1
|
Abstract
Imaging guidance is paramount to procedural success in minimally invasive interventions. Catheter-based therapies are the standard of care in the treatment of many cardiac disorders, including coronary artery disease, structural heart disease and electrophysiological conditions. Many of these diseases are caused by, or effect, a change in vasculature or cardiac tissue composition, which can potentially be detected by photoacoustic imaging. This review summarizes the state of the art in photoacoustic imaging approaches that have been proposed for intervention guidance in cardiovascular care. All of these techniques are currently in the preclinical phase. We will conclude with an outlook towards clinical applications.
Collapse
Affiliation(s)
- Sophinese Iskander-Rizk
- Department of Cardiology, Biomedical Engineering, Erasmus MC University Medical Center Rotterdam, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | | | | |
Collapse
|
2
|
Ilkay E, Karaca I, Yavuzkir M, Akbulut M, Pekdemir M. The Effect of Interventional Treatment in Acute Myocardial Infarction on ST Resolution: A Comparison of Coronary Angioplasty with Excimer Laser Angioplasty. Angiology 2016; 56:377-84. [PMID: 16079919 DOI: 10.1177/000331970505600403] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The treatment methods for acute myocardial infarction (MI) have started to change in the new millennium. Myocardial perfusion (ST-segment resolution) is the target rather than achieving TIMI-III flow in the infarct-related artery. In this study the authors compared the effect of percutaneous transluminal coronary angioplasty (PTCA) and excimer laser angioplasty (ELCA), which was accepted as one of the thrombolysis methods, on ST-segment resolution. A stent was applied after ELCA to 36 patients (4 women, 32 men; mean age 50.44 ±9.8 years) in group I and a stent was applied after balloon angioplasty to 44 patients (5 women, 39 men; mean age 50.77 ±12.2 years) in group II. Fisher’s exact test was used in the analysis of data, and p<0.05 was accepted as significant. There was no difference between the groups with respect to symptom duration, time to angioplasty, risk factors, infarct localization, stent diameter, and length. TIMI-III flow was achieved in 33 patients (92%) in group I and in 40 patients (91%) in group II. There was no statistical difference in TIMI flow between the groups. In group I, complete ST resolution was observed in 75% (27/36) of the patients, partial resolution in 22% (8/36), and resolution was unsuccessful in 3% (1/36). In group II, complete, partial, and unsuccessful ST resolution were 41% (18/44), 45% (20/44), and 14% (6/44), respectively. The mean ST resolution was 82.78 ±11.8% in group I and 66.36 ±10% in group II (p=0.001). ST segment resolution, which is a good predictor of tissue perfusion, was higher with ELCA than with balloon angioplasty. These findings should be supported by large randomized studies.
Collapse
Affiliation(s)
- Erdogan Ilkay
- Firat University, Medical School, Department of Cardiology, Elaziğ, Turkey.
| | | | | | | | | |
Collapse
|
3
|
Abstract
We evaluated the short-term results of percutaneous excimer laser angioplasty in acute myocardial infarction. Of the 18 patients studied, 2 were female and 16 male with a mean age of 56.6 ± 12.1 years. Thrombolysis in myocardial infarction grades 0, 1, and 2 flow was observed in 10, 5, and 3 cases, respectively, prior to the procedure. The degree of stenosis was 97.9% ± 5.1%. The lesion was crossed with a laser catheter in all cases, using a mean number of 808 ± 384 laser pulses. Type C dissection developed in only 1 case (6%). Except for this case, distal flow was grade 3 in all the patients. Following the procedure, ST segment resolution exceeding 70% was achieved in 14 cases (78%) within the first 90 minutes. The success rate of laser ablation was 94% (17 patients). Stent implantation was performed in all the cases. In conclusion, laser angioplasty is an effective and reliable treatment for acute myocardial infarction.
