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)     

Percutaneous transluminal coronary angioplasty through 4 french diagnostic catheters

The use of 4 French (4F) diagnostic catheters as guiding catheters for coronary angio-plasty using fixed-wire balloons in 2 patients with a stenosis of the right and left anterior descending coronary artery, respectively, is reported.     

A simple approach for the reduction of knotted coronary catheter in the radial artery during the transradial approach

Development of a catheter knot is uncommon but still a matter of concern for a catheterizing cardiologist. There are only a few case reports of percutaneous catheter unknotting in the literature. We describe for the first time a case of catheter unknotting in a radial artery using a simple technique via the transradial approach. We concluded that percutaneous catheter unknotting in a radial artery using basic and simple hardware is a good alternative option to surgical management.     

Percutaneous atherectomy catheters

Percutaneous atherectomy catheters have been developed as an alternative to balloon angioplasty for the treatment of atherosclerotic disease. This article summarizes the preliminary experimental and clinical results with these catheters.     

Percutaneous right brachial artery approach with 5F catheters for studying coronary artery disease

We prospectively studied 60 ischemic patients with 5F catheters (Pigtail and Amplatz) using the percutaneous right brachial artery approach (group I), in order to compare this technique with two groups of 100 patients each randomly studied by the femoral route with either 5F (group II) or 8F (group III) catheters (Pigtail and Judkins). The following parameters were analyzed: need to change the initially elected catheter diameter or/and artery approach; technical difficulty for obtaining LV, LCA, and RCA angiograms; total time of X-ray exposure; quality image of LV, LCA, and RCA angiograms; incidence of arterial puncture related hematomas or total arterial occlusion; and duration of local compression after sheath removal. There were no differences between 5F brachial and femoral approaches except for the arterial compression time (p less than 0.01) and the X-ray exposure time (p = 0.03) which were longer with the brachial approach. Whatever the route used, 5F showed a mild increase difficulty (brachial p = 0.001; femoral p = 0.01) and a mild decreased quality image for LCA (branchial p = 0.006; femoral p less than 0.05). Mild hematomas were more frequent with 8F catheters (p less than 0.05). The procedure could be completed by the elected first artery and type of catheter (5F or 8F) in 57/60 patients in group I, in 95/100 in group II, and in 96/100 in group III (nonsignificant differences). Thus, the percutaneous right brachial artery approach using 5F catheters is similar to the femoral artery approach with the same catheters. Although both of them showed a mild increased technical difficulty and a mild decreased quality image compared to 8F, mainly for LCA angiograms, they allowed complete and reliable angiograms reading and analysis.     

Percutaneous femoral artery coronary arteriography. 300 consecutive cases with French 5 catheters

Owing to the ever growing practice of coronary angioplasty, each patient is subjected to multiple examinations and it has become imperative, both for ethical and functional reasons, to reduce the morbidity of coronary arteriography. For this purpose, reduction in the caliber of catheters is a step forward which must be made without altering the procedure and even while making it simpler (shorter stay in bed and in hospital). Between april, 1986 and january, 1987, 300 consecutive coronary arteriographies were performed in a uniform manner and using 5 French catheters in 239 men (mean age 55.4 years) and 61 women (mean age 60.3 years). There were 13 "failures" (4 p. 100) in the sense that the examination was pursued with conventional 7 F or 8 F catheters, or that the brachial route was used. Bilateral femoral puncture was necessary in 6 cases (2 p. 100), and 2 complications (0.7 p. 100) were observed: subacute femoral thrombosis in one case, and regressive cerebral vascular accident in another patient. Thus, it seems permissible and more convenient nowadays to perform all coronary arteriographies with a 5 French catheter. The femoral route can be used in ambulatory patients who get up 4 hours after the procedure.     

Percutaneous insertion of subclavian Hickman catheters

We have assessed the percutaneous insertion of Hickman catheters implanted directly into the subclavian vein; 116 catheters were inserted in 86 patients. The catheters were all inserted by members of the haematology staff. The majority of the catheters were inserted under local anaesthetic in a haematology ward with filtered positive pressure ventilation. X-ray screening was not routinely used. The average patient age was 45 years and the average platelet count was 155 x 10(9)/l. Sixty-seven per cent of the catheters either remain in situ or have been removed electively or at death. The remainder have been removed for a variety of reasons (infection 10%, suspected infection 8%, accidental dislodgement 7%, thrombosis 4%, catheter blockage 3%, catheter fracture 0.9%). The only complication specific to direct subclavian puncture was pneumothorax (4%). This disadvantage may be offset by rapid insertion, a cosmetically superior result and the avoidance of surgical and operating theatre time.     

