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At least 667 records · Page 37Linked to original sources
PubMed1993

Directional coronary atherectomy in acute myocardial infarction.

To date, application of directional coronary atherectomy (DCA) in acute myocardial infarction (AMI) has had limited reports. In eleven patients with AMI, DCA was applied. In three of these patients, DCA was used as a stand-alone procedure without use of thrombolytic agents. In each case a guidewire was placed across the stenosis, and in eight patients balloon angioplasty was utilized as a predilating modality prior to DCA. The thrombolytic agent urokinase was utilized in five of these eight patients, either before, during, or after angioplasty and/or DCA. DCA success (defined as ability to cross the lesion, reduction of less than or equal to 20% in stenosis and thrombolysis--when a thrombus is present) was achieved in 10 of 11 patients. One patient had persistent abrupt reclosure of an LAD lesion, accompanied by hemodynamic compromise, necessitating intra-aortic balloon pump insertion and subsequent emergent coronary artery bypass graft surgery. Final angiograms revealed residual stenoses less than or equal to 20%, and adequate thrombolysis. Significant cardiac events were limited to one emergent CABG, Q wave MI in four patients, and non-Q wave MI in two patients. Clinically all eleven patients improved, survived the AMI/CABG, and were discharged. This clinical experience demonstrates the feasibility and safety of DCA application in selected patients who experience acute myocardial infarction.

Adult↗
PubMedDate not supplied

Directional coronary atherectomy and its use in treating occluded left main arteries in cardiogenic shock patients: a case study.

This article presents a case where directional coronary atherectomy was successfully performed on an occluded left main coronary artery in a cardiogenic shock patient in an emergency setting where thrombolytic agents were contraindicated. Further investigation is suggested and warranted and use of DCA may aid in management of cardiogenic shock patients.

Aged↗
PubMed1995

Directional coronary atherectomy: experience in 310 patients.

This article describes the acute and long-term clinical outcomes of 310 consecutive patients who underwent directional coronary atherectomy (DCA) for treatment of coronary artery disease. An overall procedural success rate of 95% was noted with a total major complication rate of 5%. Analyses of minimal luminal diameter (MLD) were performed pre- and post-procedure for 160 patients. Clinical follow-up including treadmill testing and/or clinical symptoms was obtained on 293 patients. Results of angiographic analyses corresponded with the Kuntz model suggesting that larger MLDs are associated with lower restenosis rates. The overall target vessel revascularization rate was 27.6%, with a mean post-procedure percent diameter stenosis of 16%. These results indicate that DCA is associated with acceptable clinical restenosis rates, complications and long-term outcome.

Adult↗
PubMed1999

Iatrogenic left anterior descending artery stenosis in response to the nose cone of a directional atherectomy device: a different sort of restenosis.

Restenosis after percutaneous transluminal coronary angioplasty (PTCA) is well described and refers to the development of a significant narrowing at the site of the lesion treated. A case is reported of a female patient who underwent directional coronary atherectomy (DCA) and stent insertion at the origin of the left anterior descending artery. This was performed without complication. Repeat angiography was performed because of return of angina after ten weeks; it demonstrated a widely patent stent, but also a significant stenosis distal to the stent where the nose cone of the DCA device had been positioned. This stenosis was successfully stented. The patient remains well at follow-up.

Atherectomy, Coronary↗
PubMed1999

Transluminal extraction catheter atherectomy for the treatment of acute occlusion of an ectatic coronary artery.

Thrombotic occlusion of an ectatic coronary artery may not respond to thrombolytic therapy or balloon angioplasty, since the infarct-related vessel contains a significant amount of thrombus. A patient with acute myocardial infarction of an ectatic right coronary artery that was occluded by a heavy clot burden is described. The patient was treated successfully with transluminal extraction catheter atherectomy and results were confirmed by intravascular ultrasound.

Acute Disease↗
PubMed2000

A rare, unreported complication during coronary rotational atherectomy.

We describe a rare and unreported complication during rotational atherectomy of a heavily calcified lesion in the left circumflex artery in a 79-year-old man. The Teflon sheath housing the drive shaft fractured, most probably due to overtightening of the Y-adapter hemostatic valve. As a result, there was intense spasm leading to acute ischemia and the procedure had to be abandoned. This case highlights the importance of using familiar and thoroughly tested hardware in technique-intensive procedures.

Aged↗
PubMed2000

Rationale for directional atherectomy and adjunctive stenting in a patient with non-Q wave myocardial infarction.

The development of percutaneous transluminal balloon angioplasty (PTCA) is the greatest revolution in the management of stenotic coronary artery disease. However, PTCA is limited in its application to some specific subgroups of complex lesions such as bifurcational, ostial and plaque burden lesions. For this reason, some new strategies including directional atherectomy (DCA) have been developed as advanced modalities in the treatment of these complex lesions, which if treated by PTCA would certainly yield poor outcomes. We report a case of non-Q wave myocardial infarction resulting from obstruction of the ostium of left anterior descending artery. DCA and adjunctive stenting to the lesion were successfully performed and the patient was discharged uneventfully after the procedure. We suggest that DCA is a striking method and has much merit in the treatment of complex lesions with a high rate of success. In view of consideration of restenosis remains an importantly unresolved problem in percutaneous coronary intervention in specific subgroups of complex lesions. In the future, adequate debulking by mean of DCA in combination with adjunctive stenting which recently emerges as a promising treatment in the prevention of restenosis may provide a more consistent and attractive method for prevention of restenosis in these complex lesions.