Collapse
Affiliation(s)
- Erdogan Ilkay
- Department of Cardiology, Firat Medical School, Zübeyde Hanim Cad. 116/6 Elaziğ, Turkey.
| | | | | | | | | | | |
Collapse
|
4
|
Ambrosini V, Sorropago G, Laurenzano E, Golino L, Casafina A, Schiano V, Gabrielli G, Ettori F, Chizzola G, Bernardi G, Spedicato L, Armigliato P, Spampanato C, Furegato M. Early outcome of high energy Laser (Excimer) facilitated coronary angioplasty ON hARD and complex calcified and balloOn-resistant coronary lesions: LEONARDO Study. Cardiovascular Revascularization Medicine 2015; 16:141-6. [DOI: 10.1016/j.carrev.2015.02.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Revised: 01/29/2015] [Accepted: 02/05/2015] [Indexed: 11/24/2022]
|
5
|
Buja LM. Coronary Artery Disease: Pathological Anatomy and Pathogenesis. Coron Artery Dis 2015. [DOI: 10.1007/978-1-4471-2828-1_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
6
|
Abstract
OBJECTIVE In this feasibility study, we investigate possible femtosecond laser thrombolysis. BACKGROUND DATA Because of low pulse energies, femtosecond laser surgery inherently minimizes side effects on the surrounding tissue. Moreover, current femtosecond laser sources as well as fiber technology allow consideration of catheter-based treatments. METHODS Two femtosecond laser systems (λ=800 nm, λ=1030 nm) along with a three dimensional (3D) scanner system (NA ~0.1) were used in this study. In vitro experiments were performed on porcine thrombi and blood vessels. Ablation thresholds were determined in air, by determining the pulse energy at which single shot ablation was visible under the optical microscope. Ablation rates were determined in physiological saline. Additionally, ablation of thrombi and blood vessels was monitored by means of a fiber spectrometer. RESULTS Depending upon the scan velocity, typical ablation rates for thrombi were ~0.04 mm(3)/sec. Ablation thresholds of thrombi and blood vessels differ by factors of 3 and 1.5 at laser wavelengths of 800 and 1030 nm, respectively. At a distance of 5 mm above the surface, second harmonic generation was observed in blood vessels, but not within thrombi. CONCLUSIONS The results show that a typical thrombus volume can be destroyed within a reasonable time frame. Because of the higher threshold difference of thrombi and blood vessels, the use of a laser wavelength of 800 nm is preferable. Furthermore, the detection of the second harmonic could provide a feedback mechanism to protect the vascular wall from mechanical and laser damage.
Collapse
Affiliation(s)
- Johannes Bidinger
- 1 Institute of Applied Physics, Abbe Center of Photonics, Friedrich-Schiller-Universität Jena , Jena, Germany
| | | | | | | | | |
Collapse
|
7
|
|
8
|
Maximilian Buja L, Mcallister HA. Coronary Artery Disease: Pathologic Anatomy and Pathogenesis. In: Willerson JT, Wellens HJJ, Cohn JN, Holmes DR, editors. Cardiovascular Medicine. London: Springer; 2007. pp. 593-610. [DOI: 10.1007/978-1-84628-715-2_25] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023] Open
|
9
|
Van Norman GA. Angioplasty and noncardiac surgery: risks of myocardial infarction. Curr Opin Anaesthesiol 2006; 12:15-20. [PMID: 17013292 DOI: 10.1097/00001503-199902000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Prophylactic percutaneous transluminal coronary angioplasty is one revascularization strategy employed to reduce risks of cardiac complications after noncardiac surgery in certain patients. Reduced adverse cardiac event rates are at least partially offset by costs and complications of angioplasty. Patients who undergo noncardiac surgery within 90 days of coronary angioplasty may be at increased risk for postoperative cardiac complications.
