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PubMed1990

[Angioscopy of the coronary vessels].

Direct visual examination of the interior surfaces of intact human coronary arteries is now a reality, both from intraoperative and transluminal approaches. As an additional investigation to angiography it improves the knowledge about the corresponding morphology of angiographically visible changes. Since the first report about percutaneous and intraoperative coronary angioscopy by Spears et al. in 1982 important indications concerning the intraoperative approach were defined such as the control of coronary atherectomy, intraoperative balloon dilatation and laser angioplasty, the inspection of the grafts prior to implantation and the assessment of the quality of the distal anastomosis after graft insertion. The most important clinical result angioscopy has brought about is the postulation of a concept of the different clinical forms of coronary artery disease based on the morphological stages of atherosclerosis, which were defined by angioscopy and could be related to clinical symptoms. Scientific studies today are concerned with determinants for the patency rate of bypasses, the restenosis rate of PTCA, the acute and chronic effects of drugs, and the mechanism of all kinds of catheter-supported angioplasties. The next important application of coronary angioscopy will undoubtedly be the simultaneous visual control of coronary angioplasty procedures such as laser angioplasty and other new methods.

Coronary Artery Disease↗
PubMed1979

[Coronary vessel abnormalities of aortal origin].

Anomalies of aortal origin of the coronary vascular system are found in approximately one percent of the population and can be exactly documented by coronary angiography. Although such variants of origin and in the coronary vascular course are not associated with an increased incidence in coronary sclerosis, it is important that they be known for several reasons: 1. in order to avoid false interpretations of the coronarogram that can be of grave consequence, 2. for the selection of the correct incision at heart surgery, 3. a very rare anomaly, the origin of the trunk of the left coronary artery in the right Valsalva's sinus, is clearly related to sudden cardiac death in children and youths. A correct diagnosis can be life-saving.

Coronary Angiography↗
PubMed1996

[Changed views on vasoconstriction of coronary vessels and angina pectoris].

Views on the impact spasms of the coronary arteries (in the work of distinguished internists and cardiologists) changed in recent years. At present it is obvious that even coronaries damaged by atherosclerosis (in particular eccentric stenoses) may react to vasoconstrictor stimuli by a spasm and this promotes various manifestations of ischaemic heart disease. The coronary arteries can respond by vasoconstriction to stimuli to which arteries without atherosclerotic changes react by vasodilatation. Hypolipidaemic treatment reduces not only stenoses of the coronaries but improves also their impaired vasomotorics. A spasm of a "sound" artery remains an exceptional occurrence. This, however, casts no doubts on the importance of the serious character of organic stenoses and the increase of cardiac work which causes ischaemia of the heart muscle.

Angina Pectoris↗
PubMed1993

Alteration in regulation of myocardial blood flow in one-vessel coronary artery disease determined by positron emission tomography.

The behavior of myocardial blood flow (MBF) regulation in territories supplied by angiographically normal vessels of patients with coronary artery disease (CAD) has been poorly investigated. Resting MBF and coronary reserve were evaluated in 32 patients with stable angina, no previous myocardial infarction, and isolated left anterior descending or left circumflex coronary artery stenosis (> or = 50% diameter narrowing). MBF was measured, in the absence of any medical therapy, by means of dynamic positron emission tomography and 13N-ammonia. MBF measurements at baseline and after intravenous dipyridamole (0.56 mg/kg administered over 4 minutes), were obtained both in the stenosis-related regions and in contralateral territories. As a control group, 14 normal subjects were evaluated according to the same protocol. At rest, the 32 patients with CAD had similar MBF values in the stenotic and remote regions (0.76 +/- 0.21 and 0.77 +/- 0.19 ml/min/g, respectively, p = NS); both these values were significantly (p < 0.01) reduced with respect to mean MBF in normal subjects (1.03 +/- 0.25 ml/min/g). The dipyridamole study was completed in 30 patients; these patients had lower values of maximal MBF in the stenotic than in the remote regions (1.52 +/- 0.65 vs 1.76 +/- 0.68 ml/min/g, p < 0.05); however, both these values were significantly reduced (p < 0.01) with respect to mean dipyridamole MBF in normal subjects (3.66 +/- 0.92 ml/min/g). Thus, in patients with CAD, resting and maximal MBF can be reduced not only in myocardial territories supplied by stenotic arteries, but also in territories supplied by angiographically normal arteries.

