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Aleem S, Parikh P, Bhasin V, Pyo RT. Interventional Approach in Small Vessel, Diffuse, and Tortuous Coronary Artery Disease. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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2
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Pyo R. Interventional Approach in Small Vessel, Diffuse, and Tortuous Coronary Artery Disease. Interv Cardiol 2016. [DOI: 10.1002/9781118983652.ch20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Robert Pyo
- Montefiore Medical Center; Albert Einstein College of Medicine; New York NY USA
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3
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Han B, Aboud M, Nahir M, Noem F, Hasin Y. Cutting balloons versus conventional long balloons for PCI of long coronary lesions. INTERNATIONAL JOURNAL OF CARDIOVASCULAR INTERVENTIONS 2005; 7:29-35. [PMID: 16019612 DOI: 10.1080/14628840510011171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND PCI for long coronary lesions remains a challenge because of high incidence of early complications and late restenosis. Cutting balloon angioplasty may result in reduced procedural complications and late restenosis than angioplasty with conventional long balloons (LBA) due to minimized injury to the culprit arteries. OBJECTIVE To compare the immediate and one-year outcomes of CBA and LBA for long coronary lesions. METHODS 169 consecutive patients were retrospectively identified who underwent CBA or LBA for de novo lesions 20 mm in length and 2.5 mm in diameter. The primary endpoint was immediate procedural outcomes and angiographic restenosis at one year. RESULTS CBA was performed in 54 patients (56 lesions) and LBA in 115 patients (151 lesions). Baseline characteristics were similar in both groups with a mean lesion length of 34.89+/-11.19 mm, and vessel diameter of 3.03+/-0.54 mm. CBA resulted in reduced incidence of side branch loss (23.2% versus 41.7%, P=0.022) which was associated with less peri-procedural infarction (OR: 11.39 (95% CI: 1.34-96.53), P=0.026). It also caused less dissection (23.2% versus 38.4%, P=0.048) leading to a trend of less provisional focal stenting (32.1% versus 41.1%, P=0.264). The rate of angiographic restenosis and clinically driven target lesion revascularization at one year (follow-up 91.1%) was similar (25% versus 21.2%, and 20.4% versus 20%, for CBA versus LBA, both P=NS). The mean event-free survival was also similar (10.15+/-0.45 months for CBA versus 9.50+/-0.39 months for LBA, P=NS). CONCLUSION CBA demonstrated better immediate results and equivalent late results than LBA, and therefore, it may be considered a reasonable firstline approach for PCI of long coronary lesions.
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Affiliation(s)
- Bo Han
- Cardiology Department, Poria Medical Center, Tiberias, MP Hatachton, Israel
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4
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Abstract
Long coronary lesions, comprising up to 20% of the interventional practice, pose a significant challenge to the interventionalist. Several approaches have been described to treat long coronary lesions with long-term suboptimal outcomes. Atherectomy and laser treatments with or without adjunctive balloon angioplasty have not been shown to be superior to conventional balloon angioplasty alone. Preliminary data with the use of drug-eluting stents in the treatment of long coronary lesions appears to be promising even in small vessels and may eventually become the mainstay treatment of long lesions.
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5
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Prieto AR, Przybysz A, Fischell TA. Long balloon angioplasty with focal stenting for the treatment of diffuse coronary artery disease. Catheter Cardiovasc Interv 2002; 57:437-43. [PMID: 12455076 DOI: 10.1002/ccd.10370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The objective of this study was to evaluate the efficacy of treating long coronary lesions (> 30 mm) with either a 40 or a 60 mm long Scimed Cobra balloon followed by focal (contingency) stenting of areas with suboptimal results. Diffuse lesion length is a morphological characteristic associated with a poorer clinical outcome after balloon angioplasty with or without stenting. Patients were enrolled in a prospective randomized fashion to have initial PTCA with either a 40 or a 60 mm long balloon followed by focal stenting in areas with suboptimal results. The MACE rate at 6-month follow-up was collected from all patients and was the primary endpoint of the study. A total of 41 patients were enrolled into the study. The acute procedural success rate was 97.5% with a 6-month MACE rate of 9.8%. The use of long balloons with contingency stenting is a highly effective strategy for the treatment of diffuse coronary lesions.
