Clinical long-term results of percutaneous transluminal angioplasty in patients with peripheral arterial occlusive disease

BACKGROUND: We investigated the long-term clinical results of percutaneous transluminal angioplasty (PTA) in patients with peripheral arterial occlusive disease (PAOD) and the influence of different parameters on the primary success rate, the rate of complications and the long-term outcome. PATIENTS AND METHODS: We reviewed clinical and hemodynamic follow-up data of 166 consecutive patients treated with PTA in 1987 in our department. RESULTS: PTA improved the clinical situation in 79.4% of patients with iliac lesions and in 88.3% of patients with femoro-popliteal lesions. The clinical stage and ankle brachial index (ABI) post-interventional could be improved significantly (each P < 0.001), the same results were observed at the end of follow-up (each P < 0.001). Major complications occurred in 11 patients (6.6%). The rate of primary clinical long-term success for suprainguinal lesions was 55% and 38% after 5 and 10 years (femoro-popliteal 44% and 33%), respectively, the corresponding data for secondary clinical long-term success were 63% and 56% (60% and 55%). Older age (P = 0.017) and lower ABI pre-interventional (P = 0.019) significantly deteriorated primary clinical long-term success for suprainguinal lesions, while no factor could be identified influencing the outcome of femoro-popliteal lesions significantly. CONCLUSION: Besides an acceptable success rate with a low rate of severe complications, our results demonstrate favourable long-term clinical results of PTA in patients with PAOD.     

Percutaneous transluminal laser angioplasty in peripheral arterial occlusive disease--development of a new laser catheter system

Percutaneous laser angioplasty in arterial occlusive disease has lately been performed clinically for the first time. Perforation of the arterial wall and formation of aneurysms are serious risks. Two novel laser catheters for laser angioplasty with minimized perforation risk are presented. Catheter I (5F) and II (6.3F) are designed in the same manner. The distal tip of these catheters is ovally formed and marked by a small X-ray dense metal ring. The silica fiber has a core diameter of 400 micron (I) respectively 600 micron (II). Its tip is also marked X-ray densely and therefore the position of the fiber tip can be controlled exactly during laser angioplasty. Using a guide wire and applicating short laser pulses the perforation risk can be minimized. In a total of 132 atherosclerotic stenosed or obstructed human arteries laser angioplasty was performed in vitro using a Nd:YAG laser. There were two perforations (1.5%). The degree of stenosis was reduced from 87 (90)% to 54 (52)%. Using the 600-micron-fiber (catheter II) the velocity of laser angioplasty was increased 2.5 times compared to laser angioplasty using the 400-micron-fiber.     

Case of spontaneous healing of occlusive dissection on percutaneous transluminal coronary angioplasty

A large pseudolumen due to dissection arose during percutaneous coronary angioplasty. The true lumen was compressed critically. However, no infarction took place because of good collaterals. During medical follow-up, the patient's angina vanished suddenly. The repeat angiography showed healing of the dissection and patency of the coronary artery.     

Renal arterial pathology after percutaneous transluminal angioplasty

Percutaneous transluminal angioplasty (PTA) has been shown to cause cracking of the intimo and atherosclerotic plaque in the renal arteries of two cases, who died from incidental causes about a week after the procedure. In addition, movement or redistribution of atheromatous gruel was seen into the cracks and dissections at the intima-medial junction and media. Thus, enlargement of the lumen by redistribution of the lipid mass by 'warm flow' may be an important beneficial result of angioplasty. One case also showed severe fragmentation of medial elastic fibres at the orifice, with rupture of the internal elastic membrane.     

