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Cin VG, Pekdemir H, Akkus MN, Camsari A, Doven O, Yenihan S. Cutting Balloon Angioplasty for the Treatment of In-Stent Restenosis in Diabetics: A Matched Comparison of 6 Months' Outcome With Conventional Balloon Angioplasty. Angiology 2016; 57:445-52. [PMID: 17022380 DOI: 10.1177/0003319706290619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Ranging from 24% to 55%, angiographic in-stent restenosis (ISR) rates in diabetics are higher than the 17% to 28% rates observed in nondiabetics. There are controversies regarding optimal treatment for ISR. Recently, cutting balloon angioplasty (CBA) emerged as a tool in management. The authors assessed the hypothesis that CBA has advantages over conventional percutaneous transluminal balloon angioplasty (PTCA) in treatment of ISR in diabetics. CBA or PTCA was applied to 165 diabetics (267 ISR lesions) in their institution. With a computer algorithm, an attempt was made to match each lesion in the CBA group with a corresponding lesion in the PTCA group. The lesion pairs should match with respect to the patients' age and gender, type of target vessel and stent, reference vessel diameter, and baseline minimal lumen diameter (MLD). Following the matching process, 55 ISR lesion pairs were identified. Baseline patient characteristics were similar among the groups (p=NS). There was no difference in the in-hospital major adverse cardiac events (MACE) between the groups, whereas MACE at follow up was significantly lower in the CBA group compared to the PTCA group (CBA, 20.0% vs PTCA, 43.6%, p<0.05). The recurrent ISR rate was significantly lower in the CBA group compared to the PTCA group (CBA, 27.3% vs PTCA, 49.1%; p<0.05). Also, a diffuse pattern of recurrence was more common in lesions treated with PTCA, whereas a focal pattern of recur- rence was more common in the CBA group. The minimal luminal diameter at follow-up, the acute gain, and net gain were significantly higher in the group of lesions treated with CBA than in the PTCA group. In addition, a significantly higher late loss and loss index at follow-up were observed in the PTCA group compared to the CBA group. CBA has advantages over PTCA in treatment of diabetic patients with ISR, with better immediate and follow-up angiographic outcomes, and better follow-up clinical outcome.
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Affiliation(s)
- Veli Gokhan Cin
- Department of Cardiology, Mersin University School of Medicine, Mersin, Turkey
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2
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The influence of composition and location on the toughness of human atherosclerotic femoral plaque tissue. Acta Biomater 2016; 31:264-275. [PMID: 26675125 DOI: 10.1016/j.actbio.2015.11.056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 11/18/2015] [Accepted: 11/29/2015] [Indexed: 11/23/2022]
Abstract
The toughness of femoral atherosclerotic tissue is of pivotal importance to understanding the mechanism of luminal expansion during cutting balloon angioplasty (CBA) in the peripheral vessels. Furthermore, the ability to relate this parameter to plaque composition, pathological inclusions and location within the femoral vessels would allow for the improvement of existing CBA technology and for the stratification of patient treatment based on the predicted fracture response of the plaque tissue to CBA. Such information may lead to a reduction in clinically observed complications, an improvement in trial results and an increased adoption of the CBA technique to reduce vessel trauma and further endovascular treatment uptake. This study characterises the toughness of atherosclerotic plaque extracted from the femoral arteries of ten patients using a lubricated guillotine cutting test to determine the critical energy release rate. This information is related to the location that the plaque section was removed from within the femoral vessels and the composition of the plaque tissue, determined using Fourier Transform InfraRed spectroscopy, to establish the influence of location and composition on the toughness of the plaque tissue. Scanning electron microscopy (SEM) is employed to examine the fracture surfaces of the sections to determine the contribution of tissue morphology to toughness. Toughness results exhibit large inter and intra patient and location variance with values ranging far above and below the toughness of healthy porcine arterial tissue (Range: 1330-3035 for location and 140-4560J/m(2) for patients). No significant difference in mean toughness is observed between patients or location. However, the composition parameter representing the calcified tissue content of the plaque correlates significantly with sample toughness (r=0.949, p<0.001). SEM reveals the presence of large calcified regions in the toughest sections that are absent from the least tough sections. Regression analysis highlights the potential of employing the calcified tissue content of the plaque as a preoperative tool for predicting the fracture response of a target lesion to CBA (R(2)=0.885, p<0.001). STATEMENT OF SIGNIFICANCE This study addresses a gap in current knowledge regarding the influence of plaque location, composition and morphology on the toughness of human femoral plaque tissue. Such information is of great importance to the continued improvement of endovascular treatments, particularly cutting balloon angioplasty (CBA), which require experimentally derived data as a framework for assessing clinical cases and advancing medical devices. This study identifies that femoral plaque tissue exhibits large inter and intra patient and location variance regarding tissue toughness. Increasing calcified plaque content is demonstrated to correlate significantly with increasing toughness. This highlights the potential for predicting target lesion toughness which may lead to an increased adoption of the CBA technique and also further the uptake of endovascular treatment.
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Westin GG, Armstrong EJ, Javed U, Balwanz CR, Saeed H, Pevec WC, Laird JR, Dawson DL. Endovascular therapy is effective treatment for focal stenoses in failing infrapopliteal vein grafts. Ann Vasc Surg 2014; 28:1823-31. [PMID: 25106106 DOI: 10.1016/j.avsg.2014.07.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2014] [Revised: 07/10/2014] [Accepted: 07/15/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND To evaluate the efficacy of endovascular therapy for maintaining patency and preserving limbs among patients with failing infrapopliteal bypass grafts. METHODS We gathered data from a registry of catheter-based procedures for peripheral artery disease. Of 1554 arteriograms performed from 2006 to 2012, 30 patients had interventions for failing bypass vein grafts to infrapopliteal target vessels. The first intervention for each patient was used in this analysis. Duplex ultrasonography was used within 30 days after intervention and subsequently at 3- to 6-month intervals for graft surveillance. RESULTS Interventions were performed for duplex ultrasonography surveillance findings in 21 patients and for symptoms of persistent or recurrent critical limb ischemia in 9 patients. Procedural techniques included cutting balloon angioplasty (83%), conventional balloon angioplasty (7%), and stent placement (10%). Procedural success was achieved in all cases. There were no procedure-related complications, amputations, or deaths within 30 days. By Kaplan-Meier analysis, 37% of the patients were free from graft restenosis at 12 months and 31% were at 24 months. Receiver-operating characteristic analysis indicated that a lesion length of 1.75 cm best predicted freedom from restenosis (C statistic: 0.74). Residual stenosis (P = 0.03), patency without reintervention (P = 0.01), and assisted patency with secondary intervention (P = 0.02) rates were superior for short lesions compared with long lesions. The cohort had acceptable rates of adverse clinical outcomes, with 96% of patients free from amputation at both 12 and 24 months; clinical outcomes were also better in patients with short lesions. CONCLUSIONS In this single-center experience with endovascular therapies to treat failing infrapopliteal bypass grafts, rates of limb preservation were high, but the majority of patients developed graft restenosis within 12 months. Grafts with longer stenoses fared poorly by comparison. These data suggest that endovascular interventions to restore or prolong graft patency may be associated with maintained graft patency and that close follow-up with vascular laboratory surveillance is essential.