Aged↗
PubMed2000

Efficacy of directional coronary atherectomy before stent implantation for coronary ostial lesions.

We evaluated stent implantation following directional coronary atherectomy (DCA) for coronary ostial lesions. The subjects were 27 patients (27 lesions) who underwent stent deployment after DCA, and 47 patients (47 lesions) who underwent stent deployment alone as the control group. There were no differences in numbers of lesions with multi-vessel disease, left anterior descending artery lesions, de novo lesions or reference vessel diameters in the two groups. The percent diameter stenosis after stent implantation was lower in the DCA-stent group than in the stent-alone group (9 +/- 10% versus 17 +/- 14%, respectively; p < 0.01). The initial procedural success rate was 92.6% in the DCA-stent group and 91.4% in the stent-alone group. The initial clinical success rate was 100% in the DCA-stent group and 95.7% in the stent-alone group. The restenosis rate was lower in the DCA-stent group (20% versus 43% in the stent-alone group). This study showed that debulking by DCA before stenting is more effective compared to stenting alone.

Aged↗
PubMedDate not supplied

Directional coronary atherectomy in acute myocardial infarction.

Catheter-based intervention with directional coronary atherectomy (DCA) involving the surgical removal of obstructive plaque has been extensively studied in patients exhibiting stable and unstable angina. However, since no studies to date have evaluated the effectiveness of stand alone DCA as a primary treatment in the acute myocardial infarction (MI) setting, we conducted a five-year retrospective study of the early clinical and in-hospital outcomes of patients who underwent DCA within the 72-hour interval following acute MI. Our study included data obtained from a total of 30 acute MI patients treated between 1993 and 1998. Twenty-six of these patients (86%) met the criteria for angiographic success, while 11 (36%) showed less than 50% residual stenosis without the need for supplemental percutaneous transluminal coronary angioplasty (PTCA) or additional treatment for other major complications. Four (13%) of the patients exhibited negative outcomes including post-procedural MI, emergency coronary artery bypass grafting, abrupt vessel closure, hemorrhage necessitating vessel repair and transfusion, and death. Although stand alone DCA is not presently a common treatment, our results suggest it to be an effective and relatively safe procedure for acute MI. However, further studies involving a larger number of patients and a longer follow-up evaluation are needed for comparison of the relative effectiveness of this procedure with other treatments of acute MI.

Adult↗
PubMed2002

Comparison of dilatation mechanism and long-term vessel remodeling between directional coronary atherectomy and balloon angioplasty assessed by volumetric intravascular ultrasound.

Although acute and late outcomes of coronary interventions have been determined by coronary angiography, this method cannot determine changes in vessel and plaque volume. Volumetric intravascular analysis has the potential to evaluate the morphology and redistribution of plaque after coronary intervention as well as longitudinal vessel remodeling. We used 3-dimensional intravascular ultrasound (3-D IVUS) to delineate the mechanism of coronary dilatation and long-term (> 1 year) remodeling in 25 patients. Ten patients underwent directional coronary atherectomy (DCA), and 15 underwent balloon angioplasty (POBA). No patients exhibited restenosis at 6-month angiographic follow-up. Validated Netra 3-D IVUS was performed pre- and post-intervention, at 6-months and at > 1-year. There were some differences in mechanism of dilatation and time course of change in vessel size between DCA and POBA patients. The principal mechanism was vessel stretching and longitudinal plaque redistribution in the POBA group and plaque debulking in the DCA group. In the POBA group, vessel volume increased just after the procedure; this increase was maintained at 6 months and at > 1-year. However, in the DCA group, vessel volume increased initially 6 months after the procedure. 3-D IVUS revealed a difference in mechanism of dilatation between POBA and DCA; this difference might affect late-term vessel remodeling even in patients without restenosis.

Aged↗
PubMed1999

[Application of intracoronary ultrasound in directional coronary atherectomy].

Intracoronary ultrasound(ICUS) was successfully applied in 32 patients who accepted directional coronary atherectomy(DCA). After the procedure, the mean internal diameter of coronary artery increased from 1.06 mm to 3.59 mm, and the residual stenosis was < 25%. No severe complications, such as rupture of perforation, occurred. The clinical application of ICUS in DCA may improve the therapeutic effects as well as success rate of DCA, and may minimize the incidence of complications.

Adult↗
PubMed2003

[Contribution of monocyte chemoattractant protein-1 and c-fms/macrophage colony-stimulating factor receptor to coronary artery disease: analysis of human coronary atherectomy specimens].

