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At least 721 records · Page 40Linked to original sources
PubMed1998

Long term results after rotation angioplasty and catheter atherectomy. A retrospective analysis.

Rotationangioplasty and catheter atherectomy using the TEC device was performed in 33 patients with peripheral arterial occlusive disease. Thirty-five femoral or popliteal artery occlusions could be recanalized with an initial patency of 100%. After 5 years the patients were re-evaluated by clinical examination, colour duplex scanning and in 5 cases by intra-arterial angiography. According to life table analysis there was no patent femoral or popliteal vessel after 5 years in those patients treated initially for rest pain or ischemic tissue loss. 82% of those treated for claudication had a re-occluded artery. In 5 cases a major amputation was necessary. 42% of those patients who were initially treated far disabling claudication had a severe deterioration of their functional status with development of critical ischemia. In 9 of these cases reconstructive arterial surgery was required which failed in one patient with subsequent limb loss. In the retrospective study presented patients with occlusions up to 30 cm and more were treated. Combining two interventional techniques there is a high initial success rate with poor long term results. Therefore these devices should be reserved for high risk patients who would not tolerate reconstructive vascular surgery. They should not be used in patients with claudication although even extensive occlusions can be recanalized there is an imminent danger of causing significant deterioration of the patients functional status.

Aged↗
PubMed1997

[Rotational atherectomy (Rotablator) for percutaneous transluminal coronary angioplasty].

BACKGROUND: The use of Rotablator in percutaneous transluminal coronary angioplasty attempts to reduce the atheromatous plaque abrading it and fragmenting the parietal calcium of the artery. AIM: To report our experience with the use of Rotablator. PATIENTS AND METHODS: Rotational atherectomy was performed in 189 patients aged 60.8 +/- 11 years (154 men). The clinical indication for the procedure was chronic angina in 22%, unstable angina in 44%, myocardial infarction in 21%, silent angina in 7% and re-stenosis in 6%. One hundred seventy seven patients were followed for a mean of 15.9 +/- 6.3 months. RESULTS: Two hundred thirty six stenoses in 215 coronary arteries were treated with a 98.7% angiographic success rate. One patient had a Q infarction and no patient died or required emergency surgery. Fourteen patients had rises in CK MB enzymes (non Q infarction). Three patients had a pseudoaneurism and three had bleedings that required transfusion. Of the followed patients, 33 had a clinically suspected re-stenosis, that was angiographically confirmed in 23. Cardiac mortality was 2.3%. Seventy nine percent of patients had an evolution without angina or coronary events. CONCLUSIONS: Percutaneous transluminal coronary angioplasty with the use of Rotablator had a high immediate success rate and a low incidence of complications. The clinical evolution of patients has been favorable with a low incidence of mortality and ischemic events.

Aged↗
PubMed1991

Acute angiographic and clinical outcome of high speed percutaneous rotational atherectomy (Rotablator).

Percutaneous rotational atherectomy (Rotablator), a high speed (greater than 100,000 RPM) rotational burr, was used successfully in 38 of 43 patients (88%) (mean age: 65 +/- 7 years) with 82 lesions (71 stenoses and 11 occlusions). The clinical indications were claudication (84%), nonhealing ulcer (7%), and renovascular hypertension (7%). Rotablation was successful in 78 of 82 lesions (95%): 68 of 71 (96%) stenoses (12 of 12 iliac, 11 of 11 femoral, 7 of 8 popliteal, 36 of 37 tibial, and 2 of 3 renal arteries; 60% of lesions were diffuse, i.e., greater than or equal to 4 cm in length), and 10 of 11 (91%) occlusions (5 of 6 femoral, 1 of 1 popliteal, 3 of 3 tibioperoneal, 1 of 1 brachial artery). The Rotablator significantly (p less than 0.001) reduced the arterial obstruction (stenoses: 85 +/- 11% to 12 +/- 12%); occlusions: 100% to 25 +/- 10%). The effective final burr size for arteries varied at 3.5-4.5 mm for renal, 3.0-3.5 mm for femoral, and 2.0-3.0 mm for brachial and tibial. Complications included gross hemoglobinuria without sequelae in 27 patients (63%), groin hematoma in 10 (23%), arterial spasm in 10 (23%), and arterial bypass in 2 (5%). The Rotablator was successfully used, without concomitant conventional balloon angioplasty, to open arterial lesions with excellent angiographic results in both diffuse and segmental peripheral vascular disease. There was gratifying patient clinical improvement.

