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PubMedDate not supplied

Evaluation of the pullback atherectomy catheter in the treatment of lower limb vascular disease.

PURPOSE: To evaluate prospectively the Pullback Atherectomy Catheter (PAC) in terms of its technical success and 1-year patency in the treatment of lower limb vascular disease.M ETHODS: Thirty-nine PAC procedures were performed in 34 patients to treat atherosclerotic disease (occlusive in 51%) of the femoropopliteal arteries, including four cases of graft neointimal hyperplasia and three dissection flaps. Follow-up was by ankle-brachial indices at 24 hr and 1 month, and arteriography at 6 and 12 months. RESULTS: Technical success was achieved in 38 of 39 procedures (97.4%). There was a reduction in mean stenosis from 89.4% to 12.1%, but 69.2% of procedures required additional balloon dilatation to achieve an adequate arterial lumen. Complications followed 15.4% of procedures, a third of which required surgery. CONCLUSION: The PAC is an easy and relatively safe catheter to use, but does not provide a satisfactory arterial lumen without additional percutaneous transluminal angioplasty (PTA). It proved to be effective, however, in the treatment of graft neointimal hyperplasia and in the resection of obstructive intimal flaps following PTA.

Aged↗
PubMed1996

[Clinical results of directional peripheral atherectomy].

I will report clinical results of directional peripheral atherectomy (DPA). DPA was performed in 81 lesions in 57 cases in our department in the period ending February 1996 (56 men and one women, age; 24-85 years old, and mean age; 67 years old). 56 stenotic lesions and 25 complete occlusive lesions were observed. Simpson AtherotrackTM from six to nine Fr was used according the degree of lesions. In the complete occlusive or severe stenotic lesions DPA was carried out only after laser angioplasty (LAP) by using Nd-YAG laser. Initial clinical success was defined as < 30% residual stenotic rate by arteriography. In cases with more than 30% residual stenosis, we performed reDPA, balloon angioplasty or stent implantation. The initial success rate was 98% in the stenotic group and 96% in the occlusive group. Five complications occurred and all complications were minor dissection caused by minor dissection caused by LAP. The late success rate was 86% in the stenotic group and 86% in the occlusive group (observation period; 1-46 mena; 28 months). This new technique might have further clinical application with improvement of the initial and long patency rate.

Adult↗
PubMed1996

[Atherectomy in patients with arteriosclerosis obliterans: angiographic follow-up study of 186 lesions in 146 patients].

Atherectomy (ATE) is a new catheter-mediated technique for the removal of atheroma in patients with arteriosclerosis obliterans (ASO). ATE was performed using 7-10 Fr. Simpson Peripheral Athero Track catheters at 186 sites in 146 patients, whose lesions involved 49 common iliac arteries, 66 external iliac arteries, 68 femoral arteries and three other arteries. The initial success rate was 94.1%. The mean percent of the diameter stenosis was reduced from 79.0 +/- 1.2% (mean +/- SD) to 22.7 +/- 1.0%. There were two cases of perforation that required surgical treatment (1.1%). The complication rate was 4.4%. The 0.5-, 1-, 2- and 3-year patency rates were 87.6%, 79.6%, 62.5% and 62.5%, respectively. The rate of long-term patency in each segment of arterial lesions revealed that the patency rate in the common iliac artery was significantly higher than the rates in the external iliac artery (p < 0.05) and femoral artery (p < 0.01). The patency rates for long lesions (> or = 2.0 cm) and occluded lesions were significantly (p < 0.01) lower than those for short lesions (< 2.0 cm). Diabetic patients had a higher re-stenosis rate than nondiabetic patients (p < 0.05). In conclusion, ATE is an effective new method for the treatment of patients with ASO.

Aged↗
PubMed1996

[Efficacy and limitation of directional coronary atherectomy for acute myocardial infarction assessed by depth of tissue resection].

The efficacy and limitations of directional coronary atherectomy (DCA) for acute myocardial infarction were evaluated in 44 patients (left anterior descending artery : 27 lesions, left circumflex artery : 2 lesions, right coronary artery : 15 lesions) who underwent DCA within 24 hours after the onset of chest pain. Thirty-two patients underwent DCA for residual stenosis of > or = 75% with TIMI flow grade II or III after thrombolysis (immediate DCA), and 12 patients underwent DCA for suboptimal results after immediate percutaneous transluminal coronary angioplasty (rescue DCA). In all patients, DCA resulted in residual stenosis of <25% (15 +/- 8%), and the primary success rate was 100%. No major complications (death, emergency bypass grafting) occurred. Repeat angiography was performed in 41 patients before discharge (2.4 +/- 0.7 weeks later) and in 39 patients during follow-up (5 +/- 2 months later). Reocclusion was not found at the follow-up. Restenosis was not found before predischarge, but was found in 19 of the 39 patients (49%) at the follow-up. Histological analysis of atheroma samples was performed to evaluate the influence of subintimal resection on restenosis. Patients were divided into two groups according to the depth of tissue resection : intimal resection and subintimal resection. The restenosis rate associated with subintimal resection was significantly higher than that associated with intimal resection (80% vs 29%, p < 0.01). DCA is useful for persistent patency of the infarct-related coronary artery in patients with acute infarction, but subintimal resection may increase the restenosis rate during the follow-up period.

