Successful excimer laser angioplasty following unsuccessful primary balloon angioplasty

We report five patients where excimer laser coronary angioplasty facilitated successful balloon dilatation of heavily calcified lesions that could not be dilated by conventional angioplasty techniques alone. In each case, the lesion was crossed successfully with a guide wire. Conventional angioplasty failed because of inability to cross the lesion with a balloon (four lesions) or inability to dilate the lesion with balloon inflation (two lesions). These cases illustrate an indication for excimer laser coronary angioplasty as an adjunctive procedure in heavily calcified coronary stenoses. © 1993 Wiley-Liss, Inc.     

Evaluation of the long-term functional outcome assessed by myocardial perfusion scintigraphy following excimer laser angioplasty compared to balloon angioplasty in longer coronary lesions

Objectives: Evaluation of the long-term functional outcome assessed by exercise myocardial perfusion imaging following excimer laser angioplasty compared to balloon angioplasty in coronary lesions >10 mm in length. Background: Previous randomized studies evaluating the effect of coronary interventions mainly focused on the long-term clinical and angiographic outcome. The functional outcome, assessed by myocardial perfusion scintigraphy, has not been evaluated in a randomized setting. Methods: A total of 308 patients with stable angina and a longer coronary lesion (>10 mm) were randomized to excimer laser angioplasty or balloon angioplasty. A ^99mTechnetium-2-methoxy isobutyl isonitrile (MIBI) single-photon emission computed tomography (SPECT) study was performed in 139 patients before the initial angioplasty procedure and at 6 months follow-up (73 patients in the laser group versus 66 patients in the balloon group, respectively). Exercise tolerance at follow-up was compared to baseline values by means of exercise duration and double product at peak exercise. Myocardial perfusion of the randomized vascular bed was assessed semi-quantitatively on the MIBI SPECT images. The reversible defects were graded as mild, moderate or severe. Myocardial perfusion at follow-up was expressed as a percentage reduction in incidence and grading of the reversible defects compared to baseline values. Results: Forty-four (61%) patients assigned to laser angioplasty were asymptomatic at 6 months follow-up compared to 34 (52%) patients assigned to balloon angioplasty (p = NS). Improvement in exercise duration and double product were 0.7 ± 2.1 min and 4.3 ± 6.2 min/mmHg/1000, respectively, in the laser group, versus 0.3 ± 2.5 min and 3.1 ± 5.5 min/mmHg/1000, respectively, in the balloon group (both p = NS). The percentage reduction of reversible defects was 23% in patients assigned to laser angioplasty vs. 29% in patients assigned to balloon angioplasty (Relative risk [RR]: 0.79, 95% confidence interval [CI]: 0.40–1.57; p = 0.50). The mild, moderate and severe reversible defects improved in 44.4, 63.6 and 66.6%, respectively, in the laser angioplasty group vs. 66.6, 53.8 and 90%, respectively, in the balloon angioplasty group. None of the comparisons were significantly different. Conclusion: Excimer laser angioplasty compared to balloon angioplasty in coronary lesions >10 mm in length yields a similar long-term functional outcome assessed by anginal status, exercise tolerance and myocardial perfusion.     

Intravascular ultrasound findings after excimer laser coronary angioplasty

Intravascular ultrasound (IVUS) was used to study 104 lesions in 98 patients after excimer laser coronary angioplasty (ELCA). Lesion site external elastic membrane (EEM) and lumen cross-sectional areas (CSA) were measured; plaque + media (P + M = EEM − lumen) CSA and percentage of cross-sectional narrowing (CSN = P + M CSA/EEM CSA) were calculated; and the results were compared to a reference site. The lumen CSA (2.6 ± 1.0 mm²) averaged 24% larger than the cross-sectional area of the largest laser catheter used, and 64 lesions (62%) fit the definition of arterial expansion (lesion EEM CSA > reference site EEM CSA). The residual percentage of cross-sectional narrowing averaged 83.8 ± 8.8%. Dissections were present in 44% of lesions, and were more common in lesions with superficial calcium (59%) than in lesions with only deep calcium (31%) or no calcium (20%, P = 0.0102). Dissections of superficial calcified plaque had an unusual “shattered” or “fragmented” appearance. These findings suggest that excimer laser angioplasty causes forced vessel expansion with dissection, but limited atheroablation. © 1996 Wiley-Liss, Inc.     

