Autologous vein graft-coated stents for the treatment of thrombus-containing coronary artery lesions

Recent studies have shown that stents may have a potential role in the treatment of thrombus-containing lesions. We report on the application of an autologous vein graft-coated stent (AVGCS) as the primary therapeutic modality for acute myocardial infarction in 10 patients. AVGCS delivery and deployment were successful and uneventful. Mean minimal lumen diameter and TIMI trial flow grade increased significantly (from 0.04 ± 0.09 mm pre-AVGCS to 3.02 ± 0.32 mm post-AVGCS, and from 10 patients with flow grade 0–1 pre-AVGCS to 10 patients with flow grade 3 post-AVGCS, respectively). Ten-day angiogram revealed maintenance of the immediate results. Nine patients had a negative exercise stress test 2 mo post-AVGCS, and at a mean follow-up of 30 ± 7 weeks, all 9 were symptom-free. One patient, 3 wk after implantation and while being hospitalized for hypovolemic shock, developed recurrent infarction. These favorable preliminary outcomes suggest that AVGCS may play a useful role in the treatment of thrombus-containing lesions. Cathet. Cardiovasc. Diagn. 40:217–222, 1997. © 1997 Wiley-Liss, Inc.     

Arterial autologous graft-stent for treatment of coronary artery disease: A new technique

The radial artery has been used as a free bypass graft with excellent results. An autologous vein graft-coated stent, a novel type of stent developed at our institution, has been applied successfully under both experimental and clinical conditions. To extend the spectrum of biological linings for coated stents, we used an arterial graft. We describe the first application of the radial artery as an autologous coating for a conventional stent to be used in treatment of coronary artery disease. Cathet. Cardiovasc. Diagn. 40:302–307, 1997. © 1997 Wiley-Liss, Inc.     

Saphenous vein covered stenting for right coronary artery lesion containing thrombus

Vein covered stenting to close coronary pseudoaneurysm and perforation and in the setting of acute myocardial infarction have been described. This case report describes saphenous vein covered stenting to exclude a large thrombus in a right coronary artery lesion. Vein covered stenting may be considered as an option when dealing with a thrombus containing lesion. Cathet. Cardiovasc. Diagn. 42:427–429, 1997. © 1997 Wiley-Liss, Inc.     

经皮冠状动脉内血管成形术中冠状动脉内支架的应用

在经皮冠状动脉内血管成形术(PTCA)中,16例患者因发生冠状动脉内膜剥离,血管急性闭塞及再狭窄而放置冠状动脉内支架,成功15例,认为冠状动脉内支架可有效地防止PTCA术急性并发症(内膜剥离、夹层形成,血管急性闭塞等)的发生.     

Successful closure of coronary-bronchial artery fistula with vein graft-coated stent

A coronary-bronchial fistula and aneurysmal dilatation of the proximal part of the fistula was successfully closed using an autologous vein graft-coated stent (Palmaz-Schatz stent). This is the first report that demonstrates the feasibility of the vein-coated stent for the treatment of congenital disease. Cathet. Cardiovasc. Intervent. 46:214–217, 1999. © 1999 Wiley-Liss, Inc.     

Successful treatment of coronary artery perforation during angioplasty using autologous vein graft-coated stent

We report a case of successful treatment of coronary arteryperforation and cardiac tamponade with an autologous vein graft-coatedstent, which were developed during percutaneous transluminalcoronary angioplasty. The method reported here may be an effectivealternative to emergency surgery and should be considered whencoronary artery perforation does not respond to conventionalprolonged inflation with perfusion catheter.     

Polytetrafluoroethylene-covered stent and coronary artery aneurysms.

Angiographically detected coronary aneurysms (i.e., coronary segment greater then 1.5 times the normal artery) have an incidence of 0.3%-4.9% among patients undergoing coronary angiography and have been reported after an intervention procedure with a frequency of 2%-10%. The indication for treatment and the best modality still need to be defined. Some authors reported the successful treatment of coronary aneurysms with the polytetrafluoroethylene (PTFE)-covered stent implantation, supporting the role of this strategy. In our institution, from September 1997 to December 1999 eight PTFE-covered stents were implanted to treat seven coronary aneurysms in seven patients. All aneurysms were successfully treated by the PTFE-covered stent. In one case, there was the necessity of an additional PTFE stent to cover the aneurysm completely. In no case did the loss of stent occur. No in-hospital MACE occurred. At 35 +/- 8 (21-44) months, six patients were symptom-free. Angiographic follow-up was performed in all patients at 10 +/- 6 months. Restenosis occurred in one patient (14%) who had repeat percutaneous coronary interventions. This preliminary experience suggests that PTFE-covered stent may be useful in the treatment of coronary artery aneurysms.     

Bail-Out coronary stenting in an extremely tortuous right coronary artery with the palmaz-schatz stent and teleguide sheath

Significant vessel tortuosity is a relative contraindication to the use of the Palmaz-Schatz coronary stent for fear of stent displacement during delivery. We describe a patient with unstable angina in whom conventional coronary angioplasty in an extremely tortuous right coronary artery resulted in an occlusive dissection. Emergency bypass surgery was avoided by the successful placement of a protected Palmaz-Schatz stent using a 5F Teleguide sheath. © 1993 Wiiey-Liss, Inc.     

