 26 months after PTCA. This successful attempt may indicate that this procedure should be considered early in subclinical stenosis to prevent ischemic cardiac damage.     

Percutaneous transluminal coronary angioplasty - Histopathological analysis of nine necropsy cases

Summary From 1982 to 1984 nine of 300 patients undergoing transluminal coronary angioplasty died. The nine coronary arteries and one saphenous aorto-coronary by-pass graft affected by angioplasty were studied by light microscopy. The following types of lesions were found, frequently in association: rupture of the plaque, circumscribed or reaching to the intimal layer or extending beyond it, dissections (fissures) between arterial layers, intra-plaque haemorrhage, plaque emboli and thrombosis. In two cases the therapeutic approach was considered to be clinically and pathologically successful; the patients survived 24 h (case 6) and forty days (case 4). Case 6 which presented recent lesions indicative of success showed, in contrast with the other non-successful cases, rupture affecting not only the initimal layer but also deeper structures of the arterial wall. There were also more extensive fissures. Case 4 which presented late alterations indicative of success showed a plaque fracture whose borders were kept apart by fibrous tissue. In conclusion, we believe that angioplasty allows the re-establishment of arterial blood flow by provoking deep intimal and medial rupture producing a small fissure between the arterial layers and a widening of the lumen; in cases with good late results these alterations cicatrize leaving a wider arterial lumen.     

Percutaneous transluminal coronary angioplasty (PTCA) in the therapy of coronary heart disease

Percutaneous transluminal angioplasty (PTCA) has been performed worldwide since 10 years and in Graz since 1980. 1977 6 procedures were performed, 1987 about 100,000 will be done worldwide. PTCA today represents a standard treatment of coronary heart disease in addition to pharmacological and surgical therapy. At the present time about one third of patients with coronary heart disease are treated by PTCA. Primary success rate ranges between 80 and 90%, complication rate has dropped under 4%. Besides patients with one-vessel-disease also those with multi-vessel-disease, reduced left ventricular function and patients with unstable angina and acute myocardial infarction are dilated. The "achilles" heel of PTCA is restenosis, which develops in 25 to 35% of cases within 6 months. At present, research is devoted to avoid or prevent this complication.     

经皮血管内支架成形术治疗颈动脉狭窄26例临床分析

目的:分析总结26例经皮血管内支架置入治疗颈动脉狭窄的方法、适应症和并发症的预防和处理。方法:所选病例均经脑血管造影确诊,围手术期及长期抗血小板聚集治疗,采用经股动脉插管,置入自膨式支架对颈动脉颅外段狭窄进行治疗。结果:26例手术均获得成功,3例出现不同程度脑血管痉挛,1例术中出现微栓子脱落轻度卒中,5例术中出现一过性心动过缓血压下降,2例术后持续性低血压,经积极处理未出现永久并发症,所有病例症状明显好转或消失,影像学上颈动脉狭窄得到有效改善,脑组织血管染色好转;随访5-18个月,未发生明显脑缺血症状,无发现支架内再狭窄病例。结论:颈动脉狭窄血管内支架治疗是一项安全有效的治疗手段,适应证的选择和术后的处理以及娴熟的操作技巧及脑保护装置的使用是手术成功的关键。     

Percutaneous transluminal angioplasty in peripheral arterial occlusive disease

Non-surgical recanalization of arterial obstructions has gained world wide acceptance since the development of the balloon dilatation catheter by Gruentzig. The indication for this treatment depends on the clinical stage of the disease, on the location and extension of the occlusion and on the general clinical situation of the patient. Ideal situations with excellent short- and long-term results are stenoses of the iliac arteries and stenoses and short occlusions of the femoropopliteal arteries, whereas treatment of long occlusions of this region is less successful. Definite recommendations concerning additional medical therapy to improve the early and longterm patency rate cannot be given because of lacking studies. The most important advantage of PTA--compared to surgical recanalization--is the lower complication rate. A further improvement of early and late results can be expected by the combined use of different non-surgical recanalization procedures.     

The role of balloon angioplasty in the management of coronary artery disease

PTCA is a new technique for the treatment of certain patients with coronary artery disease. It involves dilatation of stenotic segments of artery using a balloon catheter, and is carried out in cardiac catheterization laboratories. If successful, the need for coronary bypass surgery may be removed, although some patients with initially successful PTCA will come to surgery eventually. Successful PTCA is associated with relief of angina, improved angiographic appearances and coronary perfusion. The primary success rate is between 65% and 80%, and the restenosis rate approximately 25%. 80% of patients will be angina free one year after PTCA. In this paper the indications, contraindications, technology, results and complications are discussed.