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Affiliation(s)
- Alejandro R Prieto
- Department of Medicine, Division of Cardiology, Michigan State University, Lansing, Michigan, USA
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6
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Colombo A, De Gregorio J, Moussa I, Kobayashi Y, Karvouni E, Di Mario C, Albiero R, Finci L, Moses J. Intravascular ultrasound-guided percutaneous transluminal coronary angioplasty with provisional spot stenting for treatment of long coronary lesions. J Am Coll Cardiol 2001; 38:1427-33. [PMID: 11691519 DOI: 10.1016/s0735-1097(01)01557-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the approach of intravascular ultrasound (IVUS)-guided percutaneous transluminal coronary angioplasty (PTCA) with spot stenting (SS) for the treatment of long coronary lesions. BACKGROUND Treating long coronary lesions with balloon angioplasty results in suboptimal short- and long-term outcomes. Full lesion coverage with traditional stenting (TS) has been associated with a high restenosis rate. METHODS We prospectively evaluated a consecutive series of 130 long lesions (>15 mm) in 101 patients treated with IVUS-guided PTCA and SS. The results were compared with those of TS in a matched group of patients. Coronary angioplasty was performed with a balloon to vessel ratio of 1:1, according to the IVUS media-to-media diameter of the vessel at the lesion site, to achieve prespecified IVUS criteria: lumen cross-sectional area (CSA) > or =5.5 mm(2) or > or =50% of the vessel CSA at the lesion site. The stents were implanted only in the vessel segment where the criteria were not met. RESULTS In the SS group, stents were implanted in 67 of 130 lesions, and the mean stent length was shorter than that of lesions in the matched TS group (10.4 +/- 13 mm vs. 32.4 +/- 13 mm, p < 0.005). The 30-day major adverse cardiac event (MACE) rate was similar (5%) for both groups. Angiographic restenosis was 25% with IVUS-guided SS, as compared with 39% in the TS group (p < 0.05). Follow-up MACE and target lesion revascularization rates were lower in the SS group than in the TS group (22% vs. 38% [p < 0.05] and 19% vs. 34% [p < 0.05], respectively). CONCLUSIONS Intravascular ultrasound-guided SS for the treatment of long coronary lesions is associated with good acute outcome. Angiographic restenosis and follow-up MACE rates were significantly lower than those with TS.
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MESH Headings
- Aged
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/instrumentation
- Angioplasty, Balloon, Coronary/methods
- Angioplasty, Balloon, Coronary/mortality
- Coronary Angiography
- Coronary Disease/complications
- Coronary Disease/diagnosis
- Coronary Disease/mortality
- Coronary Disease/therapy
- Female
- Humans
- Male
- Middle Aged
- Myocardial Infarction/etiology
- Patient Selection
- Prospective Studies
- Recurrence
- Risk Factors
- Severity of Illness Index
- Stents
- Thrombosis/etiology
- Time Factors
- Treatment Outcome
- Ultrasonography, Interventional/adverse effects
- Ultrasonography, Interventional/instrumentation
- Ultrasonography, Interventional/methods
- Ultrasonography, Interventional/mortality
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Affiliation(s)
- A Colombo
- Centro Cuore Columbus, Milan, Italy.
