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At least 343 records · Page 19Linked to original sources
PubMed1995

Distal embolization is common after directional atherectomy in coronary arteries and saphenous vein grafts.

Coronary embolization is a complication of coronary intervention procedures. The incidence, predictors, and clinical significance of this phenomenon during directional atherectomy were examined in 111 consecutive patients who underwent directional atherectomy to 120 lesions. Distal embolization occurred in 31 (28%) of the patients. It was noted mainly in the saphenous vein graft group of patients (12 [48%] of 25) versus the native coronary group (19 [22% of 86]; p = 0.01). Clinical predictors were age and de novo lesions. Morphologic predictors were larger artery size, larger postprocedure minimal luminal diameter, calcific lesions, and type C lesions. The only difference in clinical outcome was a longer hospitalization in the distal embolization group with 3.9 +/- 3.7 days versus the rest of the patients 2.4 +/- 2.4 days (p = 0.01). In the majority of patients there was no significant adverse clinical outcome.

Atherectomy↗
PubMed1993

Analysis of atherectomy specimens.

Atherectomy specimens may be regarded as biopsy tissue excised from human vascular target lesions. Proceeding from contrary histologic findings that attribute focal hypercellularity to restenosis, and hypocellularity to chronic lesions, further analysis of atherectomy specimens was performed to study ultrastructural characteristics and functional aspects propagated by both lesion types. Transmission electron microscopy examination showed that intimal smooth muscle cells (SMCs) were the predominant cells in both primary and restenotic lesions. SMCs exhibited variable degrees of metabolic activation, typically higher in SMCs of restenotic lesions. This SMC phenotype was equally expressed when tissue samples were placed in a cell culture model. In an attempt to quantify SMC activity, proliferative as well as migratory activities of cultured cells were measured by growth curves and a computer-assisted motion analysis system, respectively. A 2- to 3-fold increase of both activity determinants was observed with SMCs cultivated from restenotic lesions compared with those from primary lesions, irrespective of their coronary or peripheral origin. Drug-induced interference of human SMC metabolic activation and antagonism to their proliferative and migratory activities may be helpful in evaluation of therapeutic concepts to prevent restenosis. The antitubulin colchicine was studied for its effect on the defined determinants. The data in vitro demonstrate that colchicine decreased proliferative and migratory activity of SMCs and caused disorganization of the cytoplasmic ultrastructure. In conclusion, electron microscopy and cell culture studies may help to shed more light on the structures and mechanisms underlying restenosis and plaque growth. Deliberate counteraction of any of the specific early events implicated in these complex pathobiologic processes may eventually become effective means to suppress restenosis and may thus result in a prophylactic as well as therapeutic treatment of the diseased vascular wall.

Animals↗
PubMed1996

Evaluation of a new 9F guiding catheter for directional coronary atherectomy.

Large lumen guiding catheters (9.5 to 11 French) are currently required to perform directional atherectomy. These rigid guiding catheters require modifications of usual techniques for manipulation and can induce ostial trauma and peripheral vascular complications. A new type of 9 French guiding catheter (Vista Brite tip, Cordis, Miami, FL) with an inner diameter of 0.098 inch and capable of accomodating atherectomy catheters (SCA-EX) was evaluated. In this preliminary study, 31 consecutive patients were included. Primary success was obtained in 27 (87%); no ostial trauma and only two minor groin hematomas were observed. After exchange with a conventional 10F guiding catheter, because of poor back-up, two of the four failures were successfully treated by DCA. In conclusion, these new 9F guiding catheters provide a useful alternative to currently available guiding catheters for DCA. Nevertheless, new shapes with better back-up are necessary to improve the primary success rate.

Adult↗
PubMed1996

Bail-out stenting for flow limiting dissections after rotational atherectomy in complex coronary lesions.

Flow limiting dissection may occur after rotational atherectomy and require urgent management. Important questions about the safety and effectiveness of bail-out stenting in this setting remain to be answered. We have observed that emergent stenting after rotational atherectomy can be accomplished successfully in most patients, high pressure stent dilatation is both necessary and well tolerated, and lesion debulking facilitates movement of stents into diseased arterial segments.

Aged↗
PubMed1996

Intravascular ultrasound-guided transluminal extraction atherectomy for restenosis after Gianturco-Roubin coronary stent implantation.

Two patients with restenosis following implantation of the Gianturco-Roubin stent were successfully treated with the transluminal extraction atherectomy device, with the assistance of intravascular ultrasound guidance and adjunctive balloon angioplasty. The optimal management strategy of in-stent restenosis remains unclear, but the transluminal extraction atherectomy device may be an option for the management of restenosis within the Gianturco-Roubin stent.

