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PubMed1998

Rotablator plus stent therapy (rotastent).

Over 400,000 percutaneous transluminal coronary angioplasties (PTCAs) are currently performed annually in the United States. Approximately 10% of these procedures include rotational atherectomy, although the national average rate of stent placements continues to increase in some centers to as high as 75%. The combination of rotational atherectomy and intra-coronary stent placement is between 2% and 7.5% of interventional procedures per year in the United States. This article reviews the existing literature on rotational atherectomy and stent implantation for complex lesions and describes the upcoming prospective, multicenter randomized Stent Implantation, Postrotational Atherectomy (SPORT) trial.

Atherectomy, Coronary↗
PubMed1994

Evaluating new devices. Acute (in-hospital) results from the New Approaches to Coronary Intervention Registry.

BACKGROUND: To be used optimally, new interventional devices (stent, lasers, atherectomy catheters) must be carefully evaluated in terms of optimal patient and lesion selection, technique of use, expected acute success and complications, and long-term results. Sources for that information include single-center and multicenter (single-device) reports, although randomized trials may then be performed to provide a more definitive picture of any clinical benefits. One interim option, however, consists of carefully collected registry data. The purpose of this article is to review data collected in the National Heart, Lung, and Blood Institute-funded New Approaches to Coronary Intervention (NACI) Registry and to compare them with existing reports. METHODS AND RESULTS: NACI is an independent, investigator-driven effort that seeks to collect uniform data on patients undergoing treatment with one of several investigational devices and thereby provide an unbiased report of procedure outcome. Between November 1990 and November 1992, 36 participating centers treated a total of 3201 lesions in 2835 patients, using one of seven study devices: directional atherectomy (1084 lesions), transluminal extraction atherectomy (240 lesions), rotational atherectomy (349 lesions), Palmaz-Schatz stent (674 lesions), Gianturco-Roubin stent (213 lesions), and the Advanced Interventional Systems (474 lesions) or Spectranetics (167 lesions) excimer lasers. Data on each procedure were recorded on a unique modular database that captured the reason for (and interim result after) each device use. Device success (defined here as stenosis improvement by > or = 20% and a residual stenosis < 50% after new device use) was 66.5% overall. Adjunctive angioplasty was used in 75.5% of lesions, either before (25.9%) or after (43.5%) new device use, yielding an overall lesion success (> or = 20% stenosis improvement with a final residual stenosis < 50% after all devices) of 92.2%. Adjunctive angioplasty after new device use produced further enlargement in minimal lumen diameter (from 2.2 to 2.7 mm) and further reduction in residual stenosis (26.4% to 16.1%) compared with the results present after use of the new devices themselves. Major complications consisting of death (1.6%), Q-wave myocardial infarction (1.3%), or emergency bypass surgery (1.7%) occurred in 4.0% of patients (range, 2.6% to 8.7% across devices). Procedural success, defined as lesion success in all new device-treated lesions without a major complication, was achieved in 90.8% of patients, with a median length of hospital stay of 4 days. CONCLUSIONS: NACI illustrates the type of information that can be obtained in a registry format that examines the acute angiographic and clinical results of new devices according to uniform definitions. Although no registry can substitute for formal interdevice trials, registries such as this can supplement earlier single-center and multicenter reports. In doing so, they can help focus subsequent randomized interdevice comparisons on lesion types for which two or more devices have promising acute results. Given the substantial interdevice differences in baseline patient and lesion characteristics found in NACI, simple "head-to-head" comparison of the results of different devices might give misleading impressions and should be avoided unless such comparisons are restricted to carefully matched patient and lesion subgroups.

Angioplasty, Laser↗
PubMed2006

Clinical outcomes with drug-eluting stents following atheroablation therapies.