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7
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Nageh T, de Belder AJ, Thomas MR, Williams IL, Wainwright RJ. A randomised trial of endoluminal reconstruction comparing the NIR stent and the Wallstent in angioplasty of long segment coronary disease: results of the RENEWAL Study. Am Heart J 2001; 141:971-6. [PMID: 11376312 DOI: 10.1067/mhj.2001.115301] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The role of coronary stents in reducing the incidence of acute complications and late restenosis after angioplasty has been established in randomized studies focusing on simple, short coronary lesions. The development of long coronary stents has provided a safe and predictable means of treating long coronary lesions, but this carries with it a higher risk of restenosis. By comparing the outcome of treating long lesions with two different stent types, we aimed to assess the influence of stent design rather than the nature of long lesions per se on the relatively high restenosis rates in this subgroup. METHODS This study was designed to assess procedural complications and 6-month restenosis rates in a randomized trial comparing a slotted tube stent with a self-expanding stent for the treatment of long coronary lesions. Randomization of vessels to either stent occurred after successful balloon angioplasty. Intravascular ultrasound (IVUS) was used to assess and optimize stent deployment. The patients were restudied angiographically and by IVUS at 6 months. RESULTS A total of 82 patients (85 vessels) were recruited (slotted tube stent, n = 44 vessels; self-expanding stent, n = 41 vessels). Successful deployment occurred in 41 (100%) of 41 of the self-expanding stent group and 41 (93%) of 44 of the slotted tube stent group. There was no difference in lesion length between the two groups (slotted tube stent, 26.6 +/- 6.9 [SD] mm; self-expanding stent, 28.7 +/- 9.8 [SD] mm; P = .2), but the mean length of the self-expanding stent was greater than that of the slotted tube stent (41.6 +/- 18.8 [SD] mm vs 35.4 +/- 16.2 [SD] mm, respectively; P < .05). There was no significant difference in the rate of major events between the two groups at 6-month follow-up. The angiographic restenosis rate at follow-up was less in the slotted tube stent group, but this did not reach statistical significance (26% vs 46%, respectively; P = .1) and the target lesion revascularization rate was similar for both groups (7.9% vs 7.7%, respectively; P = .8). IVUS assessment of plaque/stent ratios suggested a greater plaque burden in the self-expanding stent compared with the slotted tube stent at follow-up (0.42 +/- 1.2 [SD] vs 0.3 +/- 0.08 [SD]), but this was not statistically significant (P = .1). CONCLUSIONS Long stents can be safely and successfully deployed in long segment coronary disease, with an acceptable 6-month target lesion revascularization rate. Our results showed a trend toward lower angiographic restenosis and a lesser in-stent plaque burden at follow-up in the slotted tube stent compared with the self-expanding stent. This suggests that stent design may influence the restenotic process in long coronary lesions.
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Affiliation(s)
- T Nageh
- Department of Cardiology, King's College Hospital, London, UK.
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8
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Rozenman Y, Mereuta A, Schechter D, Mosseri M, Lotan C, Nassar H, Weiss AT, Hasin Y, Chisin R, Gotsman MS. Long-term outcome of patients with very long stents for treatment of diffuse coronary disease. Am Heart J 1999; 138:441-5. [PMID: 10467193 DOI: 10.1016/s0002-8703(99)70145-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES The study sought to determine the 6-month clinical outcome of patients who underwent implantation of very long coronary stents to treat diffuse disease and/or long dissections and to compare the findings with those reported in the literature for patients who underwent implantation of multiple short coronary stents. BACKGROUND New designs of flexible stents enable the implantation of long stents rather than multiple short, older design stents. The initial experience is very promising but the long-term outcome has not been described yet. METHODS Fifty-seven consecutive patients in whom 67 long stents (>/=30 mm) were successfully deployed were included in this study. Six-month clinical and angiographic follow-up was prospectively collected. Patients with recurrent angina underwent coronary angiography without further testing. Patients who remained asymptomatic at the 6-month follow-up visit underwent positron emission tomographic imaging, and those with results suggestive of ischemia underwent coronary angiography. A combined study end point was defined as death, myocardial infarction, and the need for target vessel revascularization. RESULTS Only 1 patient (2%) reached a study end point at hospital discharge. An additional 20 patients (total 21 patients [37%]) reached an end point by 6 months. The outcome was not influenced by the clinical presentation (stable or unstable angina) or by the indication for stenting (elective or emergency). Predictors for adverse outcome were multiple stents per narrowing (63% vs 29%, P <. 04), and stents smaller than 3.5 mm (49% vs 22%). Narrowing and stent length were not predictive of a study end point in narrowings that were successfully treated by a single long stent. CONCLUSIONS Elective stenting provides an effective solution for patients with diffuse coronary disease provided that a single long stent (usually <40 mm) can cover the full length of the narrowing. The results are better when vessels larger than 3 mm are treated. Compared with multiple short stents, implantation of a single long stent is probably at least as effective, and the procedure is quicker and cheaper and thus should be the preferred approach.