Precurved catheters for transbrachial coronary arteriography

A series of precurved catheters has been designed for use in coronary arteriography through the brachial artery. They facilitate entry of the coronary arteries, especially the left, from abnormal aortas. Their use has reduced the necessity for flushing the sinus of Valsalva as a method for viewing the coronary arteries, improved the quality of films obtained in difficult cases, and reduced fluoroscopic manipulation.     

Precurved catheters for transbrachial coronary arteriography

A series of precurved catheters has been designed for use in coronary arteriography through the brachial artery. They facilitate entry of the coronary arteries, especially the left, from abnormal aortas. Their use has reduced the necessity for flushing the sinus of Valsalva as a method for viewing the coronary arteries, improved the quality of films obtained in difficult cases, and reduced fluoroscopic manipulation.     

A rapid, effective technique for retrograde crossing of valvular aortic stenosis using standard coronary catheters

Retrograde crossing of valvular aortic stenosis can be challenging even to experienced angiographers. In 446 of 447 consecutive patients with aortic stenosis catheterized during the past 3 years, a technique using a standard Judkins right coronary catheter and a floppy straight tipped guide wire was successful in rapidly and efficiently crossing these pathologically distorted valves in retrograde fashion. Once the valve was crossed, the coronary catheter was replaced with a pigtail catheter for pressure and ventriculography. The majority of these valves required less than 2 min to cross using this technique. This method is valuable in limiting the time required for catheterization, thus helping to reduce procedure related morbidity in these oftimes critically ill patients.     

Preformed catheters for simplified transbrachial coronary arteriography

The experience in 700 patients of transbrachial selective coronary arteriography using a preformed catheter is described. The excellent plastic memory and torque control of the polyurethane catheter combined with the characteristic gentle curve permit rapid and easy intubation of the coronary arteries. The so-called ?difficult”? cases encountered with the classic Sones technique have been catheterized with ease employing the technique described in this report. The exceptionally low complication rate (no deaths), abbreviated catheterization time, a success rate of 99.2%, and the high quality cine angiographic films make this technique a highly useful and effective method of transbrachial coronary arteriography.     

Percutaneous coronary intervention for stable coronary artery disease

Patients with significant coronary artery stenoses are at increased risk of future cardiac events. However, in the absence of acute coronary syndrome or recent myocardial infarction and residual ischemia, elective percutaneous coronary intervention has not been shown to improve prognosis. Possible explanations for this might be the limited follow-up time adopted by most randomized trials comparing percutaneous coronary intervention with medical therapy, limited number of patients with proven ischemia enrolled in these trials, and adoption of complex, elaborate techniques that have not proved their usefulness. Published evidence identifies certain indications for percutaneous coronary intervention in patients with stable coronary lesions: demonstration of significant inducible ischemia, particularly in the context of a recent myocardial infarction; detection of unequivocally reduced fractional flow reserve; and specific angiographic features of coronary stenoses. Operators should take into account long-term consequences of adopted techniques rather than immediate angiographic results. We review existing evidence and provide our recommendations in this setting.     

Clinical evaluation of soft-tipped catheters for coronary angiography

New soft-tipped Judkins catheters for coronary angiography were compared with conventional femoral catheters for coronary angiography in a randomized, controlled fashion with cross-over exchange of catheters when problems occurred. The problems encountered with a first generation of soft-tipped catheters (n = 113) versus conventional catheters (n = 103) were as follows: difficult introduction 27% versus 1% (p < 0.01), difficult placement 13% versus 8% (not significant), difficult aspiration 4% versus 0% (p < 0.05), wedging 5% versus 0% (p <0.05), spasm 3% versus 0% (not significant), overselectivity 7% versus 2% (not significant), cross-over necessary and successful 18% versus 1% (p < 0.01). Problems with a second generation of soft-tipped catheters (n = 200), modified according to the experience gathered from the first generation, versus conventional catheters (n = 194) were as follows: difficult placement 10% versus 7%, difficult aspiration 2% versus 0.5%, wedging 2% versus 1%, spasm 1% versus 0%, overselectivity 3% versus 2%, ventricular fibrillation 1.5% versus 0%, cross-over necessary and successful 3% versus 2%. None of the differences attained statistical significance. The performance of soft-tipped catheters for coronary angiography was inferior for the first generation but comparable for the second generation to that of conventional catheters. In terms of safety, soft-tipped catheters were not superior on the basis of our criteria.     

Percutaneous coronary intervention for diffuse coronary artery disease

Patients with diffuse coronary artery disease present a significant management problem. It has been proposed that diffuse coronary disease is unsuitable for balloon angioplasty and surgical treatment is not ideal either. We review the evidence that coronary balloon angioplasty is not a suitable treatment for diffuse coronary disease and examine the role of alternative interventional techniques. New techniques including long angioplasty balloon catheters and atherectomy devices have shown promise. If this is confirmed by prospective randomized trials then coronary angioplasty may yet prove an attractive treatment for diffuse coronary disease.