BACKGROUND: Prior studies of atheroablation (directional atherectomy, rotational atherectomy and laser angioplasty) have demonstrated either no advantage or worse outcomes relative to conventional balloon angioplasty. Because these techniques are still required in a minority of patients, we hypothesized that the use of drug-eluting stents (DES) would minimize the rate of major adverse cardiac events (MACE) after atheroablation. METHODS: From 2,252 percutaneous coronary intervention procedures, 212 patients were extracted using case control matching and were analyzed to compare the rate of MACE across four groups (DES with atheroablation, bare-metal stent (BMS) with atheroablation, DES without atheroablation, bare-metal stent without atheroablation). A Cox proportional hazards model was constructed to determine predictors of MACE after adjustment for potential confounders. Internal validation was performed with bootstrapping. RESULTS: There were 36 patients, 42 patients, 63 patients and 71 patients in each of the groups, respectively. The incidence of 30-day and 6-month MACE was numerically lowest among patients who received DES after atheroablation, although the differences did not reach statistical significance (30-day MACE: 0% DES with atheroablation, 4.8% BMS with atheroablation, 3.2% DES without atheroablation, 8.5% BMS without atheroablation; 6-month MACE: 2.8% DES with atheroablation, 19.0% BMS with atheroablation, 6.4% DES without atheroablation, 16.9% BMS without atheroablation). After adjustment, the use of atheroablation was not a predictor of MACE. CONCLUSIONS: This study suggests that in situations where directional atherectomy, rotational atherectomy or laser angioplasty is required to optimize stenting, the use of DES can minimize MACE associated with atheroablation.

Aged↗
PubMed1996

[High frequency rotational angioplasty].

High-speed rotational coronary atherectomy is an alternative method to treat complex, especially calcified coronary stenoses. A rotating burr tip removes the occlusive plaque tissue. The applied rotating frequency is between 160 000 to 190 000 rpm. The primary technical success-rate for high frequency rotational atherectomy alone yields between 50 to 60% on average. Associated with consecutive additional balloon angioplasty, the success rate is between 80 and 95% when treating complex type B II or C stenoses. Today, the usage of a single burr tip size with adjunctive balloon angioplasty has become a standard procedure. The occurrence of serious complications such as extensive dissections or thrombotic vessel occlusion is a rare phenomenon after high-speed rotational atherectomy compared to coronary balloon angioplasty, whereas coronary spasm is more common after high-speed rotational atherectomy. According to the actual results, high-speed rotational angioplasty did not lower the rate of long-term restenosis, compared to the results achieved by balloon angioplasty alone. The rate of long-term restenosis is reported to be between 40 to 50% after highspeed rotational angioplasty with or without adjunctive balloon angioplasty.

Atherectomy, Coronary↗
PubMed1997

[Coronary angioplasty: use and cost].

OBJECTIVES: The goal of the study was to examine the utilization of cardiac catheterization laboratory resources in surgical procedures in order to determine the cost impact of introducing new devices such as stents and atherectomy. METHODS: Detailed resource utilization and costs of each cardiac catheterization laboratory procedure performed in 1995 were determined. Costs were analyzed for single-vessel and multivessel coronary angioplasty, also taking into account the additional costs for coronary stent placement or for the use of directional atherectomy. RESULTS: The mean cost of a surgical procedure was ITL 8,280,010, while the mean cost for conventional coronary angioplasty was ITL 4,352,427 (ITL 4,293,108 for single-vessel PTCA; ITL 5,072,841 for multivessel PTCA). The mean cost for a procedure with stent implantation was ITL 10,084,563. As compared to conventional angioplasty, coronary stenting had a 131.6% higher catheterization laboratory cost and an additional cath-lab resource utilization in terms of contrast medium (257 +/- 136 ml vs 216 +/- 109 ml, p = 0.018) and balloon catheter (1.97 +/- 1.27 vs 1.54 +/- 0.78, p = 0.0009). The cost for a directional atherectomy followed by stent placement was ITL 18827545, which is 332.5% higher than the cost of a conventional angioplasty. CONCLUSIONS: Coronary stents and directional atherectomy have a significant economic impact on catheterization laboratory resource utilization and costs. This aspect should be taken into consideration in analyzing the short- and long-term results of these techniques.

Angioplasty, Balloon, Coronary↗
PubMed1991

In-hospital costs associated with new percutaneous coronary devices.