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Affiliation(s)
- Gregory G Westin
- Division of Vascular and Endovascular Surgery, New York University Medical Center, New York, NY.
| | - Ehrin J Armstrong
- Division of Cardiology, University of Colorado Denver and VA Eastern Colorado Healthcare System, Denver, CO
| | - Usman Javed
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis Medical Center, Sacramento, CA
| | - Christopher R Balwanz
- Division of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City, MO
| | - Haseeb Saeed
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis Medical Center, Sacramento, CA
| | - William C Pevec
- Division of Vascular and Endovascular Surgery and the Vascular Center, University of California, Davis Medical Center, Sacramento, CA
| | - John R Laird
- Division of Cardiovascular Medicine and the Vascular Center, University of California, Davis Medical Center, Sacramento, CA
| | - David L Dawson
- Division of Vascular and Endovascular Surgery and the Vascular Center, University of California, Davis Medical Center, Sacramento, CA
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Palmer ND, Nair RK, Ramsdale DR. Treatment of calcified ostial disease by rotational atherectomy and adjunctive cutting balloon angioplasty prior to stent implantation. ACTA ACUST UNITED AC 2009; 6:134-6. [PMID: 16146906 DOI: 10.1080/14628840410030487] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Both heavily calcified and ostial lesions are difficult to deal with by percutaneous transluminal coronary angioplasty (PTCA) alone. Acute results are often sub-optimal, complications are more frequent, and long-term results are disappointing. Optimal stent deployment may not be possible unless satisfactory lesion dilatation is achieved and the lesion made more compliant. The use of rotational atherectomy and cutting balloon angioplasty to a calcified ostial lesion in the left circumflex coronary artery prior to stent implantation is reported.
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Castriota F, de Campos Martins EC, Setacci C, Manetti R, Khamis H, Spagnolo B, Furgieri A, Gieowarsingh S, Parizi ST, Bianchi P, Setacci F, de Donato G, Cremonesi A. Cutting balloon angioplasty in percutaneous carotid interventions. J Endovasc Ther 2008; 15:655-62. [PMID: 19090627 DOI: 10.1583/08-2408.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE To report a prospective feasibility study of cutting balloon angioplasty (CBA) applied in the predilation phase of carotid artery stenting (CAS) in highly calcified lesions. METHODS From January 2003 to February 2007, 178 consecutive patients (109 men; mean age 73.1+/-7.3 years) with highly calcified carotid lesions underwent CAS with CBA applied as a pre-specified strategy in the predilation phase of the procedure. All steps in the procedure were performed under cerebral filter protection. The cutting balloon ranged in diameter from 3 to 4 mm and was inflated at nominal pressures in the target lesion. Pre-CBA dilation with a low-profile coronary balloon was performed only when the cutting balloon was not able to cross the lesion. Selection of the filters and stents was at the operator's discretion. Primary endpoints were the all stroke and death rates at 30 days and 6 months. Secondary endpoints included cutting balloon success (positioning and full balloon inflation), CAS technical success (residual angiographic stenosis <30%), CAS procedural success (technical success and no complications), and in-hospital major complications. RESULTS Cutting balloon success was achieved in all 178 patients. In 32 (18.0%), pre-CBA dilation was necessary due to inability to cross the lesion with the cutting balloon initially. CAS technical success was achieved in all patients. One (0.6%) patient suffered transient neurological intolerance due to flow cessation from massive debris in the distal filter; this event was completely resolved after the filter was removed (CAS procedural success 99.4%). One patient suffered a major stroke at day 15 (0.6% 30-day all stroke and death rate). At the 6-month follow-up, 174 (97.7%) patients were evaluated; 1 patient died from myocardial infarction at day 35, and 2 patients died from non-neurological or cardiac causes at days 103 and 158. The cumulative all stroke and death rate was 2.2%. CONCLUSION These data suggest that CBA performed during the predilation phase of CAS in highly calcified lesion is a safe and useful method to prepare this lesion subset for stenting.
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Affiliation(s)
- Fausto Castriota
- Interventional Cardio-Angiology Unit, Villa Maria Cecilia Hospital, Cotignola, Italy.
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Peregrin JH, Bürgelová M. Restoration of failed renal graft function after successful angioplasty of pressure-resistant renal artery stenosis using a cutting balloon: a case report. Cardiovasc Intervent Radiol 2008; 32:548-53. [PMID: 18756369 DOI: 10.1007/s00270-008-9420-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2008] [Revised: 07/24/2008] [Accepted: 07/25/2008] [Indexed: 10/21/2022]
Abstract
This study is the report of a 37-year-old male with a transplanted kidney from a 3.5-year-old donor: the graft had two arteries transplanted with an aortic patch to an external iliac artery. Four months after transplantation, the graft function deteriorated, together with the development of hypertension. Stenosis of both graft arteries was detected and the patient was referred for angioplasty. The angiographic result was suboptimal, nevertheless, the graft function improved and was more or less stable (serum creatinine, 160-200 micromol/l) for 4 years, along with persistently difficult-to-control hypertension. Five years after transplantation, the graft function deteriorated again and severe graft artery restenosis was detected. The restenosis did not respond to dilatation, graft function failed, hypertension decompensated, and left ventricular failure developed. The patient required dialysis. A cutting balloon angioplasty opened the artery, and kidney function was restored after a few days: the serum creatinine level dropped to 140-160 micromol/l, and the glomerular filtration rate (creatinine clearance) to 0.65 ml/min/1.73 m(2). The graft function has now been stable for more than 2 years, however, the hypertension is still difficult to control.