Adult↗
PubMed1996

Technique and strategy of rotational atherectomy.

Atherosclerotic plaque heterogeneity has created the need for the development of second generation devices aimed specifically at lesions where PTCA has been shown to be suboptimal. The Rotablator system represents one of the newer technologies which utilizes plaque ablation to achieve larger lumens. The device is a high speed "rotary sander," which requires the interventional cardiologist to be keenly aware of the mechanical implications while advancing the device through the coronary vasculature. The objective of this article is to review the most recent technique refinements and strategies for rotational atherectomy as well as the available clinical data and ongoing clinical trials.

Atherectomy, Coronary↗
PubMed1996

Incremental value of intravascular ultrasound during rotational coronary atherectomy.

During the last several years, major improvements in intravascular ultrasound image quality have led to new and important information about the clinical application of rotational atherectomy. Ultrasound is providing data on the mechanism of luman enlargement, burr sizing, and the effects of the procedure on different plaque morphologies. This information is often important for optimizing device selection and procedural success, as well as for minimizing complications. In this review we first discuss the currently available data regarding the mechanisms of lumen enlargement following rotational ablation and the implications of these findings for lesion and patient selection. We review how this data is modifying several of the technical aspects of the rotational ablation procedure in the interventional laboratory. We than assess the available data that suggest that preprocedural ultrasound examination may eventually help to identify lesions at high risk for adverse outcome with stand-alone balloon angioplasty or stent placement. These ultrasound data may help triage many of these targets to initial debulking with rotational ablation. Finally, we review data that suggest that ultrasound analysis has important implications for comparative trials of new devices, particularly trials of the Rotabalator.

Atherectomy, Coronary↗
PubMed1996

Guidewire bias: potential source of complications with rotational atherectomy.

The guidewire in rotational atherectomy is an integral component in the ablative process. It functions not only to deliver the device but sets the cutting vector when the burr advances. Since the guidewire is a stiff stainless steel monofilament and the vessels are frequently tortuous and angulated, the guidewire may not be centrally oriented, but may bias preferentially to one side of the arterial wall. This may result in tangential or radial cutting. The following cases illustrate the dependence of the ablative process on the lie of the guidewire and the importance of integrating this factor in proper use of the Rotablator system.

Aged↗
PubMed1996

Rotational atherectomy for treatment of in-stent restenosis: role of intracoronary ultrasound guidance.

In-stent restenosis is becoming increasingly frequent as greater numbers of intracoronary stents are implanted, and may pose a particularly challenging management problem. Recurrent restenosis following balloon angioplasty for in-stent restenosis is common, and thus the possible role of debulking has been considered. This report describes the successful treatment of severe restenosis within a Palmaz-Schatz stent with high-speed rotational atherectomy, using intracoronary ultrasound guidance.

Atherectomy, Coronary↗
PubMed1997

Effect of rotational atherectomy on quality of life.

OBJECTIVE: To evaluate whether percutaneous coronary rotational atherectomy (RA) improves quality of life. DESIGN: Prospective sequential study of the first 20 patients who had RA at St Paul's Hospital, Vancouver from November 1993 to April 1994. SETTING: Tertiary care teaching hospital. PATIENTS: There were nine males and 11 females with a mean age of 68 +/- 9.3 years. All had angina pectoris with type B or C coronary lesions. INTERVENTIONS: RA was performed using the Rotablator device. RESULTS: The procedure was angiographically successful in 20 patients and clinically successful in 18 patients. Two patients who sustained acute myocardial infarctions underwent coronary bypass surgery. Before RA there was one patient in Canadian Cardiovascular Society angina class I, five patients in class II, 12 in class III, and two in class IV. At six months' follow-up there were 11 patients in class I, seven in class II and two in class III. The mean Duke Activity Status Index improved from 21.3 +/- 15.8 (mean +/- SD) before the procedure to 36.9 +/- 15.8 (P < 0.001) at six months' follow-up. The consumption of anti-anginal medications also decreased. CONCLUSIONS: RA was associated with improved functional status and quality of life in patients having angina pectoris with type B or C coronary lesions.

Aged↗
PubMed1997

[Histological findings of specimens obtained by directional coronary atherectomy from patients with acute myocardial infarction].