To determine the relative economic impact of alternative methods of coronary revascularization, in-hospital patient accounts were reviewed in 149 patients undergoing elective coronary angioplasty (n = 50), coronary atherectomy (n = 72) or intracoronary stent placement (n = 27) over an 18-month period. Clinical and angiographic features were similar in the 3 groups, except that prior restenosis was seen more often in patients undergoing intracoronary stent placement. Procedural success, obtained in greater than 90% of patients, was independent of the treatment strategy. Total in-hospital stay was significantly longer in patients undergoing intracoronary stent placement than in patients undergoing coronary angioplasty and directional atherectomy (4.9 +/- 2.4 days vs 1.5 +/- 1.3 and 2.2 +/- 3.9 days, respectively; p less than 0.0001). Furthermore, the total in-hospital charges were significantly higher in patients undergoing intracoronary stent placement ($12,574 +/- $4,564 vs $6,220 +/- $5,716; p less than 0.001) and directional atherectomy ($8,329 +/- $8,588 vs $6,220 +/- $5,716; p less than 0.01) than in patients undergoing coronary angioplasty, reflecting overall differences in room costs, laboratory fees and pharmacy fees. The longer in-hospital stay in the intracoronary stent group was primarily attributed to the time required for anticoagulation with coumadin. It is concluded that a 102 and 34% increase in early hospital charges resulted with stenting or directional atherectomy, respectively, compared with coronary angioplasty. These increased in-hospital charges were chiefly due to the prolonged hospitalization time, device cost, laboratory fees and, in patients with intracoronary stents, the prolonged time needed to achieve systemic anticoagulation.

Aged↗
PubMed1989

New interventional technologies in cardiology.

If atherectomy procedures are found to be safe and effective for removal of plaque in human coronary arteries, they can be expected to provide an important alternative to balloon angioplasty for the treatment of many types of coronary lesions. In addition, many patients who are candidates for coronary artery bypass procedures could likely benefit from these less invasive procedures. Although atherectomy has a theoretic potential for reducing the rate of restenosis by removing the plaque rather than pushing it to the side, it is unlikely to eliminate the restenosis problem completely. A more important advantage of atherectomy may be the potential for successful treatment of lesions that are anatomically unsuitable for PTCA. Even though balloon catheter technology has evolved to the point that almost all lesions in the coronary anatomy can be successfully negotiated, approximately half the coronary patients who require invasive therapy in the United States are still undergoing open-heart bypass procedures. Thus, if atherectomy can expand the indications for interventional therapy to the types of lesions that are currently considered unsuitable for PTCA, the large number of patients who are currently unable to benefit from interventional catheterization techniques could be treated. With all the new devices under investigation, carefully controlled prospective randomized trials must be conducted once the developmental phases have been completed. Each new technology must be compared with the current state-of-the-art techniques of balloon angioplasty and coronary artery bypass operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon↗
PubMed1995

Randomized trials of myocardial revascularization.

Over the past two decades there has been considerable refinement in randomized cardiovascular clinical trials. The common aim of randomized clinical trials of myocardial revascularization has been to understand the relative benefits of each technique on survival and nonfatal end points. The bypass surgery versus medicine trials that began in the 1970s provided evidence that the patients with advanced ischemic heart disease--three-vessel disease and/or substantially impaired LV function--have the most to gain from aggressive therapy (i.e., bypass surgery). In these cases, surgical revascularization provides survival benefit and has emerged as the reference standard for providing the most definitive revascularization. In long-term follow-up, however, surgery does not reduce the occurrence of myocardial infarction or angina compared with medical therapy. For patients with less extensive atherosclerosis and/or preserved ventricular function, trials comparing medical therapy, percutaneous coronary interventions, and bypass surgery have shown similar medium-term rates of death and infarction. In general, patients undergoing bypass surgery require the fewest subsequent antianginal medications, whereas patients undergoing PTCA require a moderate amount of antianginal medications, and patients treated solely with medical therapy require the most antianginal medications. Regardless, during long-term follow-up a similarly high number of patients are angina-free, although patients in the PTCA group require reintervention more often. Among patients treated percutaneously, techniques such as balloon angioplasty, directional atherectomy, stenting, rotablation, and laser may be considered. Compared with balloon angioplasty, greater acute gains in angiographic lumen have been obtained after directional atherectomy and stenting, but at the expense of increased periprocedural infarction after atherectomy, increased peripheral vascular complications after stenting, and increased late loss of lumen after both. Elective stenting has been associated with improved clinical outcome, whereas laser and rotational atherectomy have not, in comparison to balloon angioplasty. Restenosis remains the major limitation of all percutaneous approaches. Guidance for the individual patient is often less straightforward. Although general conclusions can be derived from patients cohorts in randomized trials, only a "gestalt" can be provided for the individual patient. For example, we have poor predictive capacity for restenosis, especially when this is recurrent despite repeated intervention. Only the demographic criteria of severe unstable angina and insulin-dependent diabetes mellitus are helpful in categorizing patients as "restenosis-prone." A substantial number of patients do not fit into the criteria adopted for entry into the revascularization trials--a point that is all too frequently forgotten.(ABSTRACT TRUNCATED AT 400 WORDS)

Coronary Disease↗
PubMed1994

[Preliminary experience in the treatment of complex stenosis in the aged (> or = 70 years) with high-speed rotational atherotomy followed by conventional PTCA].