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Affiliation(s)
- J H Peregrin
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
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Garvin R, Reifsnyder T. Cutting balloon angioplasty of autogenous infrainguinal bypasses: Short-term safety and efficacy. J Vasc Surg 2007; 46:724-30. [PMID: 17764872 DOI: 10.1016/j.jvs.2007.05.056] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Accepted: 02/15/2007] [Indexed: 11/23/2022]
Abstract
PURPOSE This study evaluated the safety and efficacy of cutting balloon angioplasty in the treatment of infrainguinal vein bypass graft stenosis. METHODS Data from a prospective database, supplemented by chart review, were obtained on all patients who underwent cutting balloon angioplasty of lower extremity vein bypass grafts at a single institution during a 4-year period. Noninvasive duplex ultrasound imaging of grafts, along with measurement of ankle-brachial indices and digital pressures, was performed on all patients before and after treatment with the cutting balloon. Efficacy of cutting balloon angioplasty and procedural complications were analyzed. Data from noninvasive vascular testing were compared using the two-tailed paired Student t test. Patency rates were calculated using the Kaplan-Meier method. Differences in patency rates were compared using the log-rank test. RESULTS From July 2002 to February 2006, 109 cutting balloon angioplasties were performed on 70 bypasses in 61 patients. There were 12 complications in 109 procedures (11%), only one of which required immediate operative intervention. Initial technical success was 96%. Noninvasive vascular testing indicators significantly improved immediately after intervention: peak systolic graft velocity decreased from 360 +/- 158 cm/s to 143 +/- 67 cm/s (P < .001), ankle-brachial index improved from 0.55 +/- 0.3 to 0.85 +/- 0.2 (P < .001), and digital pressure increased from 31 +/- 30 mm Hg to 62 +/- 32 mm Hg (P < .001). Patency rates at 6 months according to the Kaplan-Meier method were primary patency, 48% (95% confidence interval [CI], 0.36 to 0.60); assisted primary patency, 72% (95% CI, 0.61 to 0.83); and secondary patency, 99% (95% CI, 0.97 to 1.00). At 6 months, cumulative limb salvage was 94% (95% CI, 0.89 to 1.00). CONCLUSIONS Cutting balloon angioplasty of infrainguinal vein bypass graft stenosis is technically feasible but is associated with a relatively high complication rate and a relatively low short-term patency rate.
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Affiliation(s)
- Robert Garvin
- The Department of Surgery, Division of Vascular Surgery, Western Pennsylvania Hospital, Pittsburgh, PA 15224, USA.
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Peregrin JH, Rocek M. Results of a Peripheral Cutting Balloon Prospective Multicenter European Registry in Hemodialysis Vascular Access. Cardiovasc Intervent Radiol 2007; 30:212-5. [PMID: 17205361 DOI: 10.1007/s00270-006-0020-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE To report initial experience with the Peripheral Cutting Balloon (PCB) in treatment of failing hemodialysis shunts. METHODS A total of 190 patients (95 men, 95 women; average age 64.4 +/- 11.9 years, range 32-87 years) who were treated with the PCB for pressure-resistant stenosis, restenosis or failed percutaneous transluminal angioplasty (PTA) in the venous limb of an arteriovenous shunt were followed in seven European centers using a simple registry. The group consisted of 109 de novo lesions (57%) and 79 restenotic lesions (43%). RESULTS Technical success was achieved in 88.9% of cases. Primary patency was as follows (the results for whole group and simultaneous results for de novo lesions and restenoses are presented): 1 month (140 patients followed): 94%, 98%, and 93%; 3 months (116 patients followed): 93%, 98%, and 92%; 6 months (40 patients followed): 85%, 92%, and 79%; 12 months (27 patients followed): 74%, 87%, and 48%. No complication occurred. Patients experienced an equal or lower level of pain during the procedure compared with conventional PTA. CONCLUSION The PCB proved to be successful in dilating pressure-resistant stenoses. We cannot conclude whether PCB angioplasty can lower the restenosis rate in hemodialysis access lesions, but the long-term patency for de novo lesions is high. A further randomized study is advisable.
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Affiliation(s)
- Jan H Peregrin
- Department of Diagnostic and Interventional Radiology, Institute for Clinical and Experimental Medicine, Vídenská 1958/9, 14021 Prague 4, Czech Republic.
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9
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Chakraverty S, Meier MAJ, Aarts JCNM, Ross RA, Griffiths GD. Cutting-balloon-associated vascular rupture after failed standard balloon angioplasty. Cardiovasc Intervent Radiol 2006; 28:661-4. [PMID: 16010513 DOI: 10.1007/s00270-004-0158-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
The following case reports illustrate a possible complication of vascular rupture when cutting balloon dilatation is performed immediately after failed standard balloon angioplasty to the same diameter. Deferral of the cutting balloon dilatation should be considered in such circumstances.
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MESH Headings
- Aged
- Aged, 80 and over
- Anastomosis, Surgical
- Aneurysm, False/diagnosis
- Aneurysm, False/etiology
- Aneurysm, Ruptured/diagnosis
- Aneurysm, Ruptured/etiology
- Angioplasty, Balloon/adverse effects
- Arm/blood supply
- Female
- Graft Occlusion, Vascular/diagnosis
- Graft Occlusion, Vascular/etiology
- Hematoma/diagnosis
- Hematoma/etiology
- Humans
- Ischemia/diagnosis
- Ischemia/therapy
- Leg/blood supply
- Male
- Treatment Failure
- Ultrasonography, Doppler, Duplex
- Vascular Fistula/diagnosis
- Vascular Fistula/therapy
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Affiliation(s)
- S Chakraverty
- Department of Radiology, Ninewells Hospital, Dundee, DD1 9SY, UK.
