Coronary angioplasty and stenting in cardiac allograft vasculopathy following heart transplantation.
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Angioplasty, Balloon, Coronary↗
Biomedical subjects
R Koning
Publications and source records attributed to R Koning.
Percutaneous mechanical mitral commissurotomy with a newly designed metallic valvulotome: immediate results of the initial experience in 153 patients.
BACKGROUND: Percutaneous balloon valvotomy has become a common treatment of mitral stenosis, but the cost of the procedure remains a limitation in countries with restricted financial resources, leading to a frequent reuse of the disposable catheters. To overcome this limitation, a reusable metallic valvotomy device has been developed with the goals of both improving the mitral valvotomy results and decreasing the cost of the procedure. METHODS AND RESULTS: The device consists of a detachable metallic cylinder with 2 articulated bars screwed onto the distal end of a disposable catheter whose proximal end is connected to an activating pliers. By the transseptal route, the device is advanced across the valve over a traction guidewire. Squeezing the pliers opens the bars up to a maximum extent of 40 mm. The clinical experience consisted of 153 patients with a broad spectrum of mitral valve deformities. The procedure was successful in 92% of cases and resulted in a significant increase in mitral valve area, from 0.95+/-0.2 to 2. 16+/-0.4 cm2. No increase in mitral regurgitation was noted in 80% of cases. Bilateral splitting of the commissures was observed in 87%. Complications were 2 cases of severe mitral regurgitation (1 requiring surgery), 1 pericardial tamponade, and 1 transient cerebrovascular embolic event. In this series, the maximum number of consecutive patients treated with the same device was 35. CONCLUSIONS: The results obtained with this new device are encouraging and at least comparable to those of current balloon techniques. Multiple uses after sterilization should markedly decrease the procedural cost, a major advantage in countries with limited resources and high incidence of mitral stenosis.
Adolescent↗
Thallium-gated SPECT in patients with major myocardial infarction: effect of filtering and zooming in comparison with equilibrium radionuclide imaging and left ventriculography.
UNLABELLED: The effect of filtering and zooming on 201TI-gated SPECT was evaluated in patients with major myocardial infarction. METHODS: Rest thallium (TI)-gated SPECT was performed with a 90 degrees dual-head camera, 4 h after injection of 185 MBq 201TI in 32 patients (mean age 61 +/- 11 y) with large myocardial infarction (33% +/- 17% defect on bull's eye). End diastolic volume (EDV), end systolic volume (ESV) and left ventricular ejection fraction (LVEF) were calculated using a commercially available semiautomatic validated software. First, images were reconstructed using a 2.5 zoom, a Butterworth filter (order = 5) and six Nyquist cutoff frequencies: 0.13 (B5.13), 0.15 (B5.15), 0.20 (B5.20), 0.25 (B5.25), 0.30 (B5.30) and 0.35 (B5.35). Second, images were reconstructed using a zoom of 1 and a Butterworth filter (order = 5) (cutoff frequency 0.20 [B5.20Z1]) (total = 32 x 7 = 224 reconstructions). LVEF was calculated in all patients using equilibrium radionuclide angiocardiography (ERNA). EDV, ESV and LVEF were measured with contrast left ventriculography (LVG). RESULTS: LVEF was 39% +/- 2% (mean +/- SEM) for ERNA and 40% +/- 13% for LVG (P = 0.51). Gated SPECT with B5.20Z2.5 simultaneously offered a mean LVEF value (39% +/- 2%) similar to ERNA (39% +/- 2%) and LVG (40% +/- 3%), optimal correlations with both ERNA (r = 0.83) and LVG (r = 0.70) and minimal differences with both ERNA (-0.9% +/- 7.5% [mean +/- SD]) and LVG (1.1% +/- 10.5%). As a function of filter and zoom choice, correlation coefficients between ERNA or LVG LVEF, and gated SPECT ranged from 0.26 to 0.88; and correlation coefficients between LVG and gated SPECT volumes ranged from 0.87 to 0.94. There was a significant effect of filtering and zooming on EDV, ESV and LVEF (P < 0.0001). Low cutoff frequency (B5.13) overestimated LVEF (P < 0.0001 versus ERNA and LVG). Gated SPECT with 2.5 zoom and high cutoff frequencies (B5.15, B5.20, B5.25, B5.30 and B5.35) overestimated EDV and ESV (P < 0.04) compared with LVG. This volume overestimation with TI-gated SPECT in patients with large myocardial infarction was correlated to the infarct size. A zoom of 1 underestimated EDV, ESV and LVEF compared with a 2.5 zoom (P < 0.02). CONCLUSION: Accurate LVEF measurement is possible with TI-gated SPECT in patients with major myocardial infarction. However, filtering and zooming greatly influence EDV, ESV and LVEF measurements, and TI-gated SPECT overestimates left ventricular volumes, particularly when the infarct size increases.