OBJECTIVES: Primary coronary atherosclerotic lesions(de novo lesions) are a type of inflammatory vascular disease. Restenotic lesions after percutaneous coronary intervention mainly consist of proliferative vascular smooth muscle cells. Recent studies have demonstrated that locally synthesized cytokines, including chemokines, are important in both these coronary lesions. Monocyte chemoattractant protein(MCP)-1 and macrophage colony-stimulating factor(M-CSF) are two of the associated chemokines, but their role in coronary artery disease has not been sufficiently clarified. This study investigated the expression of MCP-1 and c-fms/M-CSF receptor in human coronary tissues. METHODS: Histological and immunohistochemical studies used samples obtained from patients who underwent directional coronary atherectomy(28 de novo lesions and 16 restenotic lesions). The following primary antibodies were used: anti-MCP-1, anti-c-fms, anti-macrophages and anti-alpha-smooth muscle actin. RESULTS: Focal accumulation of macrophage-derived foam cells, thrombus, cholesterol clefts and calcification tended to be more frequent in de novo lesions than in restenotic lesions. On the other hand, restenotic lesions mainly consisted of stellate vascular smooth muscle cells and extracellular matrix. The expression of MCP-1-positive cells almost coincided with the macrophages. In contrast, staining for MCP-1 was little seen in the stellate vascular smooth muscle cells. Expression of c-fms was found in both macrophages and stellate vascular smooth muscle cells. Expression patterns of MCP-1 and c-fms exhibited no difference between the two lesion types. CONCLUSIONS: Both MCP-1 and the M-CSF/c-fms system are involved in the atherogenesis of de novo lesions. However, the M-CSF/c-fms system, rather than MCP-1, is more important in the late stage of restenosis.

Aged↗
PubMed1992

[Directional atherectomy and coronary angioplasty: a therapy complementary to myocardial revascularization surgery].

A white male patient, 59 years old, with two prior surgical myocardial revascularization and unstable angina, was submitted to coronary arteriography that showed: all the saphenous vein grafts patent and obstruction of 75% in the saphenous vein graft to the second marginal branch of left circumflex artery. Left internal mammary artery (LIMA) was angiographically normal and 80% stenosis was detected in the distal segment of the left anterior descending coronary artery (LAD). The patient was submitted to directional coronary atherectomy for saphenous vein graft and coronary angioplasty for distal-LAD. Both procedures were successfully performed.

Angioplasty, Balloon, Coronary↗
PubMed1992

[Complications during directional coronary atherectomy (DCA): catheter fracture between housing assembly and shaft point with subsequent vascular occlusion].

Directional coronary atherectomy of a severe stenosis of the left anterior descending coronary artery was complicated by device fracture between the cylindric housing portion and the distal nose-cone collecting chamber. After successful removal of the DCA device, an early occlusion of the coronary vessel occurred, which could be successfully treated by perfusion balloon catheter.

Adult↗
PubMed1992

Coronary atherectomy: report of the first experience in Hawaii.

Since Andreas Gruentzig first introduced percutaneous transluminal coronary angioplasty (PTCA) in 1977, the ability to revascularize occluded coronary vessels with a catheter has enjoyed an explosive and unimaginable growth. As the equipment and operator experience improved, the possibilities appeared boundless. However, balloon angioplasty is hampered by a significant restenosis rate in the dilated vessel (approximately 30%), which is higher in selected locations (up to 60% in the proximal left anterior descending artery), even in the best of hands. This fundamental limitation may in part be due to the actual nature of the technique itself--stretching the vessel and fissuring the plaque causing remodeling without removal. The uneven, exposed vessel surface post-plaque rupture may contribute to activation of the hemostatic system, with acute thrombosis and release of various platelet and endothelial-derived growth factors, leading to long-term tissue proliferation and restenosis. Atherectomy, the mechanical removal of plaque from the vessel wall, appears to be an answer. This process actually debulks the culprit tissue and leaves behind a smoother, presumably less thrombogenic surface. We wish to report our first experience with a specific form of this technique in 4 consecutive patients, with a brief discussion of its promises and limitations.

Aged↗
PubMedDate not supplied

A two-year, single-group experience with rotational atherectomy.

Rotational atherectomy was introduced with a view to approaching percutaneously, cases that were suboptimal or unsuitable for conventional percutaneous transluminal coronary angioplasty (PTCA). In this article we present our findings for a period of two years starting in April 2001, when 60 procedures were performed on 54 patients. We found the procedure to be successful in B2 and C type lesions. It is our opinion that the lower burr-to-artery ratio used in our cases was significantly beneficial in decreasing immediate complications related to the procedure. Complimentary PTCA and stenting improved the angiographic end result. Using this strategy, we have achieved very acceptable clinical results.

Aged↗
PubMed2005

Novel use of a peripheral, self-expanding nitinol stent in adjunct to excimer laser coronary atherectomy in the treatment of degenerated vein graft disease.

Decades of successful surgical revascularization of coronary artery disease have led to a growing population with saphenous vein graft disease. However, the treatment of degenerated saphenous vein graft still remains controversial. We report a novel but successful use of a peripheral, self-expanding nitinol stent in adjunct to excimer laser coronary atherectomy (ELCA) in the treatment of symptomatic, degenerated saphenous vein graft disease. The procedure was tolerated well without any short- or long-term complications. The case report is followed by a review of the literature on the treatment of vein graft disease.

Aged↗