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10
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Vesely TM, Siegel JB. Use of the Peripheral Cutting Balloon to Treat Hemodialysis-related Stenoses. J Vasc Interv Radiol 2005; 16:1593-603. [PMID: 16371523 DOI: 10.1097/01.rvi.0000190928.19701.dd] [Citation(s) in RCA: 87] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To compare the effectiveness and safety of use of the peripheral cutting balloon (PCB) versus standard percutaneous transluminal angioplasty (PTA) for the treatment of hemodialysis-related stenoses. MATERIALS AND METHODS This prospective, randomized multicenter clinical trial included 340 patients with stenotic or thrombosed hemodialysis grafts who were randomized to receive treatment with the PCB or PTA for venous outflow stenosis. One hundred seventy-three patients underwent treatment with the PCB, 101 with stenotic grafts and 72 with thrombosed grafts. PTA was used to treat 167 patients, 94 patients with stenotic grafts and 73 with thrombosed grafts. The follow-up period extended for 6 months. RESULTS The procedural success rates were 80.8% and 75.4% for the PCB and PTA groups, respectively (P = .24). With use of the PCB, the primary patency rates of the target lesions were 84.3%, 65.8%, and 47.9% at 1 month, 3 months, and 6 months, respectively. With PTA, the primary patency rates of the target lesions were 77.7%, 63.4%, and 40.5% at 1 month, 3 months, and 6 months, respectively. The primary patency rates of the entire vascular access circuit were 82.6%, 61.0%, and 43.3% at 1 month, 3 months, and 6 months, respectively, with use of the PCB. For patients who were treated with PTA, the primary patency rates of the vascular access circuit were 75.9%, 61.0%, and 36.3% at 1 month, 3 months, and 6 months, respectively. When comparing the PCB and PTA, there was no difference in the 6-month primary patency rates in the target lesion (P = .373) or the entire vascular access circuit (P = .531). There were nine device-related complications in the PCB group (5.2%): five venous ruptures (2.9%), three venous dissections (1.7%), and one case of thrombosis (0.6%). There were no device-related complications in the PTA group. CONCLUSION This prospective, randomized trial comparing use of the PCB versus standard PTA for treatment of hemodialysis-related venous stenoses demonstrated that the PCB provides equivalent 6-month patency to PTA for stenotic and thrombosed grafts.
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Tanemoto M, Abe T, Chaki T, Satoh F, Ishibashi T, Ito S. Cutting balloon angioplasty of resistant renal artery stenosis caused by fibromuscular dysplasia. J Vasc Surg 2005; 41:898-901. [PMID: 15886679 DOI: 10.1016/j.jvs.2005.01.036] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Balloon angioplasty is an established intervention to treat renovascular hypertension. Conventional balloon angioplasty is usually effective in cases of renovascular hypertension caused by fibromuscular dysplasia. In the present report, we describe two cases of renovascular hypertension caused by fibromuscular dysplasia in which stenotic lesions were resistant to conventional balloon angioplasty but were successfully managed by a cutting balloon. After cutting balloon angioplasty, systemic blood pressure was normalized in both patients, without the use of antihypertensive agents. Angioplasty by using a cutting balloon is a new therapeutic choice against renal artery stenosis that is resistant to dilation by a conventional balloon.
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Affiliation(s)
- Masayuki Tanemoto
- Division of Nephrology, Hypertension and Endocrinology, Tohoku University Graduate School of Medicine, Miyagi 980-8574, Japan.
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12
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Rabbi JF, Kiran RP, Gersten G, Dudrick SJ, Dardik A. Early Results with Infrainguinal Cutting Balloon Angioplasty Limits Distal Dissection. Ann Vasc Surg 2004; 18:640-3. [PMID: 15599620 DOI: 10.1007/s10016-004-0103-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Infrainguinal angioplasty has less initial and long-term success compared with more proximal sites. These suboptimal initial technical results may be related to the heavy calcific burden in the femoral and popliteal arteries and, subsequently, higher incidence of distal dissection. Cutting balloon angioplasty (CBA) is a newer technique that is thought to limit distal dissection in heavily calcified vessels; although CBA has been evaluated in the coronary circulation, there are few reports of its use in peripheral vessels. This study evaluates our initial experience with CBA for the management of femoropopliteal disease. Eleven patients underwent infrainguinal CBA for symptomatic limb ischemia at a community hospital. Ten procedures (91%) were technically successful, with no distal dissections, iatrogenic vessel perforations, or surgical target vessel revascularizations. In eight patients available for follow-up, the limb salvage rate was 100% and of seven and eight CBA sites (88%) were still widely patent (mean follow-up, 3 months; range, 2-12 months). This preliminary study suggests that CBA is safe and feasible for electively performed femoropopliteal chronic occlusive disease with acceptable success rates on short-term follow-up. Long-term results and comparison with other endovascular modalities require evaluation.
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Affiliation(s)
- Jamal F Rabbi
- Department of Surgery, St. Mary's Hospital, 56 Franklin Street, Waterbury, CT 06706, USA
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Stouffer GA, Hirmerova J, Moll S, Rubery B, Napoli M, Ohman EM, Simpson R. Percutaneous coronary intervention in a patient with immune thrombocytopenia purpura. Catheter Cardiovasc Interv 2004; 61:364-7. [PMID: 14988897 DOI: 10.1002/ccd.10799] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The appropriate regimen of platelet inhibitors that should be used in patients with immune thrombocytopenia purpura (ITP; formerly called idiopathic thrombocytopenic purpura) who are undergoing percutaneous coronary intervention is unclear. We report the case of a patient with ITP who underwent two separate coronary interventions. The first involved the use of aspirin and a cutting balloon to treat obstructive disease of the left circumflex. When the patient presented with restenosis, he received eptifibatide, clopidogrel, and an intracoronary stent. He is currently 16 months removed from his second procedure and remains physically active without any anginal symptoms. Percutaneous revascularization in patients with ITP remains a challenge and this therapeutic approach, while ultimately successful in the patient, requires further validation.
