Use of a hollow wire to facilitate angioplasty of occluded vessels

An USCI 0.038 inch (0.97 mm) floppy tipped hollow wire was used to facilitate the passage of angioplasty guide wires across severe stenoses or vessel occlusions before balloon angioplasty. The hollow wire was passed through a standard 7 or 8 French gauge Judkins coronary catheter to establish whether the obstruction could be breached. This reduced the cost of failure because angioplasty guiding systems were not committed to procedures that were unlikely to be successful. The hollow wire provides stability for the passage of the guide wire and can be used to measure distal pressure and inject contrast. To date it has been used in a total of 15 cases of occluded vessels; it failed to cross the lesion in four cases. Successful angioplasty followed in all patients in whom the lesion was crossed.     

Low-pressure balloon angioplasty of an occluded portacaval shunt.

Safe angioplasty of a portacaval shunt requires particular knowledge of the tissue characteristics of an anastomosis and the behavior of a balloon during inflation. The nature and true diameter of a portacaval shunt anastomosis are more difficult to evaluate than those of a peripheral arterial lesion, and complications are potentially more hazardous than those related to peripheral arterial angioplasty. We suggest that in some instances low pressure and incomplete balloon inflation are all that is necessary to yield safe and satisfactory results.     

New balloon catheter for prolonged percutaneous transluminal coronary angioplasty and bypass flow in occluded vessels

A new balloon catheter was developed for continuous perfusion of coronary arteries during angioplasty (CPC catheter). Steerable Grüntzig balloon catheters (3.7 mm) with two lumina were formed. The first lumen was used for balloon inflation. Side holes to the second lumen proximally and distally to the balloon were created for coronary perfusion even during inflation phase. At a perfusion pressure of 120 mmHg, a flow rate of 63 +/- 3 ml/min with 0.9% saline and 43 +/- 1 ml/min with plasma expander were measured. In experiments on five dogs, dilation time until appearance of signs of ischemia could be prolonged in three of five dogs from 30 to 40 s, 120 to 203 s, and 180 to 420 s comparing conventional and CPC balloon catheters. In 11 patients with proximal lesions, dilation time could be increased from 39.5 +/- 23.9 s to 81.1 +/- 36.3 s (p less than 0.01) until appearance of angina pectoris. ST segment changes were observed in 10/11 patients using conventional catheters. Using CPC catheters, no ST segment changes were observed in four patients; time until appearance of ST segment changes was delayed in the other seven patients. The CPC catheter seems to be an alternative catheter in proximal lesions of the left and right coronary artery, allowing the possibility of prolonged dilation and increased safety to the patient. In case of dissection or perforation, the CPC catheter can be used for perfusion of the distal part of the coronary vessel until emergency bypass surgery.     

Percutaneous transluminal angioplasty of an occluded distal splenorenal shunt.

A distal splenorenal (Warren) shunt was performed on a 39-year-old female with bleeding esophageal varices secondary to portal hypertension and cirrhosis. On the twelfth postoperative day, however, she rebled, and angiography revealed that the shunt was occluded. Using a percutaneous approach, successful balloon angioplasty and recanalization was performed. The patient did well and was discharged without further bleeding. Percutaneous transluminal angioplasty (PTA) appears to be effective in dilating occluded splenorenal shunts, obviating a second surgical procedure in high-risk patients.     

Use of embolic capture angioplasty for the treatment of occluded superficial femoral artery segments

Treatment of peripheral chronic total occlusion (CTO) is one of the most challenging lesion subsets in peripheral revascularization. Advanced wire technology, novel re-entry catheters and imaging techniques help in crossing such lesions. Subintimal dissection using blunt microdissection devices along with true lumen reentry techniques have added to the success rates of treating peripheral CTOs. After crossing the occlusion, balloon angioplasty and the placement of self-expanding nitinol stents are usually performed. Peripheral embolization is a known complication of peripheral artery interventions, leading to significant lower-extremity ischemia and complications. Such interventions of peripheral CTOs have been shown to have higher rates of distal embolization. Though no dedicated distal embolic protection strategies are currently available for lower-extremity interventions, use of debris capture angioplasty balloon (Proteus?) may be a feasible alternative. We report 3 cases where this device has been used during recanalization of peripheral CTOs.     

Fate of collateral vessels following subintimal angioplasty.

PURPOSE: To evaluate the fate of collateral vessels adjacent to and within the target lesion following subintimal angioplasty (SIA). METHODS: Pre and postprocedural angiograms were reviewed for 29 patients undergoing SIA of the lower extremity arteries over a 3-year period. The number of patent collateral vessels 相似文献   

Use of the profunda femoris to facilitate closure of an antegrade puncture with the StarClose device after proximal SFA angioplasty.

PURPOSE: To report a novel technique for safely closing antegrade common femoral artery (CFA) punctures using the StarClose device after proximal superficial femoral artery (SFA) angioplasty. TECHNIQUE: The vessel locator of the StarClose device should not be deployed within a recently dilated vessel, so after proximal SFA angioplasty, the sheath is withdrawn into the CFA. A second guidewire is inserted into the profunda femoris artery followed by insertion of the StarClose sheath. The vessel locator is deployed in the profunda main stem and withdrawn into the CFA until resistance is felt, indicating apposition to the luminal aspect of the vessel wall. The device is subsequently deployed according to the manufacturer's instructions. CONCLUSION: Use of profunda femoris artery allows safe closure of the CFA using the StarClose device following antegrade puncture for proximal SFA angioplasty.     

Spontaneous recanalisation of side branches occluded during percutaneous transluminal coronary angioplasty.