Rotational coronary atherectomy with adjunctive balloon angioplasty was performed in 36 patients older than 70 years. Previous myocardial infarction, coronary angioplasty and coronary artery bypass were present in 44%, 11% and 14%, respectively. Thirty-six percent and 33% of patients presented stable and unstable angina pectoris, respectively. Totally, 46 lesions were treated (1,3 lesion/patient). All lesions had complex morphology characteristics: eccentricity (63%), calcification (69%), angulation (44%), length > 10 mm (11%), undilatable rigid lesion with failed PTCA (11%), ostial disease (9%), ulceration (7%). In 39% was present a single-vessel disease, in 44% double-vessel disease and in 17% triple-vessel disease. Five patients received rotational atherectomy on two stenoses in the same vessel, 5 received a two vessels treatment. Procedure was successful in 94% of patients; 2 patients (6%) had major complication (1 urgent coronary artery bypass and 1 acute myocardial infarction) without any death. All patients with successful rotational atherectomy had repeated coronary angiography at 24 hours. No patient showed significant deterioration (stenosis > or = 50%) of the initial result at 24 hours. Rotational atherectomy can be performed in patients over 70 years with complex coronary lesions with a high success rate, low complications and persistence at 24 hours of initial gain. It should be considered as a primary therapeutical option in selected cases with complex coronary lesions in which conventional PTCA can be unsuccessful.

Age Factors↗
PubMed1998

Chlamydia pneumoniae in coronary and iliac arteries of Japanese patients with atherosclerotic cardiovascular diseases.

Recent studies suggest the association of atherosclerotic cardiovascular diseases with Chlamydia pneumoniae infection in western populations. It is of great interest whether such an association exists in Asians with their distinct genetic background. Symptomatic patients with coronary heart disease (29) or arteriosclerosis obliterans (10) who underwent directional endo-atherectomy were studied. Atherectomy specimens of coronary and iliac arteries were examined for C. pneumoniae by culture, nested PCR and immunohistochemical stain (IHC) with one Chlamydia genus-specific, two C. pneumoniae species-specific, and two C. trachomatis species-specific monoclonal antibodies. Among the 29 patients with coronary artery disease, C. pneumoniae was detected in the coronary arteries of 13 by IHC, 16 by PCR and 20 by IHC or PCR, or both. C. pneumoniae was also found in the iliac arteries of four patients by IHC, three by PCR and five by IHC or PCR, or both, of the 10 patients with arteriosclerosis obliterans. Attempts to isolate C. pneumoniae by culture were unsuccessful. The re-stenotic rate after atherectomy was higher in the C. pneumoniae-positive group than in the negative group, but not significantly so. These findings support the high incidence of C. pneumoniae in atherosclerotic lesions of symptomatic patients with coronary heart disease and arteriosclerosis obliterans in Asians.

Aged↗
PubMed1994

Perforations after percutaneous coronary interventions: clinical, angiographic, and therapeutic observations.

Coronary perforation is a rare, but potentially catastrophic, complication of percutaneous coronary intervention. A retrospective review of the Cardiology Quality Assurance Database was performed for all percutaneous coronary interventions (n = 8,932) at William Beaumont Hospital from October 1988 to December 1992. Coronary artery perforation was reported in 35 patients (0.4%), including after percutaneous transluminal coronary angioplasty (PTCA, 11/7,905, 0.14%), transluminal extraction coronary atherectomy (TEC, 6/420, 1.3%), directional coronary atherectomy (DCA, 1/249, 0.25%), and excimer laser coronary angioplasty (ELCA, 5/242, 2%); and none after high-speed mechanical rotational atherectomy with the Rotablator (MRA, 0/116, 0%). Perforations were classified by coronary angiography as free perforations (n = 10), contained perforations (n = 17), or other types of perforation (n = 8). Although perforation was apparent in 32 (91%) of 35 angiograms, delayed cardiac tamponade occurred in 3 patients (9%), despite the absence of angiographic evidence for perforation at the time of the procedure. Causes of perforation were the guidewire in 7 (20%), an interventional device in 26 (74%), and indeterminate in 2 (6%). Complex B2 or C lesions accounted for 83% of perforations. Final treatment included conservative therapy (reversal of anticoagulation and/or PTCA) in 22 (63%) and surgical intervention (with or without bypass surgery) in 13 (37%). Serious clinical complications included cardiac tamponade in 6 (17%), blood transfusion in 12 (34%), myocardial infarction in 9 (26%), and death in 3 (9%).