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Affiliation(s)
- George A Stouffer
- C.V. Richardson Cardiac Catheterization Laboratory, Division of Cardiology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
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Oyama N, Urasawa K, Sakai H, Kitabatake A. Side branch protection with hydrophilic polymer coated guide wire during cutting balloon angioplasty of a bifurcated lesion. JAPANESE HEART JOURNAL 2003; 44:565-73. [PMID: 12906038 DOI: 10.1536/jhj.44.565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cutting balloon angioplasty (CBA) was performed in a patient with in-stent restenosis (ISR) which had an important side branch. We used a hydrophilic polymer-coated guide wire for side branch protection during CBA. After CBA was successfully performed, the cutting balloon and guide wire were microscopically examined and proven to have suffered minor damage which, in itself, did not disturb the procedure. Hydrophilic polymer-coated wire might be an effective and safe choice for ISR which needs to be treated by CBA while protecting an important side branch.
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Affiliation(s)
- Naotsugu Oyama
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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15
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Gotsman MS, Dusa C, Nassar H, Hasin Y, Lotan C, Rozenman Y. The Cutting Balloon--a new technology? INTERNATIONAL JOURNAL OF CARDIOVASCULAR INTERVENTIONS 2003; 2:187-190. [PMID: 12623588 DOI: 10.1080/acc.2.3.187.190] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The Cutting Balloon consists of a standard balloon dilatation catheter with four microtome-sharp blades that incise the plaque and minimize arterial wall trauma. It was used in 31 patients; nine had calcified arteries, ten had non-compliant lesions, three had in-stent restenosis and nine had aorto-ostial lesions. Seventeen lesions were predilated, 28 were post-dilated and 18 required stent implantation. The procedure was very effective in aorto-ostial lesions, non-compliant lesions that were not responsive to high-pressure balloon dilatation, and was partially successful in calcified arteries. It has a very specific niche in selected lesions.
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Affiliation(s)
- MS Gotsman
- Department of Cardiology, Hadassah University, Hospital, Jerusalem, Israel
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Haridas KK, Vijayakumar M, Viveka K, Rajesh T, Mahesh NK. Fracture of cutting balloon microsurgical blade inside coronary artery during angioplasty of tough restenotic lesion: a case report. Catheter Cardiovasc Interv 2003; 58:199-201. [PMID: 12552544 DOI: 10.1002/ccd.10416] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
We report a rare complication due to fracture of the blade of a cutting balloon in the setting of a tough nondilatable restenotic lesion. This resulted in a mural hematoma as a result of dissection of coronary artery.
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Affiliation(s)
- K K Haridas
- Amrita Institute of Medical Science and Research Centre, Kochi, India.
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17
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Yang CH, Guo GBF, Chang HW, Yip HK, Hsieh K, Fang CY, Chen CJ, Hung WC, Hang CL, Wu CJ. The safety and feasibility of transradial cutting balloon angioplasty: immediate results, benefits, and limitations. JAPANESE HEART JOURNAL 2003; 44:51-60. [PMID: 12622437 DOI: 10.1536/jhj.44.51] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cutting balloon angioplasty can reduce the restenosis rate more than conventional balloon angioplasty, but is traditionally performed through a femoral artery. However, it is not clear how useful a transradial approach would be for cutting balloon angioplasty. This study was conducted to examine the safety, feasibility, and limitations of transradial as opposed to transfemoral cutting balloon angioplasty. From November 1999 to August 2001, 177 patients underwent cutting balloon coronary angioplasty. We compared the success rate, angiographic results, and complication rates of two groups of patients, those undergoing transradial (168 lesions from 153 patients) and those undergoing transfemoral (24 lesions from 24 patients) cutting balloon angioplasty. In both groups of patients who had similar clinical and target lesion characteristics. the percentage of lesions that required balloon predilation (27.4% vs 29.2%). stenting (7.7% vs 4.2%), and adjunct balloon dilation (28.0% vs 33.3%) due to dissection (35.7% vs 33.3%) or suboptimal results were comparable. Both approaches achieved a 100% primary success rate with similar acute gain (2.02 +/- 0.68 mm vs 1.94 +/- 0.70 mm), residual (luminal) diameter stenosis (19.2 +/- 11.7% vs 17.0 +/- 12.7%). proportion of lesions that achieved TIMI 3 flow (98.8% vs 100%), and clinical success rate (98.8% vs 95.8%). However, patients undergoing transradial cutting balloon angioplasty had earlier ambulation and a significantly shorter hospital stay than those undergoing a transfemoral approach (2.80 +/- 2.67 days vs 4.75 +/- 5.44 days, P = 0.005). We conclude that the transradial approach is a feasible and safe alternative to the transfemoral approach for cutting balloon angioplasty. In addition, it offers patients early ambulation and a short hospital stay.
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Affiliation(s)
- Cheng-Hsu Yang
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Niao-Sung Hsiang, Kaohsiung Hsien, Taiwan
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18
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Maruo T, Yasuda S, Miyazaki S. Delayed appearance of coronary artery perforation following cutting balloon angioplasty. Catheter Cardiovasc Interv 2002; 57:529-31. [PMID: 12455089 DOI: 10.1002/ccd.10335] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Coronary artery perforation is a potential complication of percutaneous coronary intervention (PCI). It usually develops immediately following PCI, particularly when an atheroablate device is used. We report a case in which coronary artery perforation developed 4 days after PCI with a nondebulking device, a cutting balloon catheter.