Aged↗
PubMed1991

Brachial approach directional coronary atherectomy of right coronary artery saphenous vein bypass grafts.

We describe here a technique for performing directional coronary atherectomy to right coronary artery saphenous vein bypass grafts from the brachial approach using a long introducer sheath system. This technique has the advantages of 1) avoiding femoral artery trauma and 2) ease of access into the bypass graft, avoiding occasional problems with guide catheter kinking or non-coaxial alignment.

Aged↗
PubMed1992

Intracoronary thrombolysis followed by directional atherectomy: a combined approach for thrombotic vein graft lesions considered unsuitable for angioplasty.

Eccentric complex vein graft lesions with abundant luminal thrombus have been generally considered unfavorable for balloon angioplasty. We present 3 patients in whom such lesions were successfully treated by a combined approach: intracoronary urokinase (1 million units over 1 hr) administered in the catheterization laboratory followed by directional atherectomy of the residual lesions in 2 separate procedures; with the patients maintained on heparin infusion between the 2 stages. No distal embolizations were encountered. Two of the 3 patients developed a groin hematoma without vascular compromise. This combined approach may prove to be an attractive alternative to reoperation in select patients with unfavorable vein graft lesions.

Aged↗
PubMed1991

Intravascular ultrasound imaging for guidance of atherectomy and other plaque removal techniques.

Intravascular ultrasound imaging provides a direct view of atherosclerotic disease, generating in vivo information about the depth and mechanical characteristics of plaque at any point in the vessel wall. For this reason, ultrasound has significant potential to serve as a guidance modality for catheter-based techniques designed to remove or ablate plaque. Although the current generation mechanical atherectomy, laser ablation and ultrasound pulverization techniques all have some specificity for attacking plaque as opposed to normal vessel wall, it appears that in practice all of these devices will continue to carry a risk of traumatizing or even perforating arteries. In addition, it seems highly likely that aggressive 'debulking' of plaque will require some type of guidance beyond angiography - a role which ultrasound is theoretically well suited to play. The purpose of this review is to consider the theoretical and practical applications of ultrasound imaging as a guide to catheter-based plaque removal and ablation techniques. Specific uses will be discussed with respect to both directional and coaxial therapeutic devices.

Arteriosclerosis↗
PubMedDate not supplied

Percutaneous intravascular biopsy using a Simpson atherectomy catheter: technical note.

The design of the Simpson atherectomy catheter makes this device a potentially safe and technically easy tool to obtain adequate pathologic intravascular or intraluminal specimens. The risk of perforation should be low, but this use has to be further studied. We describe the first intravascular biopsy performed with the Simpson catheter.

Arteriosclerosis↗
PubMed1992

Results of directional atherectomy of primary atheromatous and restenosis lesions in coronary arteries and saphenous vein grafts.