Immediate and chronic results of cutting balloon angioplasty: A matched comparison with conventional angioplasty

Background: At the initial stages of percutaneous transluminal coronary angioplasty (PTCA), several studies reported on the feasibility of coronary artery incision and dilatation leading to the extension of the PTCA technique. Hypothesis: This study was designed to determine the immediate and chronic results of cutting balloon (CB) angioplasty. Methods: This procedure was performed on 127 lesions in 110 patients (male 83%, age 61.8 ± 9.3 years). Results: The overall procedural success rates for the CB were 93.7% (119 lesions) and 92.7% (102 patients), while solitary CB without pre- and/or postdilatation was 76.4% (91 lesions). There was one major in-hospital complication (Q-wave myocardial infarction, 0.9%), but there were no deaths or emergency coronary artery bypass graftings. Significant angiographic dissections (≥ grade C) occurred in four patients, and coronary perforation occurred in one. The successfully treated CB group (95 lesions) was matched with the successful conventional angioplasty group (PTCA group) for chronic result assessment in regard to reference vessel size and lesion characteristics. In the CB group, postprocedural minimal luminal diameters were significantly larger and the percentage of stenosis at the stenotic site was significantly lower compared with the PTCA group. Restenosis occurred in 22 lesions (23.1%). This showed a significantly lower restenosis rate compared with the PTCA group (42.1%). In addition, the restenosis rate of the CB without inclusion of the pre- and/or postdilatation-treated lesions was 19.7%. Conclusions: (1) Cutting balloon angioplasty procedures can be performed with high success rates with few major in-hospital events. (2) The restenosis rate in the CB group was significantly lower compared with the PTCA group.     

经皮冠状动脉内切割球囊成形术的临床应用

目的评价经皮冠状动脉内切割球囊成形术的临床疗效.方法使用切割球囊导管对20例冠心病患者(男18例、女2例,年龄53.4±6.3岁)的24支冠状动脉进行扩张.结果手术成功率为90%(18例),病变成功率为91.7%(22支).未出现死亡、急性Q波型心肌梗死和急性心包填塞等并发症.病变部位狭窄程度由术前的(85.6±7.3)%降至术后的(28.5±9.4)%.术后随访1～10个月,有3例复发心绞痛,其中1例经血管造影证实为再狭窄.结论切割球囊成形术是一种安全、有效的介入性治疗技术,其成功率高、并发症少.     

冠状动脉旋磨术及经皮冠状动脉成形术在复杂病变介入治疗中的应用

目的　探讨冠状动脉旋磨术 (Rotational atherectomy)及经皮腔内冠状动脉成形术 (Percutaneous translum i-nal coronary angioplasty PTCA)治疗复杂冠脉病变的临床效果。方法　对 15例患者的 2 0处病变行冠脉旋磨术及经皮腔内冠状动脉成形术 (PTCA)治疗 ,部分病例并在血管内超声指导下进行 ,观察其治疗的即刻成功率及并发症率。结果　 15例施行冠状动脉旋磨术的患者 ,旋磨头均成功地通过了病变 ,平均狭窄程度由 88.30 %± 7.5 4 %降至15 .6 0 %± 10 .75 %。其中 6 0 .0 0 %的病例选择了 1.5 mm的旋磨头 ,13.33%的病例使用了 2个旋磨头。全部病例均联合应用了 PTCA,13例在行旋磨术后置入冠脉内支架 (余下 2例为支架内再狭窄病例 )。 1例患者术中发生较严重的冠状动脉痉挛 ,经冠状动脉内给予硝酸甘油后缓解 ;2处 (10 .0 0 % )病变出现了 B型以上的内膜撕裂 ,出现缓慢血流现象发生率为 3.8%。无急诊冠状动脉搭桥及死亡病例。结论　冠状动脉旋磨术及 PTCA可选择性用于复杂冠状动脉病变 ,尤其是严重钙化病变 ,小血管长节段病变     