Aged↗
PubMed1994

Influence of coronary vessel size on renarrowing process and late angiographic outcome after successful balloon angioplasty.

BACKGROUND: Although coronary angioplasty is increasingly applied in the treatment of multivessel disease and a broadening range of vessel size, the influence of vessel size itself on the late results of intervention is unresolved. An influence of vessel size on late outcome would carry implications for the application and evaluation of interventional devices, which are selectively used in larger or smaller vessels. The purpose of the present study was to investigate the influence of vessel size on both the restenosis process and late angiographic outcome in a large homogeneous patient group after successful percutaneous transluminal coronary angioplasty (PTCA). METHODS AND RESULTS: The study population comprised 3072 patients with 3736 successfully dilated native primary coronary artery lesions and satisfactory quantitative angiographic analysis in multiple identical projections before and after PTCA and at a 6-month follow-up. Late luminal loss, minimal luminal diameter (MLD) at follow-up, and net luminal gain, as well as percent diameter stenosis at follow-up, net gain in percent diameter stenosis, restenosis rates (according to three definitions), and net gain index, were all compared among nine equally sized groups (noniles) according to vessel size. A direct influence of vessel size on continuous measures of late result was also evaluated by linear regression. These evaluations provided conflicting information with no consistent influence of vessel size emerging. To elucidate the independent influence of vessel size on the restenosis process (late loss) and late angiographic outcome (MLD at follow-up), multiple linear regression analysis was performed taking into account luminal gain, preprocedural MLD, and lesion location. In this manner, vessel size was found to be exert a significantly positive influence on MLD at follow-up (P < .0001) and an equally negative effect on loss. Correcting for vessel size by using percent stenosis measurements led to an anticipated neutralization of this influence. Lesion location in the left anterior descending coronary artery was found to be independently associated with greater loss and smaller MLD at follow-up (P < .0001). CONCLUSIONS: Increasing coronary vessel size was found to be independently predictive of decreasing late luminal loss and increasing follow-up MLD after successful balloon angioplasty. Apparently superior or inferior late angiographic results of new interventional devices may thus be explained in part by preferential use in larger or smaller vessels, respectively. Devices that can safely optimize the short-term result of intervention may realize their ultimate long-term value in larger coronary vessels.

Aged↗
PubMed1989

[Complex coronary angioplasty (II). Dilatation of multiple lesions in single-vessel and multi-vessel coronary disease].

Angioplasty (PTCA) was successfully performed in 404/428 patients (94%). Two lesions were attempted in 74%; three in 21%; and four or more in 6% of cases. Significant complications included: 11 (2.5%) transmural infarctions, 9 (2.1%) emergency surgeries, and 6 (1.4%) mortalities. A lesion recurrence occurred in 106/404 patients (26%) with 81/89 patients (91%) having a successful second PTCA. A second recurrence occurred in 15/81 patients (19%) with 13/15 patients having a successful third PTCA. Follow-up (mean: 28.3 months) showed an improved anginal status in 83% of patients. The probability of survival at 51 months was 93%. Multiple lesion PTCA in carefully selected patients has a good success rate, an acceptable complication rate, and a reasonable expectation of satisfactory long-term results, with or without the need for subsequent PTCA procedures.

Angioplasty, Balloon↗
PubMed1990

Coronary angiography and thallium-201 single photon emission computed tomography in single vessel coronary artery disease.

Polar presentations of selective coronary angiography and myocardial 201T1 SPECT were compared in 49 patients with single vessel disease. Twenty-six lesions were located in LAD, 8 in LCX and 15 in RCA. Perfusion defects were found within the supply area of 44 stenotic and 20 non-stenotic arteries. 201T1 SPECT detected coronary disease in 45 patients (92%) and the obstructed artery in 44 (90%). Single vessel disease was correctly indicated in 28 patients (57%) where the perfusion defects did not extend significantly outside the area supplied by the stenotic artery. Extensive perfusion defects could be explained by 'collateral steal', myocardial disease, LV aneurysm or spasm in 9 patients (18%). The absence of perfusion defect related to the stenotic artery could be explained by a moderate degree of stenosis or well developed collateral vessels in 5 patients (10%). Proximal LAD lesions resulted in larger perfusion defects than distal.

Angiography↗