Percutaneous transluminal coronary angioplasty was performed in a 56 year old man with postinfarction angina. During an otherwise uncomplicated dilatation of a left anterior descending artery with a 70% stenosis two diagonal branches, each measuring 1.5 mm in diameter, were occluded. The occlusions were not associated with any adverse clinical effects, though there was a small rise in plasma creatine kinase concentration. The patient became free of angina two weeks after angioplasty, and follow up angiography showed spontaneous reappearance of the occluded side branches. Redistribution of atheromatous material and its later reabsorption may have been the mechanism for the initial occlusion and later reappearance of the vessels.     

Protective effect of collateral vessels during coronary angioplasty.

To assess the potential protective role of collateral vessels 27 patients undergoing angioplasty of the left anterior descending coronary artery were studied by intravenous digital subtraction left ventriculography. Fifteen patients had no collateral vessels (group 1) and 12 had some degree of collateral supply (group 2). During balloon inflation ST segment elevation in group 1 (4.9 mm) was significantly greater than that in group 2 (0.9 mm). Similarly the reduction in left ventricular ejection fraction was significantly greater in group 1 (24%) than in group 2 (12%). Both the size of ST segment elevation and the fall in ejection fraction correlated inversely with the extent of the collateral supply (r = -0.680 and r = -0.446 respectively). During balloon occlusion of the anterior descending coronary artery the percentage shortening of the anterior and apical segments fell in both groups but apical shortening fell to a lesser extent in group 2. An additional reduction in anterobasal contraction was confined to group 1. Electrocardiographic and ventriculographic manifestations of ischaemia produced by balloon inflation during angioplasty are less pronounced when collateral vessels are present. This suggests that the collateral circulation can protect myocardium at risk of ischaemia after coronary occlusion.     

Percutaneous angioplasty of totally occluded saphenous aortocoronary bypass graft

We describe a case of successful percutaneous transluminal angioplasty of a totally occluded saphenous aortocoronary bypass graft with improvement of clinical symptoms and disappearance of collaterals.     

Percutaneous transluminal angioplasty of an occluded distal splenorenal shunt

ABSTRACT— A distal splenorenal (Warren) shunt was performed on a 39-year-old female with bleeding esophageal varices secondary to portal hypertension and cirrhosis. On the twelfth postoperative day, however, she rebled, and angiography revealed that the shunt was occluded. Using a percutaneous approach, successful balloon angioplasty and recanalization was performed. The patient did well and was discharged without further bleeding. Percutaneous transluminal angioplasty (PTA) appears to be effective in dilating occluded splenorenal shunts, obviating a second surgical procedure in high-risk patients.     

Combined distal embolization protection and rheolytic thrombectomy to facilitate percutaneous revascularization of totally occluded saphenous vein grafts.

Totally occluded saphenous vein grafts are difficult to treat percutaneously with a higher likelihood of distal embolization and slow-flow or no-reflow during percutaneous interventions. The PercuSurge system, which utilizes a distal balloon occlusive device, has been shown to improve clinical outcomes during saphenous vein graft (SVG) interventions. This device may not be optimal in the setting of heavy thrombus or debris burden, a situation frequently encountered in totally occluded SVGs. Rheolytic thrombectomy facilitates percutaneous interventions by effectively removing intraluminal thrombus and debris but lacks distal embolization protection. We report our experience with the synergistic use of balloon-based distal embolization protection (PercuSurge) and rheolytic thrombectomy (AngioJet) to optimize percutaneous revascularization of totally occluded SVGs.     

Use of a mechanical thrombectomy device to recanalize a subacutely occluded aortohepatic bypass after orthotopic liver transplantation.

PURPOSE: To report the use of a rotational thrombectomy device for recanalization of a thrombosed hepatic artery bypass graft in an orthotopic liver transplant (OLT). CASE REPORT: Six months after a second OLT in a 52-year-old man, an iliac conduit used for an aortohepatic bypass became occluded, interrupting arterial supply to the liver transplant. The 8-F Straub Rotarex system was used to successfully remove clot from the bypass graft, avoiding embolization to the hepatic arteries. The recanalized conduit has remained patent for 1 year with the patient on an anticoagulation regimen. CONCLUSIONS: The Rotarex thrombectomy system may be considered an alternative to other percutaneous interventions for the treatment of occluded bypass conduits supplying a liver transplant.     

Distal open sesame and hairpin wire techniques to facilitate a chronic total occlusion intervention

We describe a novel distal "open sesame" and "hairpin wire" technique application in a right coronary artery (RCA) chronic total occlusion intervention. Antegrade wiring was successful in entering an acute marginal branch distal to the occlusion, but not the mid RCA. After predilation, antegrade flow was restored but the mid RCA could not be wired in spite of using multiple different guidewires. A "hairpin" was created in a polymer jacketed guidewire, advanced into the acute marginal branch, and withdrawn, allowing wiring of the mid RCA, which was successfully stented using a variety of guide support and lesion preparation techniques.     

Successful use of a balloon catheter to facilitate guidewire placement in an occluded coronary artery with extreme angulations

The present report describes the case of a 77-year-old man with unstable angina, in which the culprit vessel was extremely angulated and precluded placement of a guidewire for subsequent coronary interventions. A novel technique is reported, using an undersized, uninflated and distally placed balloon catheter, which easily facilitated guidewire placement.     

Fracture of a balloon on a wire device during coronary angioplasty

In a 61-year-old patient with unstable angina an attempt was made to dilate a severe stenosis in a tortuous obtuse marginal branch. The initial attempt with conventional equipment was not successful; although the wire could be advanced distal to the stenosis, a 2.0 balloon did not cross the stenosis. A second attempt with a balloon on a wire device resulted in fracture of this catheter, with the distal 2.8-cm-long fragment looped in the left coronary artery. Immediate bypass surgery was performed and the broken fragment was easily removed from the left coronary ostium. The patient made an uneventful recovery.