Aged↗
PubMed1995

Transluminal extraction catheter for the treatment of diseased saphenous vein grafts: a multicenter experience.

To evaluate the efficacy, safety, and long-term results of atherectomy using the Transluminal Extraction catheter (TEC), patients with diseased saphenous vein grafts were enrolled in a prospective nonrandomized trial. Patients were followed to hospital discharge for acute complications and underwent routine 6-mo reevaluation with repeat cardiac catheterization to assess restenosis. Atherectomy was performed on 650 graft lesions in 538 consecutive patients (male 81%; mean age 66 yr; range 37-81). Mean graft age was 8.3 yr; (range 0.3-20) with 85% of grafts > 3 yr of age. Complex lesion morphology included thrombus (28%), ulceration (13%), and eccentricity (50%). Lesion success was achieved in 606 lesions (93%) with clinical success in 479 patients (89%). Lesion success was achieved in 90% of thrombus containing lesions, 97% of ulcerated lesions, and 97% of grafts > 3 yr. Complications included nonfatal myocardial infarction in 4 (0.7%) of patients, emergency bypass surgery in 2 (0.41%), and in-hospital death in 17 patients (3.2%). Angiographic follow-up at 6 mo was obtained from 268 lesions in 227 patients. The overall lesion angiographic restenosis rate was 60%. TEC atherectomy can be performed in patients with diseased saphenous vein grafts with high primary success and low complication rates. It is suitable for use in aged grafts, particularly in the presence of thrombus and ulcerations, and may be superior to balloon angioplasty alone in this group of patients.

Adult↗
PubMedDate not supplied

Retrograde rotablator in limb salvage: a new technique using an open approach.

Conventional vascular surgery and balloon angioplasty have poor results in severe and diffuse atherosclerotic disease of the infrapopliteal arteries. High-speed rotational atherectomy (Auth Rotablator) has not succeeded either, because of poor long-term patency and the non-reflow phenomenon. We report a case of limb salvage with long occlusion of the three infrapopliteal vessels. The anterior tibial artery was treated with retrograde Auth Rotablator atherectomy by an open approach through the pedal artery, resulting in full patency of the anterior tibial artery and healing of the skin lesions. The microparticulate debris from the ablation was drained out through the pedal arteriotomy, avoiding the complications associated with conventional antegrade high-speed rotational atherectomy.

Aged↗
PubMed2004

Stenting alone versus debulking and debulking plus stent in branch ostial lesions of native coronary arteries.

Angioplasty of branch ostial stenosis is associated with a high complication and restenosis rate. Previous investigations have demonstrated various treatments. However, the ideal strategy for treating branch ostial lesion remains uncertain. This investigation attempted to compare the acute, late results of stenting alone and debulking-based strategies in branch ostial lesions of native coronary arteries. Notably, various debulking strategies exist. This investigation also analyzed the acute and long-term results of the different treatments. In this study, we examined 86 patients with angina pectoris or exercise-induced ischemia and successful angioplasty of branch ostial lesions in native coronary arteries. The lesions were divided into two groups based on the angioplasty device used: group I (debulking devices, n=44) and group II (stenting alone, n=42). Procedural success and in-hospital complications were similar in both groups (P not significant). Following intervention, group I patients tended to show a smaller area of stenosis (42.3% +/- 9.9% vs 48.2% +/- 6.2%, P=0.05) and a smaller plaque-media cross-sectional area (6.05 +/- 1.87 vs 7.07 +/- 1.79 mm2, P=0.01) than group II. Furthermore, at 3 months' follow-up, group I exhibited a larger minimal lumen diameter (MLD) (2.30 +/- 0.91 vs 1.86 +/- 0.80 mm, P=0.03) than group II. Regarding the angiographic and clinical outcomes, group I displayed a restenosis rate of 32% (14/44), compared with 41% (17/42) in group II (P=0.40). Even during the 6-month follow-up, group I had a lower cumulative restenosis rate of 40% (17/43), compared with 60% (22/37) in group II ( P=0.04). The minimal luminal diameter of the ostium had not changed after directional coronary atherectomy or at follow-up. In contrast, MLD of another ostium was significantly reduced during stenting alone and at follow-up (P <0.01). When subgroups were studied, a debulking followed by stent group achieved a larger acute lumen gain than a debulking alone group (2.57 +/- 0.59 vs 2.32 +/- 0.55 mm, P=0.04). The optimal debulking plus stent subgroup had a restenosis rate of 9% (1/11) compared with 33% (6/18) in the optimal debulking alone group (P=0.05). The optimal debulking plus stent group also had a lower cumulative restenosis rate at 6 months than the optimal debulking alone group (9% vs 44%, P=0.04). Guided by intravascular ultrasound, atherectomy-based intervention appears superior to stenting alone for treating branch ostial lesions. Directional coronary atherectomy did not cause the narrowing of another ostium. However, optimal debulking followed by stenting minimized the restenosis and target lesion revascularization rates.

