Double wire technique for additional guiding catheter support in anomalous left circumflex coronary artery angioplasty

This case report presents an example of the use of the double wire technique for additional guiding catheter bracing support in percutaneous transluminal coronary angioplasty (PTCA) of a stenosis in an anomalous circumflex (CX) artery arising within the ostium of the right coronary artery (RCA). It illustrates the ease of this technique in comparison to conventional guiding catheter cannulation, which may be more difficult and yield poor backup support in this unusual anatomic situation.     

Usefulness of coronary MR angiography prior to angioplasty

The range of indications for percutaneous transluminal coronary angioplasty (PTCA) has increased greatly since the procedure was initially introduced. The success rate depends on the anatomy and length of the occlusion and on the state of the distal vessel. We present a case where the use of magnetic resonance angiography (MRA) allowed to evaluate the length of a subtotal occlusion prior to PTCA, and thus could have had an impact on therapeutic decisions. Coronary MR angiography is one of the many applications of breathhold MRI, where breathholding and segmented k-space acquisition are combined to provide anatomical images of coronary vessels. Coronary MR angiography allows reproducible visualization of coronary vessels. Even under adverse circumstances (poor cardiac triggering) the images are sometimes of sufficient quality to help make a diagnosis. This capability may increase the as yet limited clinical use of MR technology in the practice of cardiology.     

Early and late morphologic changes in human coronary arteries after percutaneous transluminal coronary angioplasty

Certain clinical and morphologic observations are described in 6 men who had percutaneous transluminal coronary angioplasty (PTCA) of the left anterior descending (LAD) or right (R) coronary artery early (4 hours to 7 days) or late (80, 90, and 150 days) before coronary endarterectomy and aortocoronary bypass grafting or death. Histologically, each of the 3 early patients had the site of PTCA narrowed 76–95% in cross-sectional area by atherosclerotic plaque, and each had either coronary dissection or plaque hematoma or both at the site of PTCA. Each of the 3 late patients had a decrease in the mean trans-stenotic coronary gradient (17, 38, and 43 mmHg, respectively) and an angiographic increase in the LAD luminal diameter (55, 60, and 65%, respectively) at the time of PTCA. At necropsy, 80, 90, and 150 days later, the LAD coronary artery in the area of the PTCA in each patient was narrowed 76–95% in cross-sectional area by plaques. No cracks in plaques or other lesions which may have resulted from the PTCA procedure were identified histologically in the LAD coronary artery of any late patient.     

The usefulness of a tracking catheter in complex coronary angioplasty

Complex lesion angioplasty, such as chronic total occlusions, coronary vessels with right angle take-offs, tortuous vessels, and tortuous internal mammary artery or saphenous vein grafts is a continuing challenge. The complex problems have been successfully managed with novel guiding catheter shapes and ultralow profile balloons. However, on occasion steerable guidewire placement remains extremely difficult, despite significantly improved means of intracoronary manipulations.     

多普勒血流速度测定评价冠状动脉成形术与支架术的疗效

目的 经皮冠状动脉成形术（ＰＴＣＡ）与支架术都可有效的恢复冠状动脉狭窄引起的 动因流异常。采用冠状动脉内多普勒血流速度描记技术评价ＰＴＣＡ及支架在恢复冠状动脉血流作用上的特点及差异。方法 冠心病患２１例（男１８例,女３例）,平均年龄（６４．１±５．４）岁,对２３支狭窄的冠状动脉（左前降支１５支,右冠状动脉６支,左回旋支２支）行ＰＴＣＡ之后置入支架２１枚。分析在介入治疗前后ＰＴＣＡ术后、支架术后采     

Improved support for right coronary artery angioplasty with a new guiding catheter

Inadequate guiding catheter support is a frequent cause for failure in right coronary angioplasty (PTCA). A new guiding catheter designed to provide easy placement in the right coronary and improved stability and backup support is described. Use of this catheter for PTCA of right coronary lesions, the majority of which were considered technically difficult to dilate, in 100 patients resulted in successful dilatations in 88% of patients. Failures were due to inability to seat the guide adequately in 8 patients with narrow aortic roots or unusual coronary origins and to inability to cross a lesion in 4 patients despite good support. In 4 patients successful dilatation was achieved after failure using another presently available guide.     

The long wire technique--a new technique for steerable balloon catheter dilatation of coronary artery stenoses

A new technique for steerable balloon dilatation is described.In contrast to the usual procedure the stenosis is first crossedby a long wire only. To minimize injury of the vessel wall thewire is equipped with a thickened ball-shaped tip. After thestenosis has been crossed and the wire tip has been advancedfar enough, the balloon catheter is intserted over the longwire. If necessary, the balloon catheter can be removed andanother one can be inserted without repeat crossing. If an occlusionis caused by the process of dilatation a perfusion cathetercan be advanced distal to the occlusion. Perfusion can be performedby help of a simple syringe-tap system because the cross sectionalarea of this catheter is much larger than a single lumen ofthe double lumen balloon catheter. This procedure even allows the dilatation of branching stenosesthrough the same guiding catheter whereas for the usually performed‘kissing balloon’ technique two guiding cathetersare required. Preliminary experience with 80 patients has shown that crossingof stenoses is facilitated by the new technique because steeringof the guide wire and display by contrast medium injectionsare unhindered. If required, the balloon catheter can be changedfor another one without difficulty. In case of occlusion, thelesion can be crossed again without any risk and repeat dilatationor coronary perfusion can be performed.     