Female↗
Clinical and angiographic results of stenting for long coronary arterial atherosclerotic lesions.
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.
Aged↗
Primary stenting of de novo lesions in small coronary arteries: a prospective, pilot study.
Technical advancement and new anti-thrombotic regimens have recently shown so much improvement in the results of coronary stenting that the conventional contra-indication for stenting in small coronary arteries (<3 mm) needs to be revised. We undertook a prospective pilot study of elective Palmaz-Schatz stenting in de novo lesions located in coronary arteries of less than 3 mm diameter. Fifty consecutive patients (63 +/- 9 years) with stable (n = 38) and unstable angina (n = 12) were included. Philips-DCI quantitative coronary analysis was used to measure reference diameter, minimal lumen diameter and percent diameter stenosis before PTCA, after stenting and at 6-month angiographic follow-up study. All measurements were performed after intracoronary injection of nitroglycerin (300 microg). All patients received ticlopidine (250 mg/day) and aspirin (100 mg/day). The mean lesion length was 9 +/- 3 mm. The balloon size used for stent delivery was 2.75 mm in 30 patients and 2.5 mm in 20 patients and the mean balloon inflation pressure used for stent deployment was 12 +/- 2 atm. All stents were deployed successfully. In-hospital complications occurred in two patients, diagonal branch occlusion at day 2 requiring emergency PTCA in one and a hematoma at the femoral puncture site requiring surgery in the other. Major adverse cardiac event (MACE) rate remained 2% (nonfatal infarct in one). Follow-up angiography (n = 46, 92%) at 6 +/- 3 months showed a 30% restenosis rate. Target vessel revascularization (TVR) rate was 13%. We conclude that elective stenting in small coronary arteries is feasible and involves an acceptable risk of restenosis.
Angina Pectoris↗
Balloon angioplasty for the treatment of coronary in-stent restenosis: immediate results and 6-month angiographic recurrent restenosis rate.
OBJECTIVES: The purpose of this prospective study was to evaluate the immediate results and the 6-month angiographic recurrent restenosis rate after balloon angioplasty for in-stent restenosis. BACKGROUND: Despite excellent immediate and mid-term results, 20% to 30% of patients with coronary stent implantation will present an angiographic restenosis and may require additional treatment. The optimal treatment for in-stent restenosis is still unclear. METHODS: Quantitative coronary angiography (QCA) analyses were performed before and after stent implantation, before and after balloon angioplasty for in-stent restenosis and on a 6-month systematic coronary angiogram to assess the recurrent angiographic restenosis rate. RESULTS: Balloon angioplasty was performed in 52 patients presenting in-stent restenosis. In-stent restenosis was either diffuse (> or =10 mm) inside the stent (71%) or focal (29%). Mean stent length was 16+/-7 mm. Balloon diameter of 2.98+/-0.37 mm and maximal inflation pressure of 10+/-3 atm were used for balloon angioplasty. Angiographic success rate was 100% without any complication. Acute gain was lower after balloon angioplasty for in-stent restenosis than after stent implantation: 1.19+/-0.60 mm vs. 1.75+/-0.68 mm (p=0.0002). At 6-month follow-up, 60% of patients were asymptomatic and no patient died. Eighteen patients (35%) had repeat target vessel revascularization. Angiographic restenosis rate was 54%. Recurrent restenosis rate was higher when in-stent restenosis was diffuse: 63% vs. 31% when focal, p=0.046. CONCLUSIONS: Although balloon angioplasty for in-stent restenosis can be safely and successfully performed, it leads to less immediate stenosis improvement than at time of stent implantation and carries a high recurrent angiographic restenosis rate at 6 months, in particular in diffuse in-stent restenosis lesions.
Angioplasty, Balloon, Coronary↗
[Percutaneous coronary angioscopy in the diagnosis of cardiac graft coronary disease: comparison with the results of angiography].