Light and electron microscopic study of pathomorphological changes on the arterial wall after transluminal angioplasty

The vascular complications arising after the percutaneous transluminal angioplasty (PTA) of the arteriosclerotic stenosis in the right superficial femoral artery of a 70-year old female patient six days prior to her death were studied by means of light microscopy and with the transmission and scanning electron microscopes. The pictures revealed disruption in the vascular wall of the superficial femoral artery, fresh thrombus in the dissecting aneurysm of arteriosclerotic origin in the distal part of the posterior tibial artery and haemorrhage in the media. A connection is suggested between these findings and the angioplastic intervention. To the best of the authors' knowledge this was the first time that in vivo developed vascular changes after PTA were studied by means of light microscopy and with the transmission and scanning electron microscopes.     

Long-term effects of transluminal coronary angioplasty. French multicenter study

Although transluminal coronary angioplasty is now acknowledged as an effective treatment for coronary artery disease, the long-term outcome of patients treated by this method is still under evaluation. A french multicenter trial was set up and the long-term efficacy of transluminal coronary angioplasty was assessed in 546 patients undergoing the procedure before the 31/3/83. 380 initial successes (69 p. 100) were followed up for a period ranging from 6 to 48 months (average 19.9 +/- 10.4 months). A control coronary angiography was carried out in 88 p. 100 of cases. Restenosis (loss of over 50 p. 100 of initial angiographic improvement) was observed in 27 p. 100 of cases. Including the repeat procedures, the patency rate of the dilated vessels was 82 p. 100. Progression of atherosclerosis on another coronary artery was observed in 1.3 p. 100 of cases. After transluminal coronary angioplasty, 72 p. 100 of patients remained improved, 11 p. 100 underwent repeat angioplasty, 8 p. 100 underwent coronary bypass surgery, 1.3 p. 100 suffered myocardial infarction and 1.3 p. 100 died. Restenosis was associated with recurrence of angina pectoris in 90 p. 100 of cases (within 3.3 +/- 1.6 months) and a positive exercise stress test in 87 p. 100 of cases. Recurrence of angina due to progression of disease on the dilated vessel was observed in 24.2 p. 100 of cases; repeat transluminal coronary angioplasty was carried out for this indication in 38 p. 100 of cases, coronary bypass in 34.8 p. 100 and medical treatment was continued in 27.2 p. 100 of cases.(ABSTRACT TRUNCATED AT 250 WORDS)     

Management of intracoronary thrombosis complicating percutaneous transluminal coronary angioplasty

With technological advances in equipment and increased experience of operators, the success rates of percutaneous transluminal coronary angioplasty (PTCA) now exceed 90%. However, acute periprocural occlusion continues to complicate approximately 6% of all procedures, and many of these occlusions are due to intracoronary (IC) thrombus. Patients at highest risk for this complication include those with acute ischemic syndromes or with angiographically apparent thrombus. These individuals may be candidates for the use of prolonged heparin infusions prior to dilatation, intracoronary thrombolytic therapy, or monoclonal antibody directed against the platelet glycoprotein IIb/IIIa receptor. All patients undergoing PTCA should receive adequate anti-platelet therapy, including aspirin, and heparin with dosing monitored by activated clotting times (ACT). In addition, some recommend the use of ionic contrast material. When IC thrombus accumulates following intervention, initial therapy should include IC nitroglycerin followed by a combination of redilatation and IC urokinase infusion. Prolonged balloon inflations may be useful, particularly with the use of autoperfu-sion catheters. Platelet glycoprotein IIb/IIIa receptor antagonists may prove to be beneficial in this situation as well. If the patient's clinical status deteriorates in spite of these measures, emergency coronary artery bypass graft surgery may be required.     

Successful transluminal angioplasty of renal arterial stenosis using the transcarotid approach

We successfully performed percutaneous transluminal angioplasty to treat severe renovascular hypertension with left ventricular failure in a 5-month-old infant. Using the transcarotid approach, we dilated the stenotic left renal artery without any difficulties, using progressively larger balloons designed for dilation of coronary arteries.     