Directional coronary atherectomy (DCA) was performed in 158 patients over a 2-year period at the Mayo Clinic. Primary atheromatous lesions were treated in 92 patients (group 1) and restenosis lesions were treated in 66 (group 2). Technical success (recovery of tissue and greater than or equal to 40% luminal enlargement with a residual stenosis of less than 50%) was achieved in 152 lesions (92%); clinical success (technical success and no in-hospital death, Q-wave myocardial infarction or coronary bypass surgery) was achieved in 143 patients (91%). Adjunctive balloon angioplasty was used in 41 patients. DCA was successful less often in group 1 than in group 2 (86 vs 97%; p = 0.038). A major complication occurred in 7% of patients; in-hospital death, Q-wave myocardial infarction and emergency coronary bypass surgery occurred in 3, 1 and 4% of patients, respectively. Major complications were more frequent in group 1 than in group 2 (10 vs 1; p = 0.02). During a follow-up period of 14 +/- 8 months, no difference between the groups was found in the incidence of late death (4%), Q-wave myocardial infarction (1%), recurrent severe angina (29%), bypass surgery (15%) or repeat interventional procedure of the same vascular segment (24%). Vein graft and restenosis lesions tended to have greater success and fewer complications. Angiographic restenosis (increase of greater than or equal to 30% in stenosis severity by visual assessment) occurred in 62% of patients and 58% of lesions with successful DCA, and was similar in the 2 groups; a tendency toward higher restenosis rates was seen in patients with vein graft DCA.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Correlation of clinical history with quantitative histology of lower extremity atheroma biopsies obtained with the Simpson atherectomy catheter.

The purpose of this study was to compare the histologic variability of atheromas resected from patients with various risk factors for vascular disease. Twenty-seven plaques obtained using the Simpson atherectomy catheter were studied. The results of this light and electron microscopic study indicate that patients with diabetes mellitus had increased numbers of smooth muscle cells in their plaques (P less than 0.05) and a trend toward denser, less fatty connective tissue matrix (P less than 0.07) when compared with non-diabetics, and that female diabetics had more smooth muscle cells in their plaques than male diabetics (P less than 0.05). The female patients, regardless of risk factors, had more smooth muscle cells in their plaques than male patients (P less than 0.004). Patients with poor distal runoff had more neovascularization of plaque (P less than 0.001). Tobacco use and age did not have statistically significant correlations with histologic patterns.

Arteriosclerosis↗
PubMed1992

Recurrence of stenoses following balloon angioplasty and Simpson atherectomy of the femoro-popliteal segment. A randomised comparative 1-year follow-up study using colour flow duplex.

The results of balloon angioplasty (BA) and atherectomy (AT) with the Simpson atherocath, were compared in a randomised prospective study. Thirty-one patients were randomised to one of these methods for the treatment of symptomatic stenotic or occlusive lesions in the superficial femoral and popliteal arteries. One patient died after randomisation but before the procedure, thus 30 patients were available for analysis. All patients had intermittent claudication and BA was used in 14 and AT in 16 limbs. A surveillance protocol included colour flow duplex scanning of the femoro-popliteal arteries after 6 weeks and then at 3-monthly intervals during the 1st year and every 6 months thereafter. The average duration of follow-up was 9.7 months. For confirmation intra-arterial digital subtraction angiography (DSA) was performed in all patients at 1 year following the intervention, when clinical symptoms occurred or when colour flow duplex indicated greater than 49% restenosis. Three small dissections were the only postoperative complications and residual stenoses greater than 20% diameter reduction (DR) were observed in two patients following BA and in two after AT. Improvement of clinical category according to the "Standards for evaluating results of interventional therapy for peripheral vascular disease" occurred in 13 of 14 BA patients and in 15 of 16 AT patients. Follow-up results were expressed as cumulative patency and clinical success. Endpoints for patency were recurrence of the stenosis at the treated segment or new lesions in different segments and endpoints for clinical success were a drop in clinical category (symptoms, ankle pressure indices and post-exercise ankle pressures). One-year patency (no restenosis greater than 49% DR) was 77% in patients with BA and 25% in patients with AT (p = 0.017).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed2006

Critical limb ischemia: will atherectomy and laser-directed therapy be the answer?

The interventional treatment of peripheral atherosclerotic occlusive disease is increasingly becoming accepted as an appropriate initial form of therapy. Standard methods of treatment include balloon angioplasty and stent assisted angioplasty. Laser catheters and mechanical atherectomy catheters are newer tools, which can be utilized to assist in achieving and maintaining patency in these vessels. In this report, we review the efficacy, safety, and potential advantages of these ablative devices when used for the treatment of peripheral arterial occlusive disease.

Angioplasty, Balloon↗
PubMed1991

[Simpson's atherectomy in embolizing leg artery stenoses].