Early clinical experience with the implantation of a novel synthetic coronary stent graft

Coating stents with autologous venous grafts has been suggested to prevent problems associated with conventional stenting, but the need for surgical vessel harvest hampered broad application. A novel synthetic coronary stent graft (CSG) overcomes this limitation by a synthetic membrane, fixed between two thin metallic stents. We successfully implanted 21 CSGs in 18 patients for treatment of acute coronary rupture, thrombus-containing lesions, and lesions with plaque rupture or adjacent pseudoaneurysm. Substantial residual angiographic diameter stenoses were seen in seven CSGs (25% ± 10% vs. 8% ± 6%; P < 0.01), which were implanted with relatively small balloon catheters (balloon-to-artery ratio 1.00 ± 0.09 vs. 1.24 ± 0.18; P = 0.01) and required postdilatation. Overall, the largest balloon catheter applied measured 4.0 ± 0.7 mm (balloon-to-artery ratio 1.21 ± 0.20) and the inflation pressure was 16 ± 3 atm. Final intravascular ultrasound imaging demonstrated adequate and symmetrical expansion of the CSG (≥85% ± 15% of the reference lumen). Elective implantation was associated with two small non–Q-wave myocardial infarctions, resulting from unavoidable occlusions of side branches. Thus, implantation of CSG is feasible and safe. Adequate expansion can be achieved by the use of relatively large low-compliant balloon catheters inflated with high pressure. Cathet. Cardiovasc. Intervent. 47:496–503, 1999. © 1999 Wiley-Liss, Inc.     

Rotational ablation and stent placement for severe calcific coronary artery stenosis after Kawasaki disease.

We report on a 5-year-old child who had an episode of Kawasaki disease with giant coronary artery aneurysms at the age of 4 months. Surveillance coronary angiography showed severe calcific stenosis in the proximal left anterior descending artery. Balloon angioplasty failed to resolve the obstruction. Rotational ablation was therefore performed. Surveillance angiogram performed 6 months after rotational ablation showed critical restenosis. Rotational ablation was therefore repeated, followed by stent placement. To the best of our knowledge, this is the youngest child who has undergone coronary stenting after Kawasaki disease.     

Obliteration of a coronary artery aneurysm with percutaneous transluminal coronary angioplasty and stent placement

We report the first case of obliteration of a coronary artery aneurysm by angioplasty and Palmaz-Schatz stenting. Cathet. Cardiovasc. Diagn. 41:51–52, 1997. © 1997 Wiley-Liss, Inc.     

Ultrasound as treatment for coronary artery disease

Therapeutic ultrasound is already established in the treatment of diverse surgical conditions, such as cataract, liver cancer, and stones, without danger to healthy tissue. Clinical trials of catheter-delivered, high energy, low frequency (kHz) ultrasound undertaken over the last decade have demonstrated the safety of ultrasound in the treatment of peripheral and coronary artery disease, and have identified a number of indications in which it may be particularly advantageous. The dispersal of thrombus, the recanalization of chronic total occlusions, and the favorable modification of the distensibility of small, atherosclerotic vessels are three promising areas. The authors review developments in these fields.     

A stepwise strategy for the stent treatment of bifurcated coronary lesions.

Several observational studies have shown a better late outcome in patients with coronary bifurcation lesions treated with stents in whom the side branch was not stented. Balloon dilation and provisional stenting for the side branch seem an attractive strategy to manage these challenging types of lesions. This study evaluated the results of a three-step phase strategy in the stent treatment of bifurcated coronary lesions. We treated 126 patients, 58 +/- 11 years old, with major coronary bifurcation stenosis. The therapeutic procedure was undertaken following three phases; progression through each phase was triggered by the failure of one procedure to achieve a <50% residual stenosis at the side branch: in the first step, balloon angioplasty of the side branch followed by stenting of the parent vessel; in the second, balloon redilation of the side-branch origin across the metallic structure of the stent; in the third, stenting of the side-branch origin. Immediate success was achieved in 116 patients (92%). Angiographic results in each phase were as follows: in the first step, 35 patients (28%) had procedural success, 3 patients had failure, and 88 crossed to the next step; in the second, 76 patients (86%) had procedural success, 7 patients had failure, and 5 crossed to the next step; in the third, all 5 patients had procedural success. The overall major cardiac event-free probability at 15 months was 78%. Target vessel revascularization took place in 19 patients (15%) and when stratified by phases were 13% of patients treated in the first step, 16% of patients in the second step, and 20% of patients in the third step. Patients with coronary stenosis at major bifurcations may be treated following an unitary stepwise approach. This attitude may avoid side-branch stent implantation in most patients, providing good immediate and long-term results.     