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19
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Okura H, Hayase M, Shimodozono S, Kobayashi T, Sano K, Matsushita T, Kondo T, Kijima M, Nishikawa H, Kurogane H, Aizawa T, Hosokawa H, Suzuki T, Yamaguchi T, Bonneau HN, Yock PG, Fitzgerald PJ. Mechanisms of acute lumen gain following cutting balloon angioplasty in calcified and noncalcified lesions: an intravascular ultrasound study. Catheter Cardiovasc Interv 2002; 57:429-36. [PMID: 12455075 DOI: 10.1002/ccd.10344] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Several studies have shown that mechanisms for lumen enlargement following conventional balloon angioplasty (BA) consist of plaque reduction and vessel expansion. To assess the mechanisms of lumen enlargement after Cutting Balloon (CB) angioplasty, intravascular ultrasound images were analyzed in 180 lesions (89 CB and 91 BA). External elastic membrane (EEM) cross-sectional area (CSA), lumen CSA, and plaque plus media (P+M) CSA were measured before and after angioplasty. In the CB group, lower balloon pressure was utilized (P < 0.0001). DeltaP+M CSA was significantly larger (P = 0.02) and deltalumen CSA showed a trend toward being larger (P = 0.07) compared to BA group. For noncalcified lesions, CB resulted in a larger deltaP+M CSA (P < 0.05) and a smaller deltaEEM CSA (P = 0.10) than BA. For calcified lesions, deltalumen CSA was significantly larger in the CB group (P < 0.05) without significant differences in deltaEEM CSA and deltaP+M CSA. Dissections complicated with calcified lesions were associated with larger deltalumen CSA for the CB group. In conclusion, for noncalcified lesions, CB achieves similar luminal dimensions with larger plaque reduction and less vessel expansion compared to BA. On the other hand, for calcified lesions, the CB achieves larger lumen gain, especially in lesions with evidence of dissections.
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Affiliation(s)
- Hiroyuki Okura
- Center for Research in Cardiovascular Interventions, Stanford University Medical Center, Stanford, California 94305, USA.
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20
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Mauri L, Bonan R, Weiner BH, Legrand V, Bassand JP, Popma JJ, Niemyski P, Prpic R, Ho KKL, Chauhan MS, Cutlip DE, Bertrand OF, Kuntz RE. Cutting balloon angioplasty for the prevention of restenosis: results of the Cutting Balloon Global Randomized Trial. Am J Cardiol 2002; 90:1079-83. [PMID: 12423707 DOI: 10.1016/s0002-9149(02)02773-x] [Citation(s) in RCA: 108] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The cutting balloon (CB) is a specialized device designed to create discrete longitudinal incisions in the atherosclerotic target coronary segment during balloon inflation. Such controlled dilatation theoretically reduces the force needed to dilate an obstructive lesion compared with standard percutaneous transluminal coronary angioplasty (PTCA). We report a multicenter, randomized trial comparing the incidence of restenosis after CB angioplasty versus conventional balloon angioplasty in 1,238 patients. Six hundred seventeen patients were randomized to CB treatment, and 621 to PTCA. The mean reference vessel diameter was 2.86 +/- 0.49 mm, mean lesion length 8.9 +/- 4.3 mm, and prevalence of diabetes mellitus in patients was 13%. The primary end point, the 6-month binary angiographic restenosis rate, was 31.4% for CB and 30.4% for PTCA (p = 0.75). Acute procedural success, defined as the attainment of <50% diameter stenosis without in-hospital major adverse cardiac events, was 92.9% for CB and 94.7% for PTCA (p = 0.24). Freedom from target vessel revascularization was slightly higher in the CB arm (88.5% vs 84.6%, log-rank p = 0.04). Five coronary perforations occurred in the CB arm only (0.8% vs 0%, p = 0.03). At 270 days, rates of myocardial infarction, death, and total major adverse cardiac events for CB and PTCA were 4.7% versus 2.4% (p = 0.03), 1.3% versus 0.3% (p = 0.06), and 13.6% versus 15.1% (p = 0.34), respectively. In summary, the proposed mechanism of controlled dilatation did not reduce the rate of angiographic restenosis for the CB compared with conventional balloon angioplasty. CB angioplasty should be reserved for difficult lesions in which controlled dilatation is believed to provide a better acute result compared with balloon angioplasty alone.
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Affiliation(s)
- Laura Mauri
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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21
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Takano Y, Currier JW, Yeatman LA, Kobashigawa JA, Rogers AD, Cianfichi LJ, Fishbein MC, Tobis JM. Cutting Balloon angioplasty for cardiac transplant vasculopathy. J Heart Lung Transplant 2002; 21:910-3. [PMID: 12163093 DOI: 10.1016/s1053-2498(02)00387-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
We performed Cutting Balloon angioplasty on 20 lesions in 11 heart transplant recipients 7.5 +/- 3.8 years after transplantation. The mean percentage of diameter stenosis decreased from 88.3% +/- 13.8% to 19.6% +/- 13.7% after Cutting Balloon angioplasty without complication. Seven patients underwent follow-up angiography at 4.9 +/- 1.7 months in a total of 12 lesions, and all lesions showed restenosis with a mean diameter stenosis of 84.4% +/- 19.2%. Cutting Balloon angioplasty can be used to treat obstructions in cardiac transplant coronary arteries; however, it may cause exacerbation and produce a high restenosis rate.
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Affiliation(s)
- Yuzuru Takano
- University of California, Los Angeles Center of Health Sciences, USA
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22
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Haas NA, Ocker V, Knirsch W, Holder M, Lochbuehler H, Lewin MAG, Uhlemann F. Successful management of a resistant renal artery stenosis in a child using a 4 mm cutting balloon catheter. Catheter Cardiovasc Interv 2002; 56:227-31. [PMID: 12112919 DOI: 10.1002/ccd.10171] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Percutaneous transluminal renal angioplasty (PTRA) is a well-established method to treat renal artery stenosis (RAS) in children and adults. However, a significant number of stenoses might not be treated by interventional techniques due to the inability to dilate the RAS. Conventional balloon angioplasty with a high-pressure coronary angioplasty balloon at 20 atm was unable to dilate a significant RAS in a 12-year-old child with severe renovascular hypertension (RR 195/125 mm Hg). After using a 4 mm cutting balloon, we achieved wide patency of the renal artery and an instant normalization of blood pressure without further need of antihypertensive therapy. PTRA using the cutting balloon technique may offer an additional therapeutic option for selected patients in whom conventional balloon angioplasty was not able to dilate RAS.
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Affiliation(s)
- Nikolaus A Haas
- Department of Pediatric Cardiology and Pediatric Intensive Care, Olgahospital Stuttgart, Stuttgart, Germany.
