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At least 793 records · Page 44Linked to original sources
PubMed2006

Coronary interventional devices: balloon, atherectomy, thrombectomy and distal protection devices.

With increased operator experience and improved device technology, there has been a constant growth in the number of complex lesions (ie, thrombotic lesions, diffuse lesions,calcified lesions, nondilatable rigid lesions, ostial lesions, bifurcations, and chronic total occlusions) attempted by interventionalists with the use of drug-eluting stents. Although coronary stent implantation remains the mainstay and ultimate step for the treatment of most coronary lesions, adjunctive devices may be essential for lesion preparation in some cases (5%-10%) to allow stent deployment and expansion and prevent distal embolization. Thrombectomy and distal protection devices have shown to be effective in the interventions of saphenous vein graft lesions, although their use remains unproven in acute myocardial infarctions.

Angioplasty, Balloon, Coronary↗
PubMed2002

Angiographic analysis of the angioplasty versus rotational atherectomy for the treatment of diffuse in-stent restenosis trial (ARTIST).

Patients with diffuse in-stent restenoses (ISRs) are at high risk for recurrent restenosis after percutaneous transluminal balloon angioplasty (PTCA). Percutaneous transluminal rotational ablation (PTCR) has proved effective in removing neointimal burden in ISRs. This study compares the acute and long-term results of PTCA and PTCR for the treatment of diffuse ISR in a randomized, multicenter investigation. The primary end point was the comparison of the minimum luminal diameter (MLD) between both groups at 6-month follow-up. Patients with symptomatic, diffuse, or high-grade ISRs were included; 146 patients were randomized to PTCA and 152 patients to PTCR. Diameter stenosis was reduced from 80 +/- 12% to 29 +/- 10% and from 80 +/- 11% to 28 +/- 12%, respectively, and MLD increased from 0.55 +/- 0.3 to 1.9 +/- 0.3 mm in the PTCA group and from 0.54 +/- 0.3 mm to 1.9 +/- 0.4 mm in the PTCR group. Spasm in the treated vessel and an intermittent slow flow phenomenon occurred more often after rotational ablation (17.7% vs 8.6%, p = 0.001; 5.3% vs 0%, p = 0.007). Minimum stenosis diameter at 6-month follow-up was smaller in the PTCR group than in the PTCA group (1.0 +/- 0.6 vs 1.2 +/- 0.6 mm, p = 0.008) and the restenosis rate was higher (64.9% vs 51.2%, p = 0.027). Procedural factors did not influence long-term outcome. In the PTCR group, the restenosis rate increased with decreasing vessel size, whereas this was not seen in the PTCA group. The lesion length and the baseline diameter stenosis were found to be predictive of restenosis with both treatment strategies; however, a residual diameter stenosis of <30% predicted absence of a restenosis only in the PTCR group. Thus, PTCA and PTCR of diffuse ISRs yield comparable acute angiographic results. The recurrence of a restenosis is higher after PTCR than after PTCA.

Aged↗
PubMed1997

Predictors of acute and long-term outcome with transluminal extraction atherectomy: the New Approaches to Coronary Intervention (NACI) registry.