Collapse
Affiliation(s)
- G A Van Norman
- Department of Anesthesiology, Box 356540, University of Washington, Seattle, Washington 98195, USA.
| |
Collapse
|
10
|
Abstract
The proliferation of smooth muscle cells (SMCs) was suppressed in denudated rabbit aorta by holmium-yttrium-aluminum-garnet (Ho:YAG) laser intravascular irradiation. This study was dedicated to determine the applicability of the Ho:YAG laser irradiation on chronic restenosis after balloon angioplasty. The proliferation of SMCs in denudated rabbit aortas was suppressed in vivo 6 weeks after the laser irradiation of 20 pulses with 60 mJ per pulse. To investigate the mechanisms of this in vivo effect, the death of SMCs by the Ho:YAG laser-induced bubble collapse pressure was studied in vitro. No significant cell death attributed to this pressure was found. We conclude that the suppression of the proliferation of SMCs in vivo might not be caused by a reduction in density of SMCs induced by the collapse in pressure. We submit that the suppression of SMC proliferation in vivo could be caused by the bubble expansion pressure and/or heat induced by the laser irradiation.
Collapse
Affiliation(s)
- Eriko Nakatani
- School of Fundamental Science and Technology, Graduate School of Science and Technology, Keio University, 3-14-1, Hiyoshi, Yokohama, 223-8522, Japan
| | | |
Collapse
|
11
|
Bilodeau L, Fretz EB, Taeymans Y, Koolen J, Taylor K, Hilton DJ. Novel use of a high-energy excimer laser catheter for calcified and complex coronary artery lesions. Catheter Cardiovasc Interv 2004; 62:155-61. [PMID: 15170703 DOI: 10.1002/ccd.20053] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study was designed to evaluate safety and effectiveness of the 0.9 mm excimer laser coronary catheter with increased laser parameters. We report a prospective trial of 100 calcified and/or balloon-resistant lesions where a new 0.9 mm excimer laser catheter was used at standard or higher energy level to facilitate angioplasty. Standard in-hospital clinical and angiographic parameters were collected and measured. Laser technical success was obtained in 87 lesions (92%), procedural success was reached in 88 lesions (93%), and clinical success in 82 lesions (86%). Increased laser parameters were used for 29 resistant lesions. This new 0.9 mm excimer laser coronary catheter using higher energy parameters seems to be safe and effective for management of calcified and nondilatable lesions.
Collapse
Affiliation(s)
- Luc Bilodeau
- Montreal Heart Institute, Department of Medicine, Montreal, Quebec, Canada.
| | | | | | | | | | | |
Collapse
|
12
|
Abstract
Intracoronary thrombi are commonly found in patients with acute coronary syndromes. A large thrombus burden or a platelet-rich thrombus frequently resists pharmacologic therapy ("thrombolytic ceiling"). In such cases restoration of adequate antegrade coronary flow necessitates application of a mechanical force. Power thrombectomy is a revascularization strategy incorporating a mechanical device for removal of occlusive coronary thrombi in conjunction with or following administration of either platelet glycoprotein IIb/IIIa receptor inhibitors or thrombolytic agents, or both. Mechanical devices for power thrombectomy include ultrasound sonication, rheolytic thrombectomy (Angiojet), laser, transluminal extraction catheter, aspiration catheter, and to a limited extent, balloon angioplasty. In acute coronary syndromes the strategy of power thrombectomy aims to achieve the clinical advantages of more nearly complete vessel patency, improved antegrade flow, and enhanced preservation of myocardial tissue.