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23
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Hara H, Nakamura M, Asahara T, Nishida T, Yamaguchi T. Intravascular ultrasonic comparisons of mechanisms of vasodilatation of cutting balloon angioplasty versus conventional balloon angioplasty. Am J Cardiol 2002; 89:1253-6. [PMID: 12031723 DOI: 10.1016/s0002-9149(02)02321-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Intimal hyperplasia after balloon dilatation may be related to the severity of vascular injury, and cutting balloon angioplasty (CBA) may reduce vascular injury. The present study investigated the mechanism of vasodilation by CBA. Intravascular ultrasound examination was performed before and after intervention in 40 lesions treated with CBA and in 25 lesions treated with conventional balloon angioplasty. Intravascular ultrasound measurements included the vessel area, luminal area, and plaque area. Vessel expansion was evaluated as the ratio of the postprocedural vessel area to that before intervention. The vessel area was 13.9 +/- 3.2 and 14.8 +/- 3.2 mm(2) after CBA versus conventional angioplasty, respectively, whereas the luminal area was 5.5 +/- 1.2 versus 5.7 +/- 1.2 mm(2) and the plaque area was 8.5 +/- 2.7 versus 9.1 +/- 2.2 mm(2), respectively. The vessel area was smaller and the plaque area significantly smaller after CBA. Vessel expansion accounted for 45% of luminal enlargement, and plaque compression or shift accounted for 55% after CBA. After conventional angioplasty, vessel expansion accounted for 67%, and plaque compression or shift for 33% of luminal enlargement. The vessel expansion ratio was significantly smaller after CBA than after conventional angioplasty (1.05 vs 1.22, p <0.05). These findings suggest that the predominant mechanism of dilatation after CBA is plaque compression or shift rather than vessel expansion, unlike conventional angioplasty.
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Affiliation(s)
- Hisao Hara
- Third Department of Internal Medicine, Ohashi Hospital, Toho University School of Medicine, Tokyo, Japan.
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24
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Engelke C, Morgan RA, Belli AM. Cutting balloon percutaneous transluminal angioplasty for salvage of lower limb arterial bypass grafts: feasibility. Radiology 2002; 223:106-14. [PMID: 11930054 DOI: 10.1148/radiol.2231010793] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To evaluate the feasibility of cutting balloon percutaneous transluminal angioplasty (PTA) for treatment of neointimal hyperplasia in peripheral arterial bypass grafts. MATERIALS AND METHODS Fifteen consecutive patients (six women, nine men; age range, 57-89 years; mean age, 71 years) were treated with cutting balloon PTA for 16 anastomotic stenoses after infrainguinal bypass (prosthetic grafts, seven patients; prosthetic-vein composite grafts, two; venous grafts, five; and ileofemoral stent-graft, one). Cutting balloon PTA was followed by conventional PTA to improve anastomotic diameter. Patients with stenotic vein grafts underwent cutting balloon PTA after failed conventional PTA; the other patients were treated primarily with cutting balloon PTA. Criteria for success were a lumen diameter improvement of greater than 50% or residual stenosis of 20% or less. Follow-up was performed with color duplex ultrasonographic surveillance. Patency rates and durations were calculated with Kaplan-Meier survival curves and log-rank statistics. RESULTS Attempted conventional PTA (n = 6) prior to cutting balloon PTA was unsuccessful. Cutting balloon PTA was technically successful in 15 (94%) of 16 lesions, without clinical complications. Two local restenoses and one graft occlusion occurred between 5 and 7 months. The cumulative 6-month primary and secondary graft patency rates were 84% and 92%, respectively. At 12 and 18 months, they were 67% (95% CI: 0.34, 0.86) and 83% (95% CI: 0.48, 0.96), respectively; mean follow-up was 10.0 months. CONCLUSION Cutting balloon PTA proved feasible for treatment of resistant peripheral arterial bypass graft stenosis, commonly caused by neointimal hyperplasia, with excellent technical success. Short-term patency with this technique appears to be superior to that with conventional PTA, and it compares well with patency of atherectomy for salvage of infrainguinal bypass grafts.
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Affiliation(s)
- Christoph Engelke
- Department of Diagnostic Radiology, St George's Hospital, London, England.
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25
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Miyamoto T, Araki T, Hiroe M, Marumo F, Niwa A, Yokoyama K. Standalone cutting balloon angioplasty for the treatment of stent-related restenosis: acute results and 3- to 6-month angiographic recurrent restenosis rates. Catheter Cardiovasc Interv 2001; 54:301-8. [PMID: 11747153 DOI: 10.1002/ccd.1288] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Despite excellent acute reperfusion results, 20%-30% of patients who undergo coronary stent implantation will develop angiographic restenosis and may require same additional treatments. Cutting Balloon angioplasty (CBA) causes less histological damage outside of the incised area than a regular balloon. However, regular plain old balloon angioplasty is sometimes required before CBA, as is adjunctive stenting and adjunctive angioplasty. These adjunctive strategies may negate the advantages of CBA. There is little data available on CBA as a standalone therapy for stent-related restenosis (SRS). The aim of this study was to evaluate the acute and 3- to 6-month angiographic recurrent restenosis rates following standalone CBA in a patient population treated for SRS and in whom optimal acute results were obtained. In this study, 40 patients with SRS (54 lesions) underwent standalone CBA with optimal acute results. For all lesions, coronary angiography was conducted before and after a standalone CBA procedure for SRS and systematically during 3-6 months to assess recurrent angiographic restenosis rates in the study population. In the study lesions, SRS was either diffuse disease (> 15 mm; 52%) or focal type (48%). Cutting Balloon diameter was 3.20 +/- 0.44 mm and maximal inflation pressure 8.7 +/- 1.2 atm. Ratio of Cutting Balloon diameter to restenotic stent diameter was 0.996 +/- 0.487. Multiple inflations (6 +/- 3 times) were performed. Number of used Cutting Balloon was 1.02 +/- 0.14. Complications were as follows; one non-Q-wave MI (1.9%); 0 death (0%), and 17 repeat target lesion revascularizations (TLRs; 32%). Follow-up coronary angiography (CAG) was not attained for one patient. The angiographic recurrent restenosis rate was 34%, with a higher rate observed when the SRS was diffuse type, 50% vs. 16% for focal-type SRS (P < 0.01). The recurrent restenosis rate for smaller vessels (vessel diameter < or = 3.0 mm) was the same as for larger ones. At follow-up CAG, diffuse-type recurrent restenosis (56%) presented nearly as frequently as that presenting in the original SRS lesions (52%). But four diffuse-type SRS (29%) changed into focal-type recurrent stenosis. In this study, standalone CBA for SRS with optimal acute results was associated with an angiographic restenosis rate of 34%. Diffuse-type disease had a higher recurrent restenosis rate. When CBA achieves acute optimal results, adjunctive stenting or adjunctive PTCA are not always necessary, particularly when the SRS is focal. As a result of CBA, some diffuse-type SRS may change into focal-type recurrent stenosis by the time of the next intervention.