Coronary disease in cardiac transplant patients is a major factor in the limitation of long term survival. The aim of this study was to compare the results of angioscopy with those of coronary angiography performed systematically every 18 months in our center. Twenty-nine patients (31 angioscopies) were assessed 38 +/- 21 months after transplantation. The appearance observed by angioscopy were: 1) normal, 2) yellow pigmentation of the arterial surface, 3) elevated plaque < 50%, 4) elevated plaque > or = 50% stenosis. Angiography was: 1) normal, 2) iregularities of the lumen or < 50% stenosis, 3) > or = 50% stenosis. The films were viewed by two independent investigators. Angioscopy was performed on the left anterior descending artery (N = 35), the left circumflex (N = 24) and the right coronary artery (N = 9). One to three arterial segments were examined per vessel (total of 117 segments: average 3.8 segments per patient). Angioscopy was uniterpretable in 13/117 (11%) of cases. Of the 81 (78%) segments considered normal at coronary angiography, only 55 seemed normal at angioscopy (68%). Of the 23 segments considered to be abnormal at coronary angiography, all were also considered to be abnormal at angioscopy. The authors conclude that coronary angioscopy seems to be more sensitive than coronary angiography for the detection of coronary disease due to chronic rejection. Prospective studies are required to determine whether the infra-angiographic angioscopic lesions correspond to earlier stages of coronary disease of the cardiac graft.
Aged↗
[Detection of myocardial viability by echocardiography with dobutamine infusion three weeks after myocardial infarction].
The aim of this study was to assess the value of low dose dobutamine (5 and 10 gammas/Kg/min) echocardiography for the detection of hibernating myocardium in an infarcted zone three weeks after the initial infarction. The authors studied 23 patients (18 men, 15 women) with an average age of 59 +/- 8 years before and 3 months after angioplasty of the culprit artery. Segmental wall motion was assessed semi-quantitatively by the criteria of the American Society of Echocardiography. All patients had regional contractile abnormalities under basal conditions and all underwent control coronary angiography at 3 months. Improvement of segmental wall motion with dobutamine predicted improvement after revascularisation with positive and negative predictive values of 95% and 85% respectively. The sensitivity and specificity of the test calculated in the usual manner were 83% and 96% respectively. In addition, assessment of diastolic function showed reduction of the isovolumic relaxation time with dobutamine only in patients with hibernating myocardium (120 +/- 30 ms decreasing to 114 +/- 29 ms with dobutamine, p < 0.02). Low dose dobutamine echocardiography therefore allows reliable non-invasive prediction of hibernating myocardium three weeks after infarction. The reduction of isovolumic relaxation time with dobutamine could be an additional argument in favour of the diagnosis.
Aged↗
[Immediate and 6-month results of balloon angioplasty in the treatment of intra-stent restenosis in symptomatic patients].
The aim of this prospective study was to assess the clinical and angiographic immediate and 6 month results of balloon angioplasty in intra-stent restenosis. Quantitative angiographic analysis (Philips DCI) was performed before and after implantation of the stent, before and after angioplasty for restenosis and at the 6 month control procedure. The study included 59 patients with 65 stents with an intra-stent restenosis. Restenosis was diffuse (10 mm) in 70% of cases, and focal in 30% of cases. The length of the stent was 16 +/- 7 mm (Palmaz-Schatz: 58%). The diameter of the balloon used for angioplasty was 2.9 +/- 0.4 mm and the maximal inflation pressure was 10 +/- 3 bars. The success rate was 100% with no complications. Control coronary angiography was performed in 92% of patients after an average of 5.9 months. The angiographic restenosis rate was 54% and revascularisation was required in 21 patients (36%). The restenosis rate was higher in cases of diffuse intra-stent restenosis (64%) than in focal restenosis (29%), p = 0.02. The authors conclude that balloon angioplasty for intra-stent restenosis is safe and carries a high success rate. Nevertheless, the angiographic restenosis rate at 6 months seems to be higher, especially in cases of diffuse restenosis.
Angioplasty, Balloon, Coronary↗
A new treatment for severe pulmonary embolism: percutaneous rheolytic thrombectomy.
BACKGROUND: The rheolytic thrombectomy catheter has been specially designed to remove intravascular thrombus from coronary and peripheral arteries. It demonstrates a practical application of Bernoulli's principle relating to a low-pressure zone in the region of a high-velocity jet. In this device, this effect is created by direct high-pressure saline jets located at the tip. Thrombus is drawn into this region and, because of the large pressure difference, undergoes mechanical thrombolysis due to the powerful mixing forces. The resulting microparticles are aspirated through the same catheter and removed from the body. METHODS AND RESULTS: We report the use of this device in two patients presenting with severe pulmonary embolism and contraindications to thrombolytic therapy. The two procedures were successfully performed with an excellent immediate angiographic result at the site of the rheolytic thrombectomy. In both cases, the clinical improvement was maintained at follow-up with the same good angiographic result and a decrease to a normal level of the systolic pulmonary pressure. CONCLUSIONS: This preliminary results suggest that this easy technical method may be useful in the treatment of life-threatening pulmonary embolism in patients with absolute contraindications to thrombolytic therapy. A larger cohort of patients is necessary to determine whether this treatment should be proposed as an alternative to the use of fibrinolytics in selected patients.