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Affiliation(s)
- Y Rozenman
- Cardiology Department, Hadassah University Hospital, Jerusalem, Israel
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9
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Liu MW, Luo JF, Dean LS, Baxley WA, Iyer SS, Sutor RJ, Negus B, Roubin GS. Long-term follow-up study of coronary reconstruction with multiple stents. Am Heart J 1999; 137:292-7. [PMID: 9924163 DOI: 10.1053/hj.1999.v137.92710] [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: 11/11/2022]
Abstract
BACKGROUND Conventional balloon angioplasty of very long de novo coronary lesions or very long coronary dissection caused by angioplasty is associated with low success and high complication rates. Multiple intracoronary stents have been used to treat both conditions, although long-term efficacy has not been defined. METHODS AND RESULTS Between June 1993 and December 1995, 47 consecutive patients underwent native coronary angioplasty and stenting with 4 or more stents covering at least 2 consecutive diseased coronary segments. Preangioplasty and poststenting diameter stenoses were 81% +/- 13% and 21% +/- 12%, respectively. Reference vessel diameters were 3.53 +/- 0.55 mm proximal to the stents and 2. 95 +/- 0.62 mm distal to the stents. Average lesion length was 63 +/- 20 mm. The number of stents used was 4.5 +/- 1 per vessel (from 4 to 7). Gianturco Roubin I stents were used in all patients. Coronary Palmaz-Schatz stents were used as supplementary stents in 3 patients. Angiographic success was 100%. In-hospital outcomes include 1 death, 1 coronary bypass surgery, no Q-wave myocardial infarction, and 7 non-Q-wave myocardial infarctions. Long-term follow-up at 430 +/- 199 days was completed in all patients. Thirty-five (76%) patients were asymptomatic, 8 (17%) had class 1 or 2 angina, 1 had a myocardial infarction, 13 (28%) underwent repeat angioplasty, 2 patients had subsequent elective bypass surgery, and 3 died during follow-up. CONCLUSIONS Multiple intracoronary stents for very long lesions or dissection can be performed with acceptable immediate and long-term outcomes.
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Affiliation(s)
- M W Liu
- Interventional Cardiology, University of Alabama at Birmingham, Alabama, USA
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10
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Le Breton H, Bedossa M, Commeau P, Boschat J, Huret B, Gilard M, Brunel P, Crochet D, Grollier G, Douillet R, Koning R, Lefebvre E, Meselhy M, Leclercq C, Pony JC. Clinical and angiographic results of stenting for long coronary arterial atherosclerotic lesions. Am J Cardiol 1998; 82:1539-43, A8. [PMID: 9874064 DOI: 10.1016/s0002-9149(98)00703-6] [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: 10/17/2022]
Abstract
A prospective registry of 187 patients who underwent percutaneous coronary angioplasty with attempted long NIR stent delivery was performed. A successful stent delivery was achieved in 93% of cases with a low rate of major cardiovascular events, and 6-month follow-up showed low rates of clinical events, new revascularization procedures, and angiographic restenosis.