Angioplasty, Balloon, Coronary↗
PubMed1996

Pullback atherectomy (PAC) for the treatment of complex bifurcation coronary artery disease.

We report initial successful results using a novel retrograde cutting (pullback) atherectomy catheter (PAC) to treat complex bifurcation coronary artery disease, in 2 patients. In one case a bifurcation lesion involving the left anterior descending and a large diagonal branch was treated without the need for two-wire or kissing-balloon technique. In the second case a high-grade eccentric lesion of the right coronary artery at the site of a right ventricular marginal branch was treated successfully. This report describes the first clinical application of pullback atherectomy in human coronary circulation, and suggests that this device may play a useful role in the treatment of complex bifurcation coronary artery disease.

Angioplasty, Balloon, Coronary↗
PubMed1996

Salvage atherectomy: using retrieved tissue to determine the etiology of acute closure.

Directional coronary atherectomy was successfully performed in the mid-left anterior descending artery at the site of failed balloon angioplasty. We presumed that intracoronary thrombus had resulted in acute vessel closure following balloon angioplasty, due to the angiographic appearance of the lesion and the clinical situation. However, examination of the extracted specimen from the atherectomy device revealed predominantly atheromatous tissue with minimal thrombus.

Aged↗
PubMed1996

Transluminal extraction atherectomy for aortosaphenous vein graft stent restenosis.

The optimal strategy to manage in-stent saphenous vein graft (SVG) restenosis has not been studied. We present two cases in which transluminal extraction atherectomy (TEC) was used successfully for the treatment of SVG stent restenosis. TEC atherectomy may provide an alternative to conventional balloon angioplasty for such patients.

Aged↗
PubMed1998

Fracture of coronary guidewire during rotational atherectomy with coronary perforation and tamponade.

We present the case of a calcified right coronary artery lesion with a 90-degree exit angle. Attempts at rotational atherectomy led to wire transection and vessel wall perforation necessitating emergent pericardiocentesis and bypass surgery. We review the literature on complications of rotational atherectomy and the management of coronary perforations and retained guidewire fragments.

Atherectomy, Coronary↗
PubMed1998

Neointimal response following rotational atherectomy compared to balloon angioplasty in a porcine model of coronary in-stent restenosis.

In-stent restenosis remains a clinical therapeutic challenge. Rotational atherectomy (RA) is an attractive treatment option as it may cause less vascular injury than balloon angioplasty (BA) and, therefore, limit further neointimal response. In an animal model of coronary in-stent restenosis, thermal injury and stenting created neointima (old NI). The treatment of in-stent restenosis with either BA (n = 9) or RA (n = 11) also generated neointima (new NI). The average areas (mm2) of old NI in the BA and RA groups were similar (3.77 +/- 0.40 vs. 3.67 +/- 0.53; P = 0.32). However, new NI formed after treatment of in-stent restenosis was significantly less in the RA as compared to the BA group (0.33 +/- 0.12 vs. 0.73 +/- 36, P < 0.01). In this porcine coronary artery model of in-stent restenosis, treatment with rotational atherectomy resulted in significantly less recurrent neointimal hyperplasia than balloon angioplasty. This animal study, thus, provides a rationale for the clinical use of rotablation in the treatment of in-stent restenosis.

Angioplasty, Balloon, Coronary↗
PubMed1999

Intracoronary adenosine administered during rotational atherectomy of complex lesions in native coronary arteries reduces the incidence of no-reflow phenomenon.

Rotational atherectomy (RA) of complex, calcified lesions has been associated with a high incidence of no reflow ranging from 6%-15% and concomitant myocardial necrosis with adverse prognostic implications. There are no uniform strategies for preventing this complication. The role of intracoronary adenosine for the prevention of this phenomenon during RA has not been fully evaluated. We studied the procedural outcome of 122 patients who underwent RA of complex native coronary artery lesions. Fifty-two patients received no adenosine but a variety of other agents. Seventy patients received intracoronary adenosine boluses (24 to 48 microgram prior to and after each RA run). There was no difference in the type of lesion studied, run time, or Burr to artery ratio (0.6-0.7) between the two groups. Six patients without adenosine experienced no reflow (11.6%), with resultant infarction in the target artery territory, while only 1 of 70 patients (1.4%, P - 0.023) in the adenosine group experienced no reflow. No untoward complications were observed during adenosine infusion. Intracoronary adenosine bolus administered during rotational atherectomy is easy, safe, and may significantly reduce the incidence of no reflow, which may improve the 30-day outcome of this procedure.

Adenosine↗
PubMed2002

Effective plaque removal with a new 8 French-compatible atherectomy catheter.