We report on the treatment and follow-up of six patients with an unilateral "blue toe" syndrome. This is caused by atheromatous micro-embolisation to the digital arteries and requires urgent attention due to the painful cutaneous necroses and impending digital gangrene. In all patients, Simpson's atherectomy of proximally situated femoropopliteal stenoses caused the pre-gangrenous digital changes to heal completely. In a mean observation period of ten months no relapse occurred. The embolising material was presumably parietal fibrino-platelet thrombi which could be observed with angioscopy and were regularly detectable histologically in the excised tissue.

Aged↗
PubMed1988

The Kensey catheter: preliminary results with a transluminal atherectomy tool.

The Kensey dynamic angioplasty instrument is an atherectomy device approved by the Food and Drug Administration that uses a rotating cam tip housed within a flexible polyurethane catheter to recanalize obstructed and stenotic arteries. Twenty patients with significant femoral arteriosclerotic occlusive disease underwent attempted transluminal endarterectomy of 23 extremities with the Kensey catheter. Significant improvements of superficial femoral artery luminal diameter was achieved in 10 of 13 patients with stenosis and passage of the spinning catheter tip at 60,000 to 90,000 rpm through areas of complete occlusion was successful in 4 of 10 cases. Balloon dilatation was used as an adjunct to increase the diameter of the superficial femoral artery lumen in 11 of 14 successful cases. This preliminary report provides technical data and short-term follow-up of this new innovative vascular tool.

Angioplasty, Balloon↗
PubMed1998

Plasma endothelin levels as a function of coronary artery manipulation during balloon angioplasty and high-speed rotational atherectomy.

This study was conducted to test the hypothesis that endothelin levels may be related to the coronary artery manipulation during balloon angioplasty (BA) or rotational atherectomy (RA). Blood endothelin levels were measured in 35 patients who underwent BA and in 11 patients who underwent RA followed by adjunctive balloon angioplasty. Arterial and venous levels were measured before, immediately after, and 24 h after the procedure. The levels were then related to the number of balloon inflations, the total inflation time and the maximal pressure in the balloon during inflation. There were no significant differences between groups or time periods. However, 24 h after BA the endothelin plasma levels in venous blood were directly related to the number of balloon inflations (r 3 0.49; P 3 0.03), to the total inflation time (r 3 0.67; P 3 0.005) and to the maximal inflation pressure (r 3 0.71; P 3 0.001). No such correlation was found in venous blood immediately after BA, either in arterial blood or in the RA group. It can be concluded that plasma endothelin levels do not change significantly after balloon angioplasty; however, venous endothelin levels 24 h after BA are related to procedural parameters, reflecting endothelial damage, which may determine the post-angioplasty late results.

Journal Article↗
PubMed1995

Revascularization in peripheral vascular disease: stents, atherectomies, lasers, and thrombolytics.

Peripheral vascular disease affects a significant number of individuals. Signs and symptoms may develop because of partial or total vessel occlusion due to plaque, dissection, or thrombus. Percutaneous transluminal angioplasty is effective as an independent intervention to open occluded vessels and also may be combined with other nonsurgical therapies such as stents, atherectomy, or laser treatments. Thrombolytics also are used to treat acute or chronic occlusions. The nurse's role in treating and monitoring the patient is key in minimizing complications during and after intervention.

Angioplasty↗
PubMed1990

Percutaneous transcatheter myectomy of subvalvar pulmonary stenosis in tetralogy of Fallot: a new palliative technique with an atherectomy catheter.

A male infant with tetralogy of Fallot was given a modified left Blalock-Taussig shunt at 11 days of age because of duct dependence. Twenty months later, because of increasing cyanosis and polycythaemia, he was given palliative treatment with balloon dilatation of the right ventricular outflow tract. Seven months later a right ventricular angiogram showed further progression of the infundibular stenosis with poor anterograde opacification of the pulmonary arteries. He underwent percutaneous transcatheter myectomy of the infundibulum with an atherectomy catheter. One month later he was well and less cyanosed.

Cardiac Catheterization↗