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Affiliation(s)
- H Le Breton
- Department of Cardiology, Rennes University Hospital, France
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12
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Rozenman Y, Mereuta A, Mosseri M, Lotan C, Nassar H, Hasin Y, Gotsman MS. Initial experience with long coronary stents: the changing practice of coronary angioplasty. Am Heart J 1997; 134:355-61. [PMID: 9327689 DOI: 10.1016/s0002-8703(97)70068-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The initial experience with the use of long coronary stents (> 30 mm in length) was analyzed retrospectively. Sixty-seven stents were deployed in 58 narrowings in 57 patients (34 AVE Microstents, 16 Nir stents, four Gianturco-Roubin II stents, and 13 Wallstents). Stents were implanted in 22 patients with unstable angina, 34 patients with stable angina, and one patient during direct angioplasty for acute myocardial infarction. Eighteen additional short stents were implanted to cover the entire length of the lesions so that an average of one and a half stents were deployed per patient. The length of the narrowings before stenting was 40 +/- 20 mm and the length of the stented segments was 45 +/- 20 mm. Stents were deployed for "bailout" in 23 narrowings, to improve suboptimal results of balloon angioplasty in 18 narrowings, and electively in 17 narrowings. Twenty of the 67 long stents were deployed in saphenous vein grafts. The success rate of stent implantation was 100%. One patient had a rupture of a saphenous vein graft after deployment of two long stents, with tamponade treated by emergency surgery. One patient had chest pain 18 hours after stent deployment; by the time he arrived at the catheterization laboratory the pain had subsided and the angiogram revealed a patent artery with normal flow. There were no other major complications during the hospital course and 1-month follow-up. We conclude that long coronary stents can be deployed successfully in native coronary arteries and vein grafts. They are useful for elective implantation and extremely helpful in bailout situations. The immediate results are excellent, but long-term outcome is awaited.
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Affiliation(s)
- Y Rozenman
- Cardiology Department, Hadassah University Hospital, Ein Kerem, Jerusalem, Israel
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13
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Abstract
The practice of coronary stenting is evolving rapidly, with new stent designs, deployment techniques, and adjunctive therapy. In many respects, clinical practice is changing in advance of the availability of supporting data. The consistent excellent angiographic result with stent deployment exceeds that achieved by any other previous interventional device, and the extent to which this accounts for the exponential increase in stent utilization cannot be accurately determined but is undoubtedly considerable. Controlled randomized trials have confirmed that stent deployment is superior to balloon angioplasty in certain lesion subsets or clinical scenarios. These include focal de novo native vessel lesions, lesions with late recoil after balloon angioplasty, acute closure after balloon angioplasty, and proximal left anterior descending coronary artery lesions. In addition, observational data is persuasive in focal coronary saphenous vein graft lesions and aorto-ostial lesions. On the other hand, the evidence supporting the use of stents strictly to improve on a suboptimal result, possibly the most frequent indication, is indirect and circumstantial. Stents are expensive, but it was anticipated that with the reduction in restenosis not only would they be cost-effective but also ultimately would reduce costs. This hope has not as yet been realized. However, there is little question that the introduction of intracoronary stents has been the most significant and exciting development since the introduction of percutaneous revascularization almost 20 years ago. It has revitalized the field.