Flow support catheter for prolonged maintenance of coronary blood flow

A newly designed flow support catheter with a supporting wire mesh cage which can be expanded into a tubular configuration and then readily reduced was evaluated in mongrel dogs. Regional myocardial blood flow (RMBF) was measured using the radioactive microsphere technique in the area of both balloon-denuded instrumented and control non-instrumented coronary arteries following placement of either a fixed-wire or a higher profile rapid exchange flow support catheter. At 5, 20, and 180 min following delivery and expansion of either device, RMBF was not significantly different in left ventricular subepicardium and subendocardium perfused by the instrumented vs. the control coronary arteries. Angiography demonstrated widely patent instrumented arteries in 15/18 dogs; in no dog was side branch occlusion observed. Significant cage thrombus deposition was seen angiographically in 3 animals causing temporary total coronary occlusion in 1. Following reduction and removal of the flow support catheter, vessel patency was present in all dogs. The flow support catheter is an effective endovascular stenting device capable of providing structural arterial support, while simultaneously maintaining distal coronary blood flow. It is envisioned that the primary application of this catheter will be to enable primary salvage of vessels acutely injured during coronary angioplasty, by “tacking up” intimal flaps for an extended period. It may also provide a bridge to emergency surgical revascularization.     

A new adjustable temporary stent catheter for management of acute dissection during balloon angioplasty

Acute coronary dissection remains a limitation of percutaneous transluminal coronary angioplasty. For the management of acute coronary dissection, a new adjustable temporary stent catheter that can be positioned to the lesion, deployed, and retrieved at a later stage was developed. This catheter has at its distal end a spiral stent that can be reduced and expanded in a controlled fashion by external manipulations. The adjustable temporary stent catheter was applied in three clinical cases with acute coronary dissection during balloon angioplasty. In all cases, the adjustable temporary stent catheter restored blood flow when it was expanded to the lesion for 60 min and this restoration was maintained after device removal. It is envisioned that this temporary stent device may prove a useful means for the treatment of acute coronary dissection during percutaneous transluminal coronary angioplasty. © 1996 Wiley-Liss, Inc.     

Treatment of coronary artery disease in an anomalous coronary artery by placement of an intracoronary stent

We report the use of coronary stenting to treat disease in an anomalous coronary artery. The patient had a single coronary artery with anomalous left anterior descending artery arising from the right sinus of Valsalva and coursing between the aorta and pulmonary artery. Although balloon angioplasty has been used in patients with anomalous coronary arteries, this is the first report of stent placement in this circumstance. Cathet. Cardiovasc. Diagn. 41:185–188, 1997. © 1997 Wiley-Liss, Inc.     

Thrombotic occlusion of the coronary artery associated with accidental detachment of undeployed Palmaz-Schatz stent

We describe a case of coronary stenting in which accidental detachment of the Palmaz-Schatz stent induced thrombotic occlusion of the coronary artery. This case suggests that careful consideration of the risk involving coronary occlusion is mandatory on deciding the therapeutic strategy of the cases in which the unexpanded coronary stent cannot be retrieved following unsuccessful deployment. © 1996 Wiley-Liss, Inc.     

冠状动脉支架术后不同抗凝药物的疗效观察

目的 :观察经皮腔内冠状动脉成形术 （PTCA） +支架置入术后不同抗凝药物对各种心脏事件发生的影响以及其副作用。方法 :对 884例冠心病患者置入 12 3 2个支架 ,在 6～ 12月的短期随访中 ,观察术后不同抗凝药物和抗血小板药物对 PTCA+支架术后各种心脏事件发生的影响以及其副作用。结果 :在 PTCA +支架术后 ,抗凝药物可使各种心脏事件发生率有显著降低 ,使用阿斯匹林 +噻氯匹定及低分子肝素后未发生严重出血并发症及支架内血栓。结论 :PTCA +支架术后使用不同抗凝药物和抗血小板药物效果没有明显差异     

地塞米松涂层支架治疗小直径冠状动脉病变的初步研究

目的　评价以磷酸胆碱为载体的地塞米松涂层支架 (PC MATRIX)治疗小直径冠状动脉病变的临床效果。方法　前瞻性分析了 82例患者 10 6枚小直径支架置入的临床成功率、心脏事件(MACE)及远期疗效。PC MATRIX支架组 4 1例 (支架 5 4枚 ) ,PC支架组 4 1例 (支架 5 2枚 )。结果　两组患者手术成功率均为 10 0 % ,PC MATRIX支架组的MACE率为 9 8% ,PC支架组为 2 2 0 % ;临床再狭窄率分别为 4 9%和 2 3 0 % ;造影再狭窄率分别为 6 2 %和 2 9 7% ,两组间统计学差异有显著性。结论　PC MATRIX支架治疗小直径冠状动脉病变的手术成功率高 ,术中、术后严重的心脏事件发生率低 ,并可能降低冠状动脉小血管病变支架再狭窄发生率。     

Intravascular stenting of the right internal mammary artery

Despite its tortuous course and small caliber, percutaneous transluminal coronary angioplasty of the internal mammary artery can be performed with a high initial success rate (82–94%). The successful deployment of a balloon expandable coll stent at the mid-right internal mammary artery in a patient with recurrent stenosis of that graft is reported.