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.     

经桡动脉行冠脉造影及介入中上肢径路异常时PTCA导丝的应用价值

目的 探讨经桡动脉途径行冠状动脉造影及介入术中,上肢血管异常时PTCA导丝的应用价值。方法 我院近3年行桡动脉造影及介入治疗2000例,如果 0.035"J型导丝和亲水超滑导丝在右上肢血管推送过程中遇到阻力,遂撤出导丝,进行上肢局部血管造影,如果疑似桡动脉痉挛的,局部推注维拉帕米100～200ug后再次复查血管造影。结果仍有40例未能成功,其中桡动脉环9例、严重桡动脉狭窄18例、桡动脉发育细小8例、桡动脉痉挛5例,随机分成PTCA导丝组和改股动脉组。PTCA导丝组改用PTCA导丝,最终完成冠状动脉造影检查;改股动脉组直接经股动脉途径行冠状动脉造影术。比较两组手术成功率、操作时间、造影剂用量及局部出血、血肿并发症等情况。结果 两组完成冠状动脉造影成功率比较未见统计学差异（95%比100%,P=0.746）,PTCA导丝组操作时间长于改股动脉组［（950.0±125.3）s比（710.0±98.3）s, P=0.032］,两组造影剂用量比较未见统计学差异［（50.0±6.3）ml比（47.0±5.9）ml,P=0.18］,改股动脉组出血、血肿并发症多于PTCA组（20%比0%,P=0.035 ）。结论 经桡动脉途径行冠状动脉造影及介入治疗术中,当上肢血管发生异常,常规导丝不能完成时,换用PTCA导丝,操作轻柔,并发症发生率低,是安全有效的,特别对于不适合经股动脉造影的患者尤为适合。     

Randomized comparison of coronary stenting with optimal balloon angioplasty for treatment of lesions in small coronary arteries.

AIMS: Angioplasty of lesions in small coronary arteries remains a significant problem because of the increased risk of restenosis. The aim of this study was to compare the efficacy of elective coronary stent placement and optimal balloon angioplasty in small vessel disease. METHODS: One hundred and twenty patients with lesions in small coronary arteries (de novo, non-ostial lesion and reference diameter <3 mm) were randomly assigned to either balloon angioplasty or elective stent placement (7-cell NIR stent). The primary end-point was restenosis at 6 months follow-up. Optimal balloon angioplasty was defined as diameter stenosis less than or = 30% and the absence of major dissection after the angioplasty, and crossover to stenting was allowed. RESULTS: Baseline clinical and angiographic characteristics were similar in the two groups. Procedure was successful in all patients, and in-hospital events did not occur in any patient. However, 12 patients in the angioplasty group were stented because of suboptimal results or major dissection. Postprocedural lumen diameter was significantly larger in the stent group than in the angioplasty group (2.44 +/- 0.36 mm vs 2.14 +/- 0.36, P<0.05, respectively), but late loss was greater in the stent group (1.12 +/- 0.67 mm vs 0.63 +/- 0.48, P<0.01, respectively). The angiographic restenosis rate was 30.9% in the angioplasty group, and 35.7% in the stent group (P = ns). Clinical follow-up was available in all patients (15.9 +/- 5.7 months) and clinical events during the follow-up were similar in both groups. CONCLUSIONS: These results suggest that optimal balloon angioplasty with provisional stenting may be a reasonable approach for treatment of lesions in small coronary arteries.     

A new catheter for angioplasty of the right coronary artery and aorto-coronary bypass grafts

We have developed a new guiding catheter for angioplasty of the right coronary artery (RCA) and venous bypass grafts (VG). This catheter is easy to manipulate, provides a good ?backup”?, and is unusually helpful in angioplasty of the RCA with a usual as well as a complex course. The catheter is equally successful in angioplasty of bypass grafts. We have used this guiding catheter for angioplasty of the RCA and VG in 27 consecutive cases. In 22 patients (81%), successful dilatation was achieved. Inadequate ?backup”? was responsible for two of the five unsuccessful angioplasties; therefore, the catheter provided a good ?backup”? in 25/27 (93%) cases. No major complication occurred in this group of patients.     

Origin of all three coronary arteries from separate ostia in the right sinus of valsalva: A rarely reported coronary artery anomaly

Anomalous origin of the circumflex and left anterior descending coronary arteries from separate ostia in the right sinus of Valsalva is a rarely reported phenomenon. Few clinical details concerning patients with this anomaly are available in the literature. Angiographic and clinical data in an adult patient with this finding are reported here. © 1992 Wiley-Liss, Inc.     