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Affiliation(s)
- E A Cohen
- Sunnybrook Health Science Centre and The Toronto Hospital, University of Toronto, Canada
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14
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Abstract
OBJECTIVES This study sought to determine whether in-hospital and intermediate-term posthospital outcomes have changed in elderly patients undergoing percutaneous transluminal coronary angioplasty from the period 1980 through 1989 to the period 1990 through 1992. BACKGROUND Although elderly patients have a higher incidence of procedure-related deaths and late recurrence of angina after coronary angioplasty, recent complication rates for angioplasty seem to be lower. METHODS From 1980 to 1989, 982 patients > or = 65 years old underwent nonemergent coronary angioplasty (group A). They were compared with 768 similar patients who had coronary angioplasty from 1990 to 1992 (group B). RESULTS Patients in group B were older than those in group A and had a higher mean concomitant disease score, a higher proportion of men and a greater proportion of patients with a previous myocardial infarction and previous coronary artery bypass surgery. Despite the increased complexity of the group B cohort, procedural success rates were higher, and rates of important in-hospital complications were much lower than those in group A. For group A versus group B, respectively, the technical success rate was 88.1% versus 93.5% (p < 0.001), in-hospital death rate 3.3% versus 1.4% (p = 0.014), emergency bypass surgery rate 5.5% versus 0.65% (p < 0.001) and incidence of in-hospital death or myocardial infarction 6.3% versus 3.4% (p < 0.005). However, intermediate-term posthospital event-free rates in hospital survivors did not decrease. The rate of death or myocardial infarction at 6 months was 4.7% in group A versus 7.1% in group B (p < 0.05). Survival free of acute myocardial infarction, bypass surgery, repeat coronary angioplasty or severe angina at 1 year was 66.7% in group A versus 54.9% in group B (p < 0.001). The combined in-hospital death/myocardial infarction rate plus that for the first 6 months after hospital dismissal was essentially equivalent for the two groups (10.3% vs. 9.9%, p = NS). CONCLUSIONS An increase in technical success rates and a reduction in short-term complication rates for coronary angioplasty in the elderly in recent years have not translated into an improved event-free survival rate, which continues to be influenced by important baseline characteristics of these high risk patients.
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MESH Headings
- Aged
- Aged, 80 and over
- Analysis of Variance
- Angina, Unstable/epidemiology
- Angina, Unstable/etiology
- Angioplasty, Balloon, Coronary/adverse effects
- Angioplasty, Balloon, Coronary/mortality
- Angioplasty, Balloon, Coronary/trends
- Arrhythmias, Cardiac/epidemiology
- Arrhythmias, Cardiac/etiology
- Coronary Artery Bypass
- Disease-Free Survival
- Female
- Follow-Up Studies
- Humans
- Incidence
- Logistic Models
- Male
- Myocardial Infarction/epidemiology
- Myocardial Infarction/etiology
- Outcome Assessment, Health Care
- Recurrence
- Risk Factors
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Affiliation(s)
- R C Thompson
- Division of Cardiovascular Diseases, Mayo Clinic Jacksonville, Florida, USA
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15
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Harris WO, Holmes DR. Treatment of diffuse coronary artery and vein graft disease with a 60-mm-long balloon: early clinical experience. Mayo Clin Proc 1995; 70:1061-7. [PMID: 7475335 DOI: 10.4065/70.11.1061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To report our preliminary clinical experience with a new 60-mm-long angioplasty balloon. DESIGN We reviewed the results in patients who underwent this type of angioplasty between May and October 1993 at our institution. MATERIAL AND METHODS The study group consisted of 14 high-risk patients (57% with rest-related angina) and 19 treated coronary segments--52% in native coronary arteries and 48% in saphenous vein grafts (mean age, 9 years). Often, long balloon angioplasty was used in conjunction with laser or transluminal extraction atherectomy. RESULTS Angiographic success (40% or more visual reduction in diameter stenosis) was achieved in all patients. Intimal dissection occurred in 4 of the 19 treated segments (21%), but each was less than 50% obstructive. No patient required intracoronary stenting. Clinical success was achieved in 13 patients (93%). The one death that occurred was from vein graft distal embolization. At a mean follow-up of 9 months, three patients had required reinterventional procedures, and one patient had undergone a coronary artery bypass operation. No myocardial infarction or death occurred during this period. CONCLUSION Preliminary clinical experience with a 60-mm-long angioplasty balloon to treat complicated coronary lesions in high-risk patients suggests that, when used alone or in combination with other devices, this new balloon results in high initial success and low complication rates. A larger clinical experience is necessary for accurate assessment of the role of this new balloon catheter.