Aged↗
Adaptation to myocardial ischemia during coronary angioplasty demonstrated by clinical, electrocardiographic, echocardiographic, and metabolic parameters.
It has been shown that brief episodes of myocardial ischemia can render the heart more resistant to a prolonged subsequent ischemic episode. This phenomenon, called "preconditioning," has been described in human beings during coronary angioplasty with the use of clinical, electrocardiographic (ECG), or metabolic parameters. The goal of this study was to assess this phenomenon further with the use of echocardiographic and metabolic parameters in addition to clinical and ECG parameters. Eighteen patients with isolated stenosis of the left anterior descending coronary artery and a normal left ventricular function were included. Angioplasty consisted of four consecutive balloon inflations. Sequential changes in clinical, ECG (intracoronary ECG), echocardiographic, and metabolic parameters of myocardial ischemia were compared between the first and the fourth balloon inflations. Improved tolerance to myocardial ischemia with repeated coronary occlusions was demonstrated by a significant reduction in the severity of angina, ST-segment elevation, wall motion abnormalities, and lactate production. This study confirms the adaptation of myocardial ischemia to repeated coronary occlusions through measurement of clinical, ECG, echocardiographic, and metabolic parameters.
Angioplasty, Balloon, Coronary↗
Angioscopic evaluation of rotational atherectomy followed by additional balloon angioplasty versus balloon angioplasty alone in coronary artery disease: a prospective, randomized study.
OBJECTIVES: This study sought to compare, by angioscopy, the morphologic changes induced by rotational atherectomy, followed by additional angioplasty, with those observed after balloon angioplasty alone. BACKGROUND: Rotational atherectomy and balloon angioplasty act by different mechanisms, which could explain the difference in morphologic changes induced by these two techniques. METHODS: The study group included 50 patients with 50 lesions who were randomly assigned to undergo rotational atherectomy (n = 24) or balloon angioplasty (n = 26). Rotational atherectomy with a single burr (approximately equal to 70% of coronary diameter) was systematically followed by additional balloon angioplasty. Angioscopy was performed immediately after the procedure. Abnormal angioscopic findings were 1) flaps, graded from 1 to 3 (1 = intimal flap; 2 = flap protruding into < 50% of the lumen; 3 = flap protruding into > or = 50% of the lumen); 2) thrombi, graded from 1 to 3 (1 = flat deposits; 2 = protruding but nonocclusive thrombus; 3 = occlusive thrombus); 3) subintimal hemorrhage; 4) longitudinal dissection. The two groups were comparable for clinical and angiographic baseline data. RESULTS: On angioscopy, flaps were observed less frequently after rotational atherectomy followed by additional balloon angioplasty (8 [33%] of 24 lesions) than after balloon angioplasty alone (14 [54%] of 26 lesions, p = 0.08) and were also less severe (grade 1 in 6 lesions, grade 2 in 2 and grade 3 in none vs. grade 1 in 4 lesions, grade 2 in 5 and grade 3 in 5). Longitudinal dissections were also significantly less frequent: one versus six (p = 0.05). There was no difference in the incidence of angioscopic thrombi (p = 0.16) or subintimal hemorrhage (p = 0.15), but the power to detect a significant difference was low for these variables (37% and 26%, respectively). CONCLUSIONS: Rotational atherectomy followed by additional balloon angioplasty leads to fewer angioscopic dissections and a trend toward fewer intimal flaps than balloon angioplasty alone. However, our angioscopic differences did not lead to an outcome difference between the two groups.
Aged↗
[Primary treatment of left coronary artery diseases by percutaneous implantation of stents].
