The effect of predilatation on coronary angioplasty-induced vessel wall injury

Oscillating balloon angioplasty: does pressure oscillation reach the balloon?

Oscillating pressure inflations may minimize trauma to the coronary artery during coronary angioplasty. We measured in vitro diameters of polyolepin copolymer compliant angioplasty balloons (as a surrogate for pressure) during pressure oscillation at the inflator to determine if pressure oscillations at the inflator were conducted to the balloon. Balloon diameter oscillation increased as cycle length and inflator pressure amplitude increased. Currently practiced oscillating inflation (cycle length 2-3 sec, amplitude 2-3 atm) did not effectively transmit oscillation to the balloon. Clinically feasible optimal balloon oscillation was achieved at a cycle length of 6 sec and pressure amplitude of about 3 atm.

Dual-balloon progressive coronary dilatation catheter: design and initial clinical experience

As newer interventional devices continue to enter the marketplace, balloon angioplasty remains the standard by which all devices are judged with regard to both safety and efficacy. It has been observed that predilating a stenosis with a small balloon followed by dilatation with an optimally sized larger balloon creates a more controlled arterial injury, reduces complications, and thus improves success rates. Exchanging two balloons for each lesion, however, increases the complexity and cost of the procedure in addition to increasing the amount of time required and the amount of radiation exposure. Therefore an "over-the-wire" dual-balloon catheter was developed with a small distal balloon and a larger proximal balloon on a 2.9F shaft to allow progressive coronary dilatation with a single device, without necessitating a balloon catheter exchange. The device was used successfully in 45 of 47 patients (78 lesions). The two failures were related to an inability to cross the lesion in one and failure of the device in the other. Twenty-one patients (47%) underwent a multivessel procedure. There were 29 left anterior descending/diagonal, 17 circumflex/marginal, 20 right coronary artery/posterior descending artery, and 10 vein graft lesions. The device was successfully delivered in the native anatomy to 12 distal, 27 mid, and 27, proximal lesions of which nine were osteal, for a procedural success rate of 97%. The mean stenosis was reduced from 80.7 +/- 11.5% to 15.2 +/- 11.9%. There were no major dissections, only 9 (11.2%) minor dissections, and no myocardial infarctions.(ABSTRACT TRUNCATED AT 250 WORDS)

Balloon catheter requirements during contemporary percutaneous transluminal coronary angioplasty

In order to examine the outcome of utilizing multiple balloon catheters during the percutaneous transluminal coronary angioplasty (PTCA), 300 consecutive PTCAs were analyzed. PTCA was performed in a single lesion in 163 patients (54%), in multiple lesions in 52 patients (18%), and in multiple vessels in 85 patients (28%). A total of 488 balloon catheters were used (1.6/case, range 1-9) and in 112 cases (37%) > or = 2 catheters were used. Multiple balloon catheters were needed in 27 single lesion (17%), 24 multilesion (48%), and 61 multivessel (72%) cases (p < .05). There was no difference in the angiographic success rate in cases completed with 1 balloon catheter (238/251, 95%) compared to those requiring > or = 2 catheters (260/274, 95%). Emergency bypass was required in 5 patients (1.7%) and there were 2 deaths (0.6%). Thus, although contemporary PTCA frequently requires multiple balloon catheters for completion, success rates remain high and appear to offset the increased procedural expenses.