The histological characteristics of acute myocardial infarction were examined in specimens obtained from infarct-related coronary artery lesions (20 left anterior descending artery, 2 left circumflex artery, 8 right coronary artery) in 30 patients with initial acute myocardial infarction who underwent directional coronary atherectomy following intracoronary thrombolysis within 6 hours after the onset of chest pain. Resected tissues were fixed in 10% buffered formalin and embedded in paraffin, and the 4 microns-thick paraffin sections were stained with hematoxylin-eosin and examined by light microscopy. Thrombus and/ or intramural hemorrhage were present in all samples. There were high incidences of cholesterol cleft in 19 (63%), foam cell in 21 (70%), calcium deposit in 19 (63%) and intimal proliferation in 16 (53%). These data suggest that thrombus and/or intramural hemorrhage are important in the onset of acute myocardial infarction.

Aged↗
PubMedDate not supplied

[Directional coronary atherectomy after unsuccessful angioplasty].

Directional coronary atherectomy (DCA) is a percutaneous revascularization procedure. The basic indications are complex lesions (excentricity, irregular borders with ulceration and in non-calcified lesions in large coronary vessels or in vein grafts). DCA in recent years has been a useful procedure in several circumstances, in which initial results with conventional coronary angioplasty had failed, specifically in those conditions like acute occlusions, threatened closure or "elastic recoil" phenomenal, focal dissection or residual stenosis > 50% due to hare atherosclerotic plaque. In this report two cases of "rescue" DCA due to residual stenosis > 50% because of "elastic recoil" are presented. One of them had a concentric lesion and the other a marked excentricity. Both cases had primary success. Atheroma was shown by histopathology. Rescue DCA is a useful feasible alternative procedure in selected cases, in which conventional coronary angioplasty had initially not been successful.

Aged↗
PubMed1996

[Evaluation of efficacy and mechanism of action of angioplasty and directed atherectomy assisted by intravascular ultrasonography].

Intravascular ultrasound (IVUS) is a unique method of coronary lumen visualization enabling also examination the structure of the artery wall. Aim of this study was to assess efficacy and mechanisms of action of balloon angioplasty (PTCA) and directional atherectomy by means of IVUS. IVUS examination was performed before and after mechanical revascularization procedure in 37 pts (DCA-19 pts, PTCA-18 pts). Both PTCA and DCA resulted in enlargement of the coronary artery lumen (2.29 +/- 1.19 mm2 vs 2.93 +/- 1.55 mm2) but, also external diameter of the vessel increased after the procedure (1.94 +/- 1.10 mm2 and 0.74 +/- 1.01 mm2 retrospectively). In 55.6% of cases after PTCA plaque rupture or artery wall dissection was observed, mainly in eccentric lesions (70%). IVUS allowed to recognize details of artery lumen and define efficiency of procedure. In about 15% cases decision to continue PTCA or DCA was made on the basis of IVUS images only. The mechanism in which PTCA modifies the artery lumen is diverse and depends on the structure of lesion. Factors possibly responsible for enlargement of the lumen are: stretching, squeezing and translocation of atheroma as well as cracking and dissections along the arterial wall. DCA effectiveness depends on the withdraw of the atheromatous deposit, however, in over one-half of cases also stretching has some effect.

Aged↗
PubMed1997

[Usefulness of directional coronary atherectomy as a bail-out device for acute closure after coronary angioplasty].

The usefulness of directional coronary atherectomy (DCA) as a bail-out device for acute closure (reclosure) after percutaneous transluminal coronary angioplasty (PTCA) was evaluated. PTCA was performed in 1,023 patients (182 with acute myocardial infarction) between January 1993 and January 1994 in our hospital. Thirty-one patients (11 with acute myocardial infarction) suffered acute closure (reclosure) after PTCA. In six patients (five with acute myocardial infarction), DCA was performed as a rescue treatment for acute closure (reclosure). In three of these patients, angioscopy was performed before DCA, which demonstrated intimal tear and some thrombi although coronary angiography showed no evidence of thrombus. Bail-out DCA was successful in all six patients without complications. DCA is useful as a bail-out device for acute closure (reclosure) after PTCA when the thrombus is not massive.

Angioplasty, Balloon, Coronary↗
PubMed1997

[Are directional coronary atherectomy and Palmaz-Schatz stent more efficacious than conventional balloon angioplasty for treating de novo coronary artery lesions?].