The purpose of this study was to evaluate the safety and efficacy of the new 8 Fr guide catheter-compatible Flexicut directional atherectomy device and to compare it with the conventional Atherocath GTO catheter. The 6 Fr Flexicut catheter has a larger cutting window and a titanium nitride-coated cutter to effect more tissue removal as well as treat mildly calcified lesions. A group of 143 lesions in 117 consecutive patients treated with the Flexicut catheter in four centers were compared with a control group of 277 lesions in 212 consecutive patients treated with the GTO device. Postatherectomy luminal diameters were larger (2.92 +/- 0.79 vs. 2.52 +/- 0.64 mm; P < 0.0001), with more luminal gain (relative gain: 0.58 +/- 0.24 vs. 0.48 +/- 0.25; P = 0.0007) using fewer directional coronary atherectomy (DCA) cuts (12 +/- 7 vs. 16 +/- 9; P = 0.0001) in the Flexicut group. A residual diameter stenosis < 20% immediately after DCA was obtained in 77% of the lesions in the Flexicut group vs. 45% in the GTO group (P < 0.0001). Histology in the former group revealed large calcium speckles in the retrieved specimens. In the Flexicut group, there was a lower incidence of access site complications and damage to the coronary ostium (2.5% vs. 7.5%; P = 0.08). The new Flexicut catheter is more effective than the conventional GTO catheter with a trend for reduced guiding catheter-related complications.

Atherectomy, Coronary↗
PubMed2003

Successful stent ablation with rotational atherectomy.

We describe the findings from two patients with coronary artery disease treated with stents who had unexpandable rings after deployment. These covered rings were successfully ablated with rotational atherectomy. The treated segment was then scaffolded with a new stent. Our observations confirm the efficacy of rotational atherectomy for stent ablation.

Atherectomy, Coronary↗
PubMed2001

Coronary angioplasty and Rotablator atherectomy trial (CARAT): immediate and late results of a prospective multicenter randomized trial.

Mechanical rotational atherectomy with the Rotablator is widely used for percutaneous coronary revascularization, but the ideal debulking strategy remains unknown. The purpose of this study was to compare the immediate and late results after Rotablator using two treatment strategies: Large burrs (burr/artery ratio of >0.7) to achieve maximal debulking (lesion debulking strategy) or small burrs (burr/artery ratio < or = 0.7) to modify lesion compliance (lesion modification strategy). Two hundred twenty-two patients at six centers were prospectively enrolled in this study and randomly assigned to large (n = 104 patients with 118 lesions) or small (n = 118 patients with 136 lesions) burrs. The primary endpoint was final diameter stenosis at the end of the procedure, and secondary endpoints included inhospital angiographic and clinical complications, and target lesion revascularization at 6 months. Baseline demographic and angiographic characteristics were similar. There were no differences in procedural success, the extent of immediate lumen enlargement, inhospital ischemic complications, or late target vessel revascularization. However, compared with small burrs, patients randomized to large burrs were more likely to experience serious angiographic complications (5.1% vs. 12.7%, P < 0.05) immediately after atherectomy. This study suggests that a routine lesion modification strategy employing small burrs (burr/artery ratio < or = 0.7) achieves similar immediate lumen enlargement and late target vessel revascularization compared with a more aggressive debulking strategy (burr/artery ratio >0.7), but with fewer angiographic complications.

Aged↗
PubMed1992

Coronary artery aneurysm formation following directional coronary atherectomy.

Directional coronary atherectomy has recently become available to treat coronary stenosis by excision and removal of tissue. The optimal depth of resection by this method has not been determined and complications have occurred. This report describes the formation of a coronary aneurysm at an atherectomy site in an asymptomatic patient, a finding not reported previously.

Angioplasty, Balloon, Coronary↗
PubMed1993

Directional coronary atherectomy in a distal right coronary lesion using a shorter standard guide catheter.

An ulcerated and eccentric distal right coronary artery plaque was found in a 56-year-old male with post-infarction angina. The 100 cm length of present DVI (Devices for Vascular Intervention, Inc., Redwood City, CA) atherectomy guiding catheters limits the ability to reach many complex distal stenoses with the 125 cm Simpson Atherocath. After shortening the proximal portion of a standard DVI Judkins right guiding catheter without changing the distal contour, successful directional coronary atherectomy was performed.

Atherectomy, Coronary↗
PubMed1993

Transluminal extraction atherectomy and adjunctive balloon angioplasty for restenosis after Palmaz-Schatz coronary stent implantation.

Two patients who developed restenosis after implantation of Palmaz-Schatz coronary stents were successfully treated by transluminal extraction atherectomy and there has been no recurrence on follow-up angiograms. The optimum strategy for managing restenosis after coronary stenting remains unclear, but transluminal extraction atherectomy appears to be a safe and effective option.

Angioplasty, Balloon, Coronary↗