Contained rupture following percutaneous transluminal coronary angioplasty: Long-term outcome

Coronary artery aneurysm formation can occur as a complication of balloon angioplasty. We present a case of a contained rupture of the left circumflex artery following angioplasty which resulted in an unusual pseudoaneurysm on angiography at 3-year follow-up. © 1993 Wiley-Liss, Inc.     

准分子激光冠状动脉成形术治疗支架内再狭窄

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Coronary artery perforation during coronary angioplasty

In one patient percutaneous transluminal coronary angioplasty was complicated by coronary artery perforation of the left anterior descending coronary artery with light pericardial effusion. The outcome was favorable without either pericardiocentesis or emergency surgery.     

Excimer laser facilitated percutaneous coronary intervention of a nondilatable coronary stent.

A patient is described in which excimer laser percutaneous coronary intervention is performed inside a suboptimally expanded stent due to nondilatable calcified plaque. The use of excimer laser facilitated full expansion of the stent with a balloon.     

冠状动脉成形术中正常参考段的血管内超声研究

目的　应用血管内超声研究冠心病介入治疗时“正常”参考段的病变情况。方法　 12 0例冠心病患者行介入治疗 ,术中血管内超声 (IVU S)评价造影显示正常的参考血管段。结果　 (1)冠状动脉造影显示“正常”的参考段仅10 .8%经 IVUS证实无明显病变 ;(2 )参考段平均面积狭窄百分比为 (4 2 .6± 11.9) % ,参考段狭窄程度与目标病变的狭窄程度呈轻度正相关 (r=0 .32 7,P<0 .0 0 1) ;(3)参考段的病变中纤维斑块及钙化斑块较少而脂质斑块较多。结论　造影显示的“正常”参考段冠状动脉常存在不同程度的粥样硬化病变。     

Coronary angioplasty of anomalous right coronary arteries

We report 2 cases of successful angioplasty of anomalous right coronary arteries originating above the sinotubular line at the junction of the right and left sinus of Valsalva. The use of Amplatz left guiding catheters provided optimal support for performing angioplasty. © 1993 Wiley-Liss, Inc.     

The STAFF studies of the first 5 minutes of percutaneous coronary angioplasty balloon occlusion in man

The Staff Studies comprise a database of 228 patients undergoing elective 5 minute coronary artery balloon occlusion angioplasty at a single center in the pre-stent era in whom standard and high-frequency electrocardiographic and nuclear information was obtained immediately before, during and after balloon occlusion. The data were then analyzed by multiple investigators at different international academic centers from different perspectives. Simulating in a clinical setting the first 5 minutes of a heart attack, this database, now in digital format, is the largest database to date documenting standard and high-frequency ECG changes from the onset and for 5 minutes during acute coronary artery occlusion, with resting and occlusion imaging in a subset of these patients. The history, methodology, and legacy of these studies are discussed in this paper.     