Collapse
Affiliation(s)
- On Topaz
- Cardiac Catheterization Laboratories, Division of Cardiology, Medical College of Virginia Hospital, Medical College of Virginia/Virginia Commonwealth University, Richmond, VA 23249, USA
| | | | | | | | | | | |
Collapse
|
13
|
Abela GS, Hage-Korban EE, Tomaru T, Barbeau GR, Abela OG, Friedl SE. Vascular procedures that thermo-coagulate collagen reduce local platelet deposition and thrombus formation: laser and laser-thermal versus balloon angioplasty. Lasers Surg Med 2002; 29:455-63. [PMID: 11891734 DOI: 10.1002/lsm.10000] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVE Exposure of the arterial wall matrix to blood leads to platelet deposition resulting in thrombosis. Because heat alters tissue matrix we proposed that heating reduces platelet deposition. STUDY DESIGN/MATERIALS AND METHODS Sixty arterial homografts (15 dogs) were mounted in an arterio-venous "shunt." Interventions included balloon angioplasty (BA), direct laser (LA), laser-thermal (LTA), and combined LTABA. 111Indium-labeled platelets were circulated, radio activity measured, and homografts processed for histology. RESULTS Radioactivity count (mean+/- SE) at BA sites (13,853+/-3,192 cpm/cm(2)) was greater than LA (7,038+/-981), LTA (5,294 +/-1,145), LTABA (6,176+/-1,571), and control (1,826+/-339), P<0.05. Electron microscopy showed fewer platelets at LA, LTA, and control than BA sites. BA spread the collagen on the arterial lumen while heat gelled collagen and confined it to the arterial media. CONCLUSIONS Heating the artery and gelling collagen during LA, LTA, or LTABA significantly reduced thrombogenicity.
Collapse
Affiliation(s)
- G S Abela
- Department of Medicine, Division of Cardiology, Michigan State University, East Lansing, Michigan 48824, USA.
| | | | | | | | | | | |
Collapse
|
14
|
Abstract
BACKGROUND AND OBJECTIVE Patients presenting with acute myocardial infarction who fail to respond to standard therapy with thrombolytics or have contraindications for their use oftentimes need revascularization with a mechanical device for removal of an occlusive coronary thrombus and its underlying atherosclerotic plaque. As both thrombi and plaques absorb laser energy in the ultraviolet wavelength (308 nm), we studied the feasibility and safety of excimer laser angioplasty in selective patients with complicated acute myocardial infarction. STUDY DESIGN/MATERIALS AND METHODS Fifty patients with acute myocardial infarction complicated by continuous chest pain and/or ischemia who had a total of 54 obstructive lesions were treated with percutaneous excimer coronary laser angioplasty (ELCA). A Q-wave myocardial infarction was documented in 56% and a non-Q-wave myocardial infarction in 44%. The baseline left ventricular ejection fraction was reduced at 43 +/- 13% and six patients (12%) presented to the cardiac catheterization laboratory in cardiogenic shock. Twenty-nine patients failed to respond to thrombolytic therapy and 16 had contraindications for thrombolytics and IIb/IIIa receptor antagonists. Following laser debulking, all patients received adjunct balloon dilation and then stents were deployed in 83% of the target lesions. Quantitative coronary arteriography (QCA) was performed at an independent core laboratory. RESULTS Ninety-eight percent laser success and 100% procedural success were achieved. By QCA the minimal luminal diameter increased from baseline of 0.7 +/- 0.5 to 1.3 +/- 0.5 mm post-lasing and then to 2.0 +/- 0.6 with balloon dilation to a final of 3.0 +/- 0.5 mm. Pre-laser percent stenosis diameter of 77 +/- 17% was reduced to 51 +/- 22% post-laser to 3.0 +/- 17% post-balloon and to a final of 15 +/- 25%. An 83% laser-induced reduction of thrombus burden area was achieved as well as an increase in TIMI flow from baseline of 1.7 +/- 1.1 to 2.8 +/- 0.4 by laser to a 2.9 +/- 0.4 final. There were no deaths, emergency bypass surgery, cerebral vascular accident, neurologic injury, or major perforation. In one case, a laser-induced major dissection was successfully treated by stenting. All 50 patients survived the procedure, improved clinically, and were discharged. CONCLUSION Application of excimer laser coronary angioplasty is feasible and safe in selected patients with acute myocardial infarction who either fail to respond to thrombolytics or have contraindications to these agents. Intracoronary thrombus at the target lesion can be successfully dissolved with this wavelength laser energy without adverse effect on the procedure results.