It is unclear whether new devices such as directional coronary atherectomy (DCA) or Palmaz-Schatz stent implantation improve long-term outcomes compared with conventional balloon angioplasty in patients with stable angina and de novo coronary artery lesions of type A or type B except for complete occlusive lesions investigated by the American College of Cardiology/American Heart Association task force on percutaneous transluminal coronary angioplasty. A total of 146 patients with stable angina and simple lesions were assigned to either conventional balloon angioplasty (62 patients), DCA (50 patients), or Palmaz-Schatz implantation (34 patients). The acute results and late outcomes were assessed by coronary angiography. The results of the three procedures were similar with respect to procedural success and complications. Patients who underwent stenting or DCA had a larger immediate increase in the diameter of the lumen and a larger luminal diameter immediately after the procedure than those who underwent balloon angioplasty. At six months follow-up, the patients treated by stenting continued to have a larger luminal diameter and a lower rate of restenosis than those treated with balloon angioplasty (2.30 +/- 0.66 vs 1.85 +/- 0.83 mm, p < 0.005; 5.9% vs 29%, p < 0.05) and DCA (2.30 +/- 0.66 vs 1.90 +/- 0.96 mm, p < 0.05; 5.9% vs 24%, NS). The patients treated with balloon angioplasty had a smaller late loss than those treated with DCA or Palmaz-Schatz stent. The patients treated with DCA had a larger loss index than those treated with balloon angioplasty or Palmaz-Schatz stent. Stenting was a significant factor in decreasing the rate of restenosis by logistic regression analysis, compared with balloon angioplasty. The angiographic outcomes were better in patients who received a stent than in those who received other treatments. This study suggests that even lesions stable for treatment by balloon angioplasty and DCA can also be treated with Palmaz-Schatz stents.

Aged↗
PubMed1997

[Emergent operation after percutaneous transluminal coronary rotational atherectomy (ROTABLATOR)].

Emergent operations were performed in seven patients after percutaneous transluminal coronary rotational atherectomy (PTCRA). The causes of the emergent operations were coronary rupture in three patients, acute coronary occlusion in two patients, perforation of the ascending aorta in one patient and impossible weaning from IABP in one patient. IABP was used preoperatively in all patients. Coronary artery bypass grafting was performed in all patients. Ruptured sites of the coronary arteries were closed and perforated site of the ascending aorta was repaired. Two patients died due to cardiac failure but five patients were recovered. Coronary artery rupture was main complication after PTCRA. It is important to recognize the difference between the complication after PTCRA and that after conventional PTCA.

Adult↗
PubMed1994

[Percutaneous transluminal coronary angioplasty and directional coronary atherectomy: a short review of recent progress].

Since the invention of Gruentzig AR in 1977, percutaneous transluminal coronary angioplasty (PTCA) has become a widely accepted therapeutic measure for the treatment of patients with ischemic heart disease (IHD), as well as coronary artery bypass grafting (CABG). The rate of initial success in PTCA elevated up to more than 90% recently, in accordance with the progress in technology and the operator's skill. The limitations of PTCA are acute coronary occlusion which occurs in a few percent during or just after the procedure, and restenosis which occurs in thirty to fourty percent within six months. Some new devices have been invented to add better results for the patients. Directional coronary atherectomy (DCA) is one of the devices to remove atheroma in narrow segment, instead of splitting it. DCA can create a larger and smoother lumen than that created with PTCA, and it may be expected to reduce the restenosis rate. The therapeutic choice in IHD is still controversial. At present, several clinical trials are being conducted in order to evaluate and compare medical therapy, CABG, and PTCA. These results will provide informations to help the decision making in the management of the patients with IHD.

Angioplasty, Balloon, Coronary↗
PubMed1997

[Influence of the clinical presentation on immediate and long-term results after rotational atherectomy].

PURPOSE: To analyse the influence of unstable coronary syndromes (UCS) in the early and late prognosis after rotational atherectomy (RA). METHODS: We treated 236 patients with RA between Aug/1992 and May/1996. Patients were divided into two groups: A) stable coronary syndromes 120 (51%) patients; B) UCS: 116 (49%) patients. DEFINITIONS: 1) procedure success (PS)--lesion success in all locations were RA use was attempted, without a major complication; 2) late coronary events (LCE)--angina, MI, additional revascularization or death. RESULTS: There was a significant predominance of age > 70 (A = 14% x B = 24%, p = 0.03) in B and previous MI (A = 32% x B = 11%, p = 0.0001) in A. Other characteristics were similar in both groups, including complex lesions (type B2/C), which were observed in 77% A stenosis and 80% B lesions. PS was 95% in A and 92% in B (p = NS). In-hospital major complications were observed in 2.5% A and 4.3% B patients, (p = NS). One patient died in each group. A and B patients had similar time of follow-up. LCE occurred in 25% A and 39% B patients (p = 0.002). Recurrence of angina (36% x 23%; p = 0.01) and target lesion revascularization (29% x 18%; p = 0.03) were also more frequently required in B cases. CONCLUSION: This study suggests that UCS (group A) does not implicate in worse acute results after RA. However, UCS patients present greater incidence of late coronary events, particularly recurrence of angina and target-lesion revascularization.

Aged↗