新西兰白兔髂动脉植入新型“支撑者”支架的初步实验研究

目的：观察“支撑”支架的性能,疗效,以求研制成技术性能达标的国产化支架。方法：（1）急性血栓形成检测：雄性新西兰白兔10只,髂动脉支架植入术后24h行髂动脉造影术。（2）中远期疗效检测：雄性新西兰白兔20只,给予高胆固醇饲料（4％胆固醇）饮食1个月后行髂动脉支架植入术,随机分为2组：（1）30天组10只,于术后1个月行动脉造影术。（2）60天组10只,术后2个月行髂动脉造影术。30天组9只动物完成实验,60天组8只动物完成实验。结果：（1）共27只兔完成实验,27个支架植入成功23个（成功率85．2％）,（2）急性血栓形成检测：10个支架,9个完全张开,未见血栓形成,血流TIMI Ⅲ级,1个脱落。（3）中远期疗效检测：（1）30天组（n=9)：7个支架在髂动脉完全张开,1个在腹主动脉下段完全张开,未见血栓及狭窄,血流TIMIⅢ 有,1个脱落,（2）60天组（n=8)：6个支架完全张开,未见狭窄,2个脱落。．（4）无其他并发症发生。结论：支撑支架性能稳定,没有出现支架内急性,亚急性血栓形成和狭窄。     

The haemodynamic effects of percutaneous transluminal angioplasty

The aim of the study was to measure the haemodynamic effect of percutaneous transluminal angioplasty (PTA). Twenty-one consecutive patients with unilateral stenosis of the iliac (n = 13) or femoropopliteal arteries (n = 8) causing intermittent claudication were studied with ankle and brachial systolic pressure measurements before and after PTA and at six monthly intervals. In 15 patients, the pressures were measured not only at rest, but after exercise on a standard treadmill. There were six technical failures. All of the remaining patients were improved clinically and objectively. The resting pressure index increased from mean (+/- ISD) of 0.65 +/- 0.22 to 0.88 +/- 0.17 and the postexercise index from 0.43 +/- 0.21 to 0.82 +/- 0.22. The preoperative claudication distance was improved from 83 m +/- 31 to 252 m +/- 104 and the recovery time from 6.3 mins +/- 5.7 to 1.5 mins +/- 2.3. During the follow up period of six weeks to 2 1/2 years, the initial improvement was maintained and there were no failures clinically or on further Doppler examination. The results suggest that for patient with a single significant stenosis, PTA is an effective alternative method of treating claudication.     

Percutaneous transluminal angioplasty for ischaemic arterial disease of the lower extremities

We attempted percutaneous transluminal angioplasty (PTA) in 43 patients with limb-threatening ischaemia (rest pain, nonhealing ulcer or gangrene) or lifestyle-limiting claudication. Of the 51 lesions dilated, 31 were in iliac, 12 in femoral, 6 in popliteal and 2 in tibial arteries. Overall primary success rate was 90.2 percent (46/51); 96.8 percent (30/31) in iliac, 83.3 percent (10/12) femoral, 66.7 percent (4/6) popliteal and 100 percent (2/2) in tibial arteries. Marked relief of ischaemic symptoms and increase in ankle-arm pressure index from 0.45 +/- 0.14 to 0.94 +/- 0.23 (P less than 0.005) were seen in the 39 patients with initial technical success. Three (6.9%) patients had minor complications. On 1-33 (mean 13.4 +/- 7.5) months follow up, 89.5 percent patients showed continued clinical improvement as well as improvement in noninvasive parameters of lower limb perfusion. We conclude that angioplasty of iliac, femoral, popliteal and tibial arteries is a highly effective and safe procedure to revascularize the ischaemic lower extremity.     