Collapse
Affiliation(s)
- O Topaz
- Division of Cardiology, McGuire VA Medical Center, Medical College of Virginia Hospitals, 1201 Broad Rock Road, Richmond, VA 23249, USA
| | | | | | | | | | | |
Collapse
|
15
|
Abstract
Information from histopathologic examination of coronary arterial atherosclerotic plaques treated with in vivo laser energy is sparse. Directional atherectomy provides biopsies for study of tissue changes (injury) due to coronary arterial debulking devices, including laser. Sixteen patients who presented with acute ischemic coronary syndromes underwent debulking of a total of 17 obstructive intracoronary lesions with pulsed-wave holmium:YAG laser (2.1 microm wavelength). Laser was performed with the "pulse and retreat" technique which incorporates slow catheter advancement (0.5-1 mm/s) with controlled emission of energy. Immediately postlasing, directional atherectomy was utilized to obtain irradiated plaque tissue for pathologic examination. Extent of laser-induced tissue injury to plaques was graded as 0 (no tissue damage), 1 (small foci or charring and vacuoles), 2 (large amount of charring, edge disruption and vacuoles) and 3 (extensive tissue damage). Angiographically and clinically, all 17 lesions were successfully debulked with the laser energy (mean 47+/-25 pulses), with a reduction of target lesion percent diameter stenosis from 92+/-6% to 47+/-25%. Adjunct balloon dilations further reduced the target lesions to a final of 10+/-10% stenosis. The histopathologic examination of the lased specimens demonstrated that 13 lesions (76%) had no evidence of laser-induced injury (Grade 0). Four lesions had low-level injury (Grade 1), and none had evidence of Grade 2 or 3 laser-induced trauma. Therefore, a laser debulking technique, which incorporates slow catheter advancement with controlled emission of pulses, does not cause significant injurious effects to the irradiated plaque.
Collapse
Affiliation(s)
- O Topaz
- Division of Cardiology, McGuire VA Medical Center, Medical College of Virginia Hospital, Virginia Commonwealth University, 1201 Broad Rock Boulevard, Richmond, VA 23249, USA.
| | | | | | | | | |
Collapse
|
16
|
Topaz O, Bernardo NL, Shah R, McQueen RH, Desai P, Janin Y, Lansky AJ, Carr ME. Effectiveness of excimer laser coronary angioplasty in acute myocardial infarction or in unstable angina pectoris. Am J Cardiol 2001; 87:849-55. [PMID: 11274939 DOI: 10.1016/s0002-9149(00)01525-3] [Citation(s) in RCA: 67] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study was conducted to evaluate the feasibility, safety, and acute results of percutaneous excimer laser coronary angioplasty (ELCA) in acute coronary syndromes. Fifty-nine patients were treated with ELCA (308 nm), including 33 patients with unstable angina pectoris (UAP) (35 vessels with 39 lesions) and 26 patients with acute myocardial infarction (AMI) (26 vessels with 29 lesions). In each patient the target lesion had a complex morphology. Overall, 71% of the patients had contraindications for pharmacologic thrombolytic agents or glycoprotein IIb/IIIa receptor antagonists. All patients received adjunct balloon dilation followed by stent implantation in 88% of patients with AMI versus 76% of patients with UAP (p = NS). Quantitative angiography was performed at an independent core laboratory; 86% laser success and 100% procedural success was achieved in the AMI group versus 87% laser success and 97% procedural success in the UAP group (p = NS). In the AMI group, the minimal luminal diameter increased from 0.77 +/- 0.56 to 1.44 +/- 0.47 mm after lasing to a final 2.65 +/- 0.47 mm versus 0.77 +/- 0.38 to 1.35 +/- 0.4 mm after lasing to 2.66 +/- 0.5 mm final in the UAP group. A prelaser percent stenosis of 76 +/- 17% for the AMI group versus 70 +/- 16% for the UAP group (p = NS) was decreased after lasing to 52 +/- 16% for the AMI group versus 51 +/- 14% for the UAP group (p = NS) and to a final stenosis of 15 +/- 17% for the AMI group versus 12 +/- 15% for the UAP group (p = NS). A 96% laser-induced reduction of thrombus burden area was achieved in the AMI group versus 97% in the UAP group (p = NS). Preprocedure Thrombolysis In Myocardial Infarction flow of 1.3 +/- 0.9 in the AMI group versus 2.3 +/- 1.2 for the UAP group (p = 0.01) increased to a final flow of 3.0 +/- 0 for the AMI group versus 3.0 +/- 0 for the UAP group (p = NS). There were no deaths, cerebrovascular accident, emergency bypass surgery, acute closure, major perforation or major dissection, distal embolization, or bleeding complications in either group. One patient with AMI had localized perforation (caused by guidewire) without sequelae and 1 patient with UAP had an abnormal increase in creatine kinase levels. All 59 patients survived the laser procedure, improved clinically, and were discharged. Thus, early experience in patients with acute coronary syndromes suggest that percutaneous ELCA is feasible and safe.