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Affiliation(s)
- W O Harris
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic Rochester, Minnesota 55905, USA
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16
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Ghazzal ZM, Burton E, Weintraub WS, Litvack F, Rothbaum DA, Klein L, King SB. Predictors of restenosis after excimer laser coronary angioplasty. Am J Cardiol 1995; 75:1012-4. [PMID: 7747679 DOI: 10.1016/s0002-9149(99)80714-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
One hundred twenty-five lesions successfully treated with excimer laser coronary angioplasty at 3 centers were analyzed in a central core laboratory using detailed quantitative angiographic analysis. Sixty-seven narrowings had restenosis (> or = 50% diameter stenosis at restudy). Correlates of restenosis were as follows: baseline diameter stenosis was 79% in the restenosis group versus 71% in the group without restenosis (p = 0.0002), baseline minimal diameter stenosis was 0.55 mm in the restenosis group versus 0.72 mm in the group without restenosis (p = 0.006), final diameter stenosis was 40% in the restenosis group versus 32% in the group without restenosis (p = 0.002), lesion length > or = 7 mm was present in 43% of the restenosis group versus 21% in the group without restenosis (p = 0.009), and Thrombolysis in Myocardial Infarction trial flow 0 to 2 was 33% in the restenosis group versus 15% in the group without restenosis (p = 0.025). The strongest multivariate correlate of restenosis was the baseline diameter stenosis (p = 0.003). Whereas most predictors were not controllable, achieving a low residual diameter stenosis that is operator-dependent can favorably influence the restenosis rate.
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Affiliation(s)
- Z M Ghazzal
- Division of Cardiology, Andreas Gruentzig Cardiovascular Center, Emory University School of Medicine, Atlanta, Georgia 30322, USA
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17
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Ormiston JA, Webster MW. Simultaneous inflation of tandem (sequential) angioplasty balloons: a means of simultaneously treating multiple lesions in one coronary artery. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1995; 34:365-367. [PMID: 7621551 DOI: 10.1002/ccd.1810340219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
We report a novel approach to dilating multiple lesions in a coronary artery. Through the same guide and over different wires, a 3.5 mm diameter, 20 mm length, and a 3.0 mm diameter, 90 mm length balloon were simultaneously inflated in a right coronary artery. This approach, which simultaneously treats sequential (tandem) lesions of different diameter and length, allows reduction of both the total duration of ischemia and procedural time and may improve early angiographic outcome.
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18
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Tan K, Sulke N, Taub N, Sowton E. Clinical and lesion morphologic determinants of coronary angioplasty success and complications: current experience. J Am Coll Cardiol 1995; 25:855-65. [PMID: 7884088 DOI: 10.1016/0735-1097(94)00462-y] [Citation(s) in RCA: 150] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVES This study evaluated the validity of the American College of Cardiology/American Heart Association ABC lesion classification scheme and its modifications. BACKGROUND With the continued refinement in angioplasty technique and equipment evolution, the lesion morphologic determinants of immediate angioplasty outcome have changed significantly. Hence, the validity of the classification scheme has been questioned. METHODS We assessed the lesion morphologic determinants of immediate angioplasty outcome in 729 consecutive patients who underwent coronary angioplasty of 994 vessels and 1,248 lesions. RESULTS Angioplasty success was achieved in 91% of lesions, and abrupt closure occurred in 3%. Success was achieved in 96%, 93% and 80% of type A, B and C lesions, respectively (A vs. B, p = NS; B vs. C, p < 0.001; A vs. C, p < 0.001; A vs. B1, p = NS; A vs. B2, p = 0.03; B1 vs. B2, p = 0.02; B2 vs. C, p < 0.001; C1 vs. C2, p = NS). Abrupt closure occurred in 2.1%, 2.6% and 5% of type A, B and C lesions, respectively (A vs. B, B vs. C, A vs. C and A vs. B1, all p = NS; B1 vs. B2, p = 0.01; B2 vs. C1, p = NS; C1 vs. C2, p = 0.04). Type B characteristics had a success rate ranging from 74% to 95% and an abrupt closure rate ranging from 2.2% to 14%. Type C characteristics had a success rate ranging from 57% to 88% and an abrupt closure rate ranging from 0% to 16%. Longer lesions, calcified lesions, diameter stenosis of 80% to 99% and presence of thrombus were predictive of a lower success rate. Longer lesions, angulated lesions, diameter stenosis of 80% to 99% and calcified lesions were predictive of an abrupt closure. CONCLUSIONS The previously proposed classification schemes are outdated and need to be changed for application in current angioplasty practice. Analyzing specific lesion morphologic characteristics rather than applying a simple lesion classification score when evaluating angioplasty outcome may be more useful because it provides a more precise profile of the lesion and allows better patient stratification and selection.