犬脑血管痉挛经皮腔内血管成形术治疗

目的　探讨经皮腔内血管成形术 (PTA)治疗顽固性脑血管痉挛的可行性和效果。方法　成年杂种犬 2 0只 ,采用枕大池两次注血模型。应用扩张后直径为 1.5mm的硅胶球囊 ,扩张压力为 2个大气压、持续时间 10s,在痉挛的基底动脉近、远端分别扩张 1次。结果　 2 0只犬的基底动脉均发生痉挛 ,为其中的 14只进行了PTA治疗 ,成功13只、死亡 1只 ;另外的 6只犬 ,由于血管解剖原因 ,无法进行PTA操作。PTA治疗后 ,痉挛的基底动脉明显扩张 ,犬神经功能恢复明显加快。 2 0d后复查脑血管造影 ,接受PTA治疗犬的基底动脉显影基本正常 ,而未进行PTA治疗犬的基底动脉仍有明显的痉挛。结论　PTA是治疗顽固性脑血管痉挛的一种有效方法     

Percutaneous transluminal coronary angioplasty for chronic total coronary arterial occlusion

Experience is reported with 100 consecutive patients in whom percutaneous transluminal coronary angioplasty (PTCA) was attempted on chronically occluded coronary arteries that had no visible anterograde flow. Ninety-eight patients had angina and all had collateral vessels to the occluded artery on angiography. A movable guidewire/dilatation system was used in all cases. Overall initial PTCA success rate was 56% and was related to duration of occlusion (69% success rate for occlusions of 1 month or less, 50% for 1 to 6 months and 11% after 6 months). Complications were minor; no patient died or required emergency bypass operation. Of the 44 patients in whom PTCA failed, 20 underwent elective bypass surgery for relief of angina and 24 were treated medically. Follow-up at a mean of 8 months (range 1 to 48) was available for 49 of the 56 patients in whom PTCA was successful: 40 had subjective improvement, 6 no change and 3 felt worse. Control angiography was carried out in 40 of the 56 patients with primary success and showed long-term success in 18 and reocclusion or significant stenosis in 22. Of these 22, 11 were successfully treated by a second PTCA, 2 underwent operation and 9 were treated medically. Recanalization of totally occluded coronary arteries with no forward flow has a lower initial success rate (56%) than PTCA for stenoses and the recurrence rate is higher (55%), but effective relief of angina is achieved in successful cases. The risk of serious complications appears to be low.     

Acute coronary occlusion during transluminal angioplasty: role of coronary thrombosis

We here report on 2 patients treated by transluminal coronary angioplasty, who presented baseline angiographic aspects of an intracoronary thrombus upon vessel stenosis. In both cases mechanical dilatation was successful in increasing vessel diameter, but was complicated by activation of the thrombotic process with clot proliferation--as shown by multiple coarse filling defects irregularly stained by contrast material--and vessel occlusion. The intracoronary injection of streptokinase achieved partial slowing of the thrombotic process, but did not succeed in inhibiting it completely or in restoring vessel patency. As clinical conditions were stable, the patients were not sent to emergency surgery, but were treated conservatively with anticoagulants and platelet inhibitors: in only one patient the procedure was followed by moderate myocardial enzyme release. In both cases the coronary artery was patent at short term angiographic control. These 2 cases confirm that in the outset of transluminal angioplasty an acute coronary occlusion can be managed conservatively by thrombolytic treatment when thrombus formation can be clearly identified the cause of vessel occlusion: the activation of spontaneous lytic systems can completely restore vessel patency. If coronary occlusion was of short duration or collateral supply was adequate, myocardial infarction may not occur and emergency coronary surgery will not be necessary.     

Effect of simvastatin on restenosis after percutaneous transluminal angioplasty of femoropopliteal arterial obstruction

This retrospective observational intravascular ultrasound study evaluated whether simvastatin therapy limits lumen area reduction 1-year after percutaneous transluminal angioplasty (PTA) by reducing reactive plaque growth, reducing reactive vasoconstriction, or both. This study showed that plaque growth is a general response 1 year after PTA regardless of the use of simvastatin; simvastatin has the potential to induce positive vascular remodeling, thereby reducing the occurrence of restenosis.