Initial experience with an extendable and reusable probe balloon-on-a-wire dilatation catheter in multivessel coronary angioplasty

The “probe” balloon-on-a-wire device is an excellent balloon catheter for traversing very tight stenoses. Extending the probe by transecting its proximal inflation hub and then linking it to an extension wire has further enhanced its utility, as a wire exchange can then be performed without loosing wire access across a dilated lesion. We now report a previously undescribed technique for reconstituting and reusing an extended probe. The probe is initially transected at its proximal end. It is then extended by connecting a “Linx” wire into the open central lumen of the probe's hypotube. An over-the-wire balloon dilatation system is then substituted, via a wire exchange using a probing catheter, for final definitive dilatation. The probe is then reconstituted in the following manner. The inflation hub of the probe is recreated by modifying a standard USCI Tuohy-Borst Y adaptor and attaching this to the transected probe hypotube. It is subsequently used for dilating other stenotic arteries during multivessel angioplasty. The utility of this method was demonstrated in 5 consecutive cases. All cases underwent successful dilatations. There were no complications. This initial experience would suggest that the probe can be reused quite safely and effectively. © 1994 Wiley-Liss,Inc..     

Physiological aspects of percutaneous transluminal coronary angioplasty

Summary Percutaneous transluminal coronary angioplasty (PTCA) can serve as a model for controlled coronary artery occlusion and reperfusion, which enable the dynamic physiological alterations related to PTCA to be assessed. In this review, physiologically related changes pertinent to PTCA in human subjects will be discussed.     

Implication of transstenotic coronary pressure gradient measurement during coronary angioplasty

The aim of this study was to establish a criterion for the success of an angioplasty based upon pressure gradients across coronary lesions. Sixty-two percutaneous transluminal coronary angioplasties (PTCA) in 56 patients with isolated left anterior descending artery disease were examined. Pressure gradients measured before and after PTCA were expressed as normalized mean pressure gradients (NMPG) computed by dividing mean pressure gradient by mean aortic or proximal coronary artery pressure. Angiographic severity was expressed as percentage area stenosis (AS) calculated from diastolic caliper measurements of diameter of each lesion and the nearest normal adjacent segment in at least two projections. The relationship between AS and NMPG was nonlinear with a steep increase in gradients beyond a critical value of AS of about 60%. This relationship was unaffected by angiographically visualized collaterals. All except one of 65 coronary stenotic lesions with NMPG of more than 0.32 had an AS of more than 60%. Only three of 57 coronary stenoses with NMPG of less than 0.32 had severe AS (p < 0.001). The results indicate that NMPG is a reliable, practical guide to the severity of coronary stenosis and is therefore a useful measurement for assessing either the success or the residual stenosis during PTCA.     

Serial angiographic appearance of healing dissection after balloon angioplasty

In this report we describe the case of a patient with a significant coronary artery dissection following percutaneous transluminal coronary angioplasty (PTCA) in whom serial coronary arteriograms were obtained over a 6-week period. These demonstrated healing of the dissected vessel and correlated with abatement of the patient's angina. © Wiley-Liss, Inc.     

Percutaneous closure of a coronary aneurysm with a vein-coated stent

Coronary artery aneurysm is a rare but recognized complication following percutaneous intervention. We report the formation of such an aneurysm after recanalization with Excimer laser wire of a chronic totally occluded left anterior descending coronary artery and stent implantation and its subsequent treatment using an autologous vein graft-coated stent. Cathet. Cardiovasc. Diagn. 43:308–310, 1998. © 1998 Wiley-Liss, Inc.     

缺血预适应在经皮冠状动脉腔内成形术中的应用

对２６例冠心病患者随机分为预适应组（１４例）和对照组（１２例），分别观察经皮冠状动脉腔内成形术（ＰＴＣＡ）中心绞痛及心电图变化和术后心绞痛及运动心电图。结果显示：预适应组术中心绞痛积分和ＳＴ段抬高幅度均显著低于对照组（均Ｐ＜０．０５），心绞痛及ＳＴ段抬高出现时间均显著迟于对照组（均Ｐ＜０．０５）。术后随访６个月，预适应组心绞痛及运动心电图阳性例数显著低于对照组（均Ｐ＜０．０５）。表明缺血预适应不但可以减轻ＰＴＣＡ中心肌缺血的程度，而且也能降低术后心肌缺血的复发。