Utility of pilot wire in angioplasty of tortuous and highly angulated coronary arteries

We present a case of severe proximal circumflex artery tortuosity with two 90° bends and then a tight stenosis in the mid part of first obtuse marginal branch. Conventional method used to cross the lesion by wire failed. However, a commercially available new wire with ability to change the degree of tip angulation (Pilot wire, USCI Bard) was then used successfully to cross the stenosis. In addition, the wire straightened the tortuosities and provided good trackability to the balloon. Thus, this new wire is a valuable addition to the angioplasty armamentarium. © 1996 Wiley-Liss, Inc.     

Validation of an automated technique for determining the mechanical characteristics of coronary arteries during balloon angioplasty: laboratory assessment with necropsy segments

OBJECTIVES: To develop a technique for automatic inflation of a percutaneous transluminal coronary angioplasty (PTCA) balloon, with continuous measurement of the balloon pressure and volume; to validate the technique for determining the mechanical characteristics of coronary arteries. METHODS: During necropsy examination of the hearts of nine patients, 17 coronary artery samples were obtained for histological examination. A PTCA balloon was inserted into each artery, and the balloon pressure and volume were measured continuously during four repeat automatic inflations of the balloon. RESULTS: Of the 17 arteries, eight showed elastic, six plastic, and three fracture pressure-volume deformation characteristics. For the plastic deformations, the first inflation required a higher pressure than subsequent repeat inflations of 82 (61) kPa (mean (SD), range 25 to 175 kPa). For the three in the fracture group, the pressure drop because of the fracture occurred between 210 and 540 kPa. Two of these three showed a tear on visual inspection, and the other showed disruption of the intimal plaque on blinded histological examination. Of the six with plastic deformation characteristics alone, one showed a tear, and on histological examination two others showed splitting of the internal and external elastic lamina and one showed separation of intima and media. None in the elastic group showed any of these characteristics. CONCLUSIONS: Plastic and fracture deformation characteristics could be differentiated from elastic characteristics. Visual or histological evidence of fracturing was present in all three arteries identified during angioplasty as having pressure-volume fracture characteristics.     

Magnum Meier wires with Crag Fx wire catheter for total occlusive coronary arteries

Magnum Meier wire was used with Crag Fx wire catheter instead of Magnum balloon catheter to facilitate wire crossing through total occlusion by improving flexibility of the system without losing wire pushability. Of 372 coronary angioplasty procedures performed between January 1994 and April 1995, there were 12 subacute occlusions with an interval of 3 wk or less and 30 chronic occlusions with an interval of >3 wk. Regular over-the-wire-type balloon catheters failed to dilate four subacute occlusions and nine chronic total occlusions. Magnum Meier wire with Crag Fx wire catheter was tried for one subacute occlusion and four chronic occlusions that were undilatable with a regular balloon system and successfully dilated the subacute occlusion and three of the chronic occlusions. The lesions successfully dilated by this new approach were either long or tandem lesions in vessels that were excessively tortuous or showed an acute angle at the orifice. Thus the Magnum Meier wire with Crag Fx wire catheter can be a useful tool for dilating totally occluded lesions in tortuous coronary arteries. Cathet. Cardiovasc. Diagn. 40:198–201, 1997. © 1997 Wiley-Liss, Inc.     

A new catheter system for coronary angioplasty

A new catheter system has been designed for percutaneous transluminal coronary angioplasty. An independently movable, flexible-tipped guide wire within the balloon dilation catheter facilitates selection of the involved vessel. This guide wire can be passed slowly and carefully beyond the coronary stenosis, permitting safe advancement of the balloon catheter. After testing in animal and cadaver hearts, this system was used in 53 patients (56 stenoses) with single vessel coronary artery disease, with an overall primary success rate of 64 percent. In the last 41 of these 56 cases, use of a balloon catheter with a smaller deflated diameter increased the success rate to 73 percent. In patients with lesions of the left anterior descending coronary artery, the success rate was 89 percent. Three (6 percent) of the 53 patients had complications during coronary arterial dilation that necessitated emergency coronary arterial bypass graft surgery. There were no procedure-related or late cardiac deaths. During the mean follow-up period of 8 months (range 1 to 21), there were one late death (of noncardiac causes) and no late myocardial infarctions. Clinical status was persistently improved in 31 of the 36 patients who had successful dilation. The remaining five patients experienced restenosis at the angioplasty site and return of angina pectoris within 3 months of dilation. Two of these patients had repeat coronary angioplasty with restoration of asymptomatic status, and three had elective coronary bypass graft surgery.     

Double-wire angioplasty of the right coronary artery bifurcational stenosis

Two cases of distal right coronary artery (RCA) bifurcational stenoses involving ostia of the posterolateral (PLA) and the posterior descending (PDA) branches in patients who underwent successful coronary angioplasty using a double-wire technique are reported. A single guiding catheter and sequential balloon inflations were utilized in one, and two guiding catheters and simultaneous balloon inflations in the other. The indications, techniques, and outcomes are described.