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Affiliation(s)
- T Miyamoto
- Department of Cardiology, Musashino Red Cross Hospital, Tokyo, Japan.
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26
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Martí V, Salas E, Aymat RM, García J, Guiteras P, Romeo I, Kozak F, Augé JM. Influence of residual stenosis in determining restenosis after cutting balloon angioplasty. Catheter Cardiovasc Interv 2000; 49:410-4. [PMID: 10751767 DOI: 10.1002/(sici)1522-726x(200004)49:4<410::aid-ccd13>3.0.co;2-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The cutting balloon is a new device for coronary angioplasty, which, by the combination of incision and dilatation of the plaque, is believed to minimize arterial wall trauma, the neoproliferative response, and subsequent restenosis. In this study, we sought to determine predictors of the restenosis using this technique. Seventy-seven patients underwent successful coronary angioplasty with cutting balloon alone. In 67 of these patients (87%), we performed a control angiogram at 6-month follow-up. Pre-, post-, and late angiographic results were evaluated by quantitative coronary analysis. Clinical and angiographic variables were correlated with restenosis as a binary variable and a continuous variable (late loss and late minimum luminal diameter). Univariate analysis showed that the immediate postprocedure minimum luminal diameter (MLD) was smaller in the restenotic group (defined as MLD > 50% by quantitative coronary angiography) than in the nonrestenotic group (1.90 +/- 0.47 mm vs. 2.19 +/- 0.56 mm, P < 0.05). In addition, the immediate percentage of stenosis was higher in the restenotic group than in the nonrestenotic group (37% +/- 10% vs. 27% +/- 11%, P < 0. 003). Multivariate analysis identified the immediate postcutting balloon percentage of stenosis as an independent determinant of binary restenosis (P < 0.008). When restenosis was defined as a continuous variable, the immediate postprocedure MLD was an independent predictor of late loss (P < 0.02) and of late MLD (P < 0. 0002). No clinical, preprocedure angiographic, or technical variables tested were associated with restenosis. The degree of postprocedural residual stenosis after cutting balloon angioplasty is predictive of late restenosis.
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Affiliation(s)
- V Martí
- Interventional Cardiology Unit, Department of Cardiology and Cardiac Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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27
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Esplugas E, Alfonso F, Alonso JJ, Asín E, Elizaga J, Iñiguez A, Revuelta JM. [The practical clinical guidelines of the Sociedad Española de Cardiología on interventional cardiology: coronary angioplasty and other technics]. Rev Esp Cardiol 2000; 53:218-40. [PMID: 10734755 DOI: 10.1016/s0300-8932(00)75087-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Interventional cardiology has had an extraordinary expansion in last years. This clinical guideline is a review of the scientific evidence of the techniques in relation to clinical and anatomic findings. The review includes: 1. Coronary arteriography. 2. Coronary balloon angioplasty. 3. Coronary stents. 4. Other techniques: directional atherectomy, rotational atherectomy, transluminal extraction atherectomy, cutting balloon, laser angioplasty and transmyocardial laser and endovascular radiotherapy. 5. Platelet glycoprotein IIb/IIIa inhibitors. 6. New diagnostic techniques: intravascular ultrasound, coronary angioscopy, Doppler and pressure wire. For the recommendations we have used the classification system: class I, IIa, IIb, III like in the guidelines of the American College of Cardiology and the American Heart Association.
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Affiliation(s)
- E Esplugas
- Servicio de Cardiología, Hospital de Bellvitge Príncipes de España, L'Hospitalet de Llobregat, Barcelona
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28
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Schöbel WA, Voelker W, Haase KK, Karsch KR. Occurrence of a saccular pseudoaneurysm formation two weeks after perforation of the left anterior descending coronary artery during balloon angioplasty in acute myocardial infarction. Catheter Cardiovasc Interv 1999; 47:341-6. [PMID: 10402295 DOI: 10.1002/(sici)1522-726x(199907)47:3<341::aid-ccd22>3.0.co;2-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
We describe the occurrence of a localized saccular pseudoaneurysm in a 69-year-old patient 2 weeks after perforation of the left anterior descending coronary artery during balloon angioplasty in acute myocardial infarction. The therapy of perforations requires prolonged balloon inflations, perfusion balloons, covered stents, or surgery. Coronary peudoaneurysm formations are rare; their therapy requires covered stents or surgery. Cathet. Cardiovasc. Intervent. 47:341-346, 1999.
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Affiliation(s)
- W A Schöbel
- Department of Cardiology, University of Tübingen, Tübingen, Germany.
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29
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YAMAGUCHI TETSU, NAKAMURA MASATO, NISHIDA TAKAHIRO, HARA HISAO, ASAHARA TOSHIYUKI, TOHMA HIROKO. Update on Cutting Balloon Angioplasty. J Interv Cardiol 1998. [DOI: 10.1111/j.1540-8183.1998.tb00200.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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30
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Martí V, Martín V, García J, Guiteras P, Augé JM. Significance of angiographic coronary dissection after cutting balloon angioplasty. Am J Cardiol 1998; 81:1349-52. [PMID: 9631974 DOI: 10.1016/s0002-9149(98)00165-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We studied 2 groups of patients with (n = 14) and without (n = 42) minor coronary dissections following cutting balloon angioplasty. Patients with a minor dissection had a longer length of lesion, higher percentage of stenosis, and greater acute gain after angioplasty; at 6-month follow-up both groups had a similar net gain and restenosis rate, suggesting that minor dissection after cutting balloon angioplasty has no influence on restenosis.
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Affiliation(s)
- V Martí
- Department of Cardiology and Cardiac Surgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
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