Left main coronary artery (LM) stenting has only been reported in bail-out situations or absolute contraindications so surgery. The authors report the immediate and midterm results of primary Palmaz-Schatz stent implantation in two young patients without contraindication to surgery. The first patient, 58 year-old, was admitted for unstable angina in October 1994. Coronary angiography showed an isolated severe ostial lesion of the LM. After conferring with the surgical team which remained on stand-by, angioplasty and stent implantation were performed with excellent results, no complications and no restenosis on angiographic controls at 3 and 12 months. The patient remained asymptomatic 24 months later. The second patient, 38 year-old, was admitted in June 1995 for unstable angina, and coronary angiography showed a severe isolated stenosis in the middle of a long and wide LM. Primary coronary stenting was also performed with excellent results, no complication and no restenosis on angiographic controls at 4 and 8 months. This patient was still asymptomatic 16 months after stenting. These excellent immediate and medium-term results are encouraging and suggest that this form of treatment might be extended to patients with an isolated whether primary LM stent implantation could become a suitable alternative to surgery in the future.
Adult↗
Effects of prolonged sequential balloon inflations on results of coronary angioplasty.
In percutaneous transluminal coronary angioplasty (PTCA), prolonged balloon inflations using perfusion balloon catheters have shown a higher procedural success rate and fewer in-hospital complications than short balloon inflations. However, perfusion balloons have well-recognized limits for routine use. This study assessed the effects of a prolonged cumulative occlusion time obtained with sequential balloon inflations using a routine balloon catheter, applicable to all lesions, and compared these results with those obtained with standard short balloon inflations. Three hundred ten lesions (in 289 patients) were randomized to either standard (3 to 5 inflations < or = 1 minute each; n = 161) or prolonged (3 to 5 inflations of 3 to 5 minutes each; n = 149) balloon inflations. Angiographic success (residual stenosis <50% and no dissection > or = D1) was assessed at the end of this "protocol" phase. Further dilatation was performed if required ("adjunctive" phase). Systematic repeat catheterization was scheduled 4 to 6 months later. Cumulative inflation time was 198 +/- 58 seconds in the "standard" group versus 782 +/- 303 seconds in the "prolonged" group. At the end of the protocol phase, the success rate was higher after prolonged than after standard dilatation (92% vs 80%; p <0.002), with less frequent dissections (14% vs 30%; p = 0.0009). At the end of the adjunctive phase, required for 12 patients in the prolonged group and 32 patients in the standard group (p = 0.003), results were comparable in the 2 groups and the restenosis rate was similar at 6 months. The prolonged cumulative occlusion time achieved with sequential balloon inflations using a routine balloon catheter improves the immediate results of PTCA. Repeat catheterization shows no effect of prolonged sequential inflations on the restenosis rate.
Aged↗
[Myocardial adaptation to ischemia. A study during repeated prolonged coronary occlusions in angioplasty].
Coronary angioplasty provides an ideal model for studying ischemic preconditioning in humans. Four coronary occlusions, each lasting 5.2 +/- 1.3 min, separated by 3 min of reperfusion, were performed during angioplasty of isolated stenosis of the left anterior descending artery of 18 patients with stable angina and normal left ventricular function. The ischaemia was evaluated and compared during the first and fourth coronary occlusion with the aid of clinical, electrocardiographic, echocardiographic and metabolic parameters. We analysed: 1) interval to chest pain and its intensity; 2) degree of ST change on the intracoronary electrocardiogram; 3) regional wall motion abnormalities on 2D echocardiography; 4) coefficient of myocardial lactate extraction. The results showed that during the fourth occlusion: chest pain occurred later (93 +/- 57 vs 60 +/- 49 s; p < 0.05) and ST elevation was less (0.69 +/- 0.5 vs 1.03 +/- 0.8; p < 0.05). During the fourth occlusion, there was a delay in appearance and a decrease in the regional wall motion abnormalities: anterior wall hypokinesia occurred later: 26 +/- 15 vs 19 +/- 19 s (p = 0.08). Akinesia observed in 10 patients out of 13 (77%) during the first occlusion, was only observed in 8 patients (62%) and dyskinesia, observed in 5 patients out of 13 (38%) during the first occlusion was not observed thereafter in any patient. The production lactate was less important during the fourth occlusion than during the first one: -3 +/- 17% vs -12 +/- 19% (p < 0.05). This study confirms that, in man, preconditioning allows myocardial adaptation to successive episodes of acute ischaemia.
Adaptation, Physiological↗
[Determination of cardiac troponin I on Stratus analyzer: prospective evaluation in unstable angina].