Collapse
Affiliation(s)
- O Topaz
- Division of Cardiology, Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, Virginia, USA.
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Abstract
BACKGROUND Acute myocardial infarction (MI) remains a leading cause of death in the United States. There is evidence that primary (direct) percutaneous intervention (PCI) may improve survival and reduce morbidity in patients with acute MI. METHODS We present a concise, comprehensive, evidence-based literature review of modern techniques of primary PCI in patients with acute MI. A comparison to thrombolytic therapy, especially in selected patient subgroups is made. Rescue angioplasty is also addressed. Adjunctive pharmacology, economic implications, and feasibility of implementation are discussed. A brief discussion of experimental therapies is included. RESULTS Primary PCI is an acceptable alternative to thrombolytic therapy in patients with acute MI and may result in superior outcomes in select patient populations, especially the elderly, patients with prior coronary artery bypass surgery, those with congestive heart failure, and those in cardiogenic shock. CONCLUSIONS Clinical trials support the use of primary PCI as first-line therapy for acute myocardial infarction. Patients in whom thrombolytic therapy is contraindicated or known to have reduced efficacy are also excellent candidates for this therapy. Ongoing advancements in equipment and adjunctive therapies continue to enhance delivery of this treatment as well as improve patient outcome.
Collapse
Affiliation(s)
- V S Degeare
- Department of Cardiology, Brooke Army Medical Center, Fort Sam Houston, Tex, 78234-6200, USA.
| | | | | | | |
Collapse
|
18
|
Abstract
Accelerated allograft vasculopathy significantly limits the survival of heart transplant recipients. The prevalence of allograft coronary artery disease is as high as 18% by 1 year and 50% by 5 years following heart transplant. Heart failure and sudden cardiac death are the two most common clinical presentations. In heart transplant recipients with severe, discrete focal allograft vascular disease, percutaneous balloon angioplasty is a viable palliative option. However, its application is limited by a significant restenosis rate and progression of allograft disease in nontreated segments. Diffuse disease with tapering of vessels may be approached by debulking devices. Emerging revascularization modalities for focal stenoses and some of the diffuse tapering vessels include coronary stents, rotational atherectomy, various wavelength lasers, and, to a lesser extent, directional atherectomy. Conceivably, stents will reduce restenosis rates related to focal, discrete plaques; yet it is unknown whether they will be efficacious in short- and long-term treatment of diffusely diseased segments affected by allograft disease. Accurate assessment of clinical outcomes and long-term evaluation is imperative prior to acceptance of these devices as fundamental interventional tools for treatment of allograft coronary artery disease.
Collapse
Affiliation(s)
- O Topaz
- Cardiac Catheterization Laboratories, McGuire VA Medical Center and Medical College of Virginia Hospitals, Medical College of Virginia, Virginia Commonwealth University, Richmond 23249, USA
| | | | | | | |
Collapse
|