The New Approaches to Coronary Intervention (NACI) registry was established to define the role of new coronary devices in overcoming the limitations of balloon angioplasty. The purpose of the present study was to evaluate the acute and long-term efficacy of the transluminal extraction catheter (TEC) device utilizing data from the NACI registry and identify clinical and anatomic patient subsets who may benefit from this device. From 1990-1994, >4,300 patients from 39 clinical sites enrolled consecutive patients treated with one of the 7 new devices to the NACI registry. The study population consists of 331 patients (385 lesions) treated with planned TEC as the sole new device. Of these patients, 243 (292 lesions) were treated for saphenous vein graft (SVG) disease and 88 (93 lesions) for native disease. Patients undergoing SVG treatment were older and more likely to be male. They had lower ventricular function, more unstable angina, and a higher incidence of congestive heart failure. Multivessel disease was more prevalent in the SVG cohort, as was evidence of thrombus before treatment. Although device success was achieved in 50% of SVG lesions and 41% of native lesions, lesion success was achieved in 90% and 78%, respectively, after adjunctive balloon angioplasty, and procedure success rates were 86% and 79%, respectively. The in-hospital major complication (death/Q-wave myocardial infarction/emergency coronary artery bypass graft [CABG] surgery) rate was higher in the SVG cohort (6.2% vs 2.3%), mainly due to higher mortality rate (5.3% vs 1.1%). Multivariate analysis showed that SVG was not an independent predictor for either an in-hospital major complication or clinical failure. The risk factors for major in-hospital complications were history of congestive heart failure (odds ratio = 3.17) and thrombus (odds ratio = 3.36). For clinical failure the risk factors were diabetes (odds ratio = 1.88), thrombus (odds ratio = 2.08), and calcium (odds ratio = 3.09). One-year rates of death, Q-wave myocardial infarction, or any repeat revascularization were 51% in the SVG cohort and 41% in the native cohort. Following adjustment, patients treated for SVG disease did not have a higher risk when compared with those treated for native disease. The factors significantly associated with this composite event at 1 year are male (relative risk = 1.41), patients with history of congestive heart failure (relative risk = 1.56), and total occlusions (relative risk = 1.52). This study shows that for both SVG and native cohorts, device success rates were low with TEC alone, but acceptable lesion success rates were achieved when adjunctive PTCA was used. In-hospital as well as 1-year major complications were higher in the SVG cohort. However, after adjusting for other risk factors, SVG attempt was not significantly associated with either in-hospital or 1-year events.

Aged↗
PubMed1998

Extended aortic arch atherectomy.

We report 2 cases of extensive atherosclerosis of the ascending aorta, arch of the aorta, innominate artery, and bilateral carotid arteries treated surgically at St. Vincent and Veterans Administration Medical Centers of Portland, Oregon.

Aged↗
PubMed2002

Relationship between residual atheroma burden and neointimal growth in patients undergoing stenting: analysis of the atherectomy before MULTI-LINK improves lumen gain and clinical outcomes trial intravascular ultrasound substudy.

OBJECTIVES: The objective of this study was to examine the relationship between quantitative volumetric and cross-sectional measures of residual atheroma burden and neointimal growth after coronary stenting. BACKGROUND: Previous intravascular ultrasound (IVUS) studies have demonstrated a correlation between residual atheroma burden and neointimal growth after coronary stenting. However, postmortem studies contradict this finding. METHODS: The study population included 34 patients who underwent IVUS six to eight months after stent placement, including 26 patients who underwent IVUS immediately after stent placement and at six to eight months follow-up. Using manual planimetry, the lumen cross-sectional area (LA), stent cross-sectional area (SA) and external elastic membrane cross-sectional area (EEM) were measured at 1-mm intervals after the procedure and at follow-up. Percent neointimal area (NA) and atheroma area (AA) were calculated as: percent neointimal area = ([SA - LA]/SA) x 100; percent AA = ([EEM - SA]/EEM) x 100 in the entire cross section and in individual quadrants. Postinterventional atheroma volume and neointimal volume at follow-up were calculated using Simpsons's rule. RESULTS: In pooled analyses using all cross sections and cross-sectional quadrants, there was a weak correlation between percent AA and NA (r = 0.11 and 0.12, respectively). Analysis in individual patients demonstrated no significant relationship between total or quadrant measurements of percent AA and NA (p = 0.47 and 0.4, respectively). No relationship between atheroma volume postintervention and neointimal volume at follow-up was observed (r = 0.1, p = 0.62). CONCLUSIONS: This study failed to demonstrate a clinically significant relationship between quantitative volumetric and cross-sectional measures of residual atheroma burden and subsequent neointimal growth.

Adult↗