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Affiliation(s)
- K Tan
- Department of Cardiology, Guy's Hospital, London, England, United Kingdom
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Blankenship JC, Ford AC, Henry SD, Frey CM. Coronary dissection resulting from angioplasty with slow oscillating vs. rapid inflation and slow vs. rapid deflation. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1995; 34:202-9. [PMID: 7497485 DOI: 10.1002/ccd.1810340105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
To determine if slow inflation or slow deflation (compared to standard rapid inflation/deflation) would minimize coronary arterial dissection, we randomized 162 lesions from 136 patients undergoing coronary angioplasty with polyolefin copolymer balloons to slow oscillating (1 atmosphere/20 sec) vs. rapid (over 30 sec) inflation and slow (over 15 sec) vs. rapid deflation. The incidence of any dissection was nearly identical in the four inflation/deflation groups. The incidence of severe dissection, however, was significantly higher for the slow inflation/slow deflation group compared to the other three groups (38% vs. 15%, P = .024). For angioplasty performed with polyolefin copolymer balloons, slow deflation combined with slow oscillating inflation is associated with more frequent severe dissections.
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Affiliation(s)
- J C Blankenship
- Department of Cardiology, Geisinger Medical Center, Danville, PA 17822, USA
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Cannon AD, Roubin GS, Hearn JA, Iyer SS, Baxley WA, Dean LS. Acute angiographic and clinical results of long balloon percutaneous transluminal coronary angioplasty and adjuvant stenting for long narrowings. Am J Cardiol 1994; 73:635-41. [PMID: 8166057 DOI: 10.1016/0002-9149(94)90925-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Historically, long coronary artery stenoses undergoing percutaneous transluminal coronary angioplasty (PTCA) are reported to have reduced procedural and clinical success in comparison with shorter lesions. The efficacy of long balloons (30 or 40 mm) in long lesions was evaluated. Eighty-two patients had 84 PTCA procedures with a primary long balloon. In all, 86 lesions were available for analysis. Data were collected prospectively on standard PTCA procedure forms. Coronary angiograms were reviewed and measured with digital calipers. Hospital charts were examined for complications. PTCA was performed in the left anterior descending artery in 44 cases (51%), the right coronary artery in 29 (34%) and the circumflex artery in 13 (15%). With the use of a modified classification system, 47 lesions (55%) were class C, 24 (28%) were class B2 and 15 (17%) were class B1. Mean lesion length was 22 +/- 11 mm (range 10 to 72), and 38 lesions (44%) were > or = 20 mm. Twelve patients received an intracoronary stent. The long balloon alone produced angiographic success (< 50% residual stenosis) in 77 lesions (90%). Angiographic success was achieved ultimately in all stenoses, using a stent in 7 patients and a short balloon in 2. There were 2 deaths (2%) and 1 Q-wave myocardial infarction (1%). One patient needed coronary artery bypass surgery. Clinical success without death, Q-wave infarction or bypass surgery was achieved in 83 of 86 procedures (97%). In conclusion, the use of long PTCA balloons with adjuvant stenting produced excellent results in these long stenoses. Lesion length was not a precursor of poor angiographic or clinical outcome.
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Affiliation(s)
- A D Cannon
- Department of Medicine, University of Alabama at Birmingham 35294-0007
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