Cardiac troponin I (troponin lc) has been measured on the Dade Stratus analyzer. Cardiac specificity has been studied in patients presenting a rhabdomyolysis syndrome. The obtained results clearly demonstrated that this parameter may be used as a specific marker of myocardial injury, in contrast to total creatine kinase- or mass CK-MB measurements. In unstable angina, two groups of patients may be defined: one group with elevated troponin lc (> 0.60 microgram/L; 31 patients, group I), one other with normal troponin lc (< 0.35 microgram/L; 49 patients; group II). Quantitative angiographic analysis was performed on 50 patients including 18 patients from group I. Group I showed a more severe culprit lesion than group II. All the results suggested that troponin Ic might be an indicator of severity in unstable angina.
Adult↗
Dobutamine stress echocardiography in orthotopic heart transplant recipients. VACOMED Research Group.
OBJECTIVES: This study sought to determine whether dobutamine stress echocardiography could accurately identify coronary artery disease after heart transplantation. BACKGROUND: After heart transplantation, coronary artery disease is related to either diffuse concentric intimal thickening or focal stenosis and may be underdiagnosed by coronary angiography. METHODS: We enrolled 41 patients, a mean (+/- SD) of 40 +/- 20 months after heart transplantation, at the time of their routine control coronary angiogram. Three patients were excluded because of poor echogenicity on the angiogram and one because of ventricular premature beats. Standard echocardiographic views were acquired at baseline and at incremental dobutamine infusion levels (from 5 to a maximal dose of 40 micrograms/kg body weight per min at 3-min intervals). Regional wall motion score was calculated from a 16-segment model, and each segment was graded from 1 (normal) to 4 (dyskinesia). Coronary angiography was performed 24 h after dobutamine stress echocardiography, and angiograms were analyzed in blinded manner. RESULTS: Twenty-three (62%) of 37 patients had normal coronary angiographic findings. Dobutamine stress echocardiography showed abnormalities in only 2 of 23 patients. Fourteen patients (38%) had abnormal angiographic findings, seven of whom had stenoses > 50%. Dobutamine stress echocardiography correctly identified the corresponding hypoperfused segments in these seven patients. More of interest were the other seven patients, of whom three had angiographic nonsignificant stenoses (< 50%), and four had minor diffuse coronary irregularities. Dobutamine stress echocardiography showed hypokinesia in five of these seven patients despite nonsignificant lesions at coronary angiography. The respective overall sensitivity and specificity of dobutamine stress echocardiography were 86% and 91%. At follow-up, 2 of the 37 patients had an acute myocardial infarction. Both had abnormal findings on dobutamine stress echocardiography: One had normal coronary angiographic results, and one had significant coronary lesions. CONCLUSIONS: Dobutamine stress echocardiography is a useful technique for the diagnosis of coronary artery disease after heart transplantation. These preliminary results indicate that dobutamine stress echocardiography may have a predictive value for further ischemic events in heart transplant recipients.
Cardiac Catheterization↗
Angioscopic evaluation of prolonged vs standard balloon inflations during coronary angioplasty. A randomized study.
UNLABELLED: To study the immediate effects of prolonged total balloon inflation during PTCA, 41 patients (44 lesions) with chronic stable angina were randomized for prolonged sequential inflations (three to five inflations of 3 to 5 min each, for a total duration of > or = 12 min, group 1, n = 20 lesions) or 'standard' sequential inflations (three to five inflations of < or = 1 min each, for a total duration of < or = 3 min, group 2, n = 24 lesions). The mean duration of total balloon inflation time was 958 +/- 129 s in group 1 vs 205 +/- 46 s in group 2. Results of angioplasty were assessed on both angiography and percutaneous transluminal coronary angioscopy performed immediately after the procedure. High quality imaging of the coronary lumen and lesion morphology was possible on angioscopy in all patients without any complications. Post-PTCA angiographic percent diameter stenosis was significantly less in group 1 compared to group 2: 26 +/- 10% vs 36 +/- 8% (P < 0.05). On angioscopy, flaps were seen in 16 patients in group 2, but in only six in group 1 (P < 0.02). There was no difference in the incidence of thrombi on angioscopy between the two groups (group 1: nine cases, group 2: 10 cases). Sensitivity of angiographic detection of flaps and thrombi was poor: 10% and 12% respectively. One patient in each group developed a longitudinal dissection, detected on both angiography and angioscopy. CONCLUSIONS: (1) prolonged sequential balloon inflations lead to less residual luminal stenosis after PTCA, with a decreased incidence of intimal flaps in comparison with standard inflations. (2) Post-PTCA transluminal coronary angioscopy is safe and offers better assessment of luminal effects of PTCA than angiography.
Adult↗