Aged↗
PubMed1994

Impact of preintervention intravascular ultrasound imaging on transcatheter treatment strategies in coronary artery disease.

Preintervention intravascular ultrasound (IVUS) imaging was performed in 313 target lesions in 301 patients. Revascularization strategy intended before imaging was compared with the treatment actually performed; there was a change in therapy in 124 lesions (40%) in 121 patients (40%). This included: (1) assessment of lesion severity leading to revascularization when none had been planned (n = 20, 6%), (2) avoiding surgery or catheter-based revascularization that had originally been planned (n = 21, 7%), and (3) assessment of lesion composition leading to a change in revascularization strategy (n = 20, 6%) or for selecting the revascularization strategy (n = 63, 20%). Nine of these 121 patients were referred for coronary artery bypass graft surgery. IVUS minimal lumen diameter correlated well with angiography (r = 0.83); however, a disagreement was the reason for deciding to perform or not to perform revascularization in 41 lesions (13%). IVUS assessment of target lesion calcification, eccentricity and unusual morphology were the reasons for changing or selecting specific devices: (1) concentric and eccentric lesions with significant superficial calcium were treated with rotational atherectomy, excimer laser angioplasty or surgery; (2) eccentric lesions that did not contain significant superficial calcium were treated with directional atherectomy; (3) dissections and true aneurysms were treated with stent placement even if calcified; (4) thrombus-containing lesions in vein grafts were treated with thrombolytic therapy or extraction atherectomy, or both; and (5) fibrotic vein graft lesions were treated with balloon angioplasty or stent placement.

Adult↗
PubMed1994

Usefulness of percutaneous transluminal coronary angioplasty after new device coronary interventions.

Percutaneous transluminal coronary angioplasty (PTCA) is often required immediately after laser and atherectomy devices to enlarge lumen dimensions and to salvage device failures. Between January 1989 and June 1992, adjunctive PTCA was applied to 83% of narrowings treated with new interventional devices, including 85% of transluminal extraction atherectomy (n = 290), 72% of high-speed mechanical rotational atherectomy (n = 79), and 89% of excimer laser angioplasty (n = 118) lesions (p = NS). Device success was defined as a decrease in diameter stenosis > or = 20%; procedural success was defined as a final diameter stenosis < or = 50% after PTCA; and salvage PTCA was defined as use of PTCA to manage device-induced vessel occlusion. Although adjunctive PTCA was applied to 487 lesions, it was used to further enlarge the lumen after initial device success in 139 lesions (28.5%). In contrast, adjunctive PTCA was used after initial device failure in 348 lesions (71.5%), including after minimal or no change (decrease in diameter stenosis by 0 to 19%) in diameter stenosis in 244 lesions (50%) and after worsening of diameter stenosis in 104 lesions (21.5%). Salvage PTCA after device-induced vessel occlusion was performed in 61 lesions (12.6%). However, final procedural success after PTCA was achieved in 412 lesions (85%), with a low incidence of Q-wave myocardial infarction (3.5%), emergency bypass surgery (1.8%) and death (2.3%).

Aged↗
PubMed1994

Does the use of new intracoronary interventional devices prolong radiation exposure in the cardiac catheterization laboratory?

OBJECTIVES: The aim of this study was to compare the duration of radiation exposure associated with new percutaneous coronary interventional devices with that associated with conventional balloon angioplasty. BACKGROUND: Radiation exposure levels have been documented to be higher with coronary balloon angioplasty than with routine diagnostic coronary angiography. However, the effect of new interventional devices on radiation exposure has not been studied. METHODS: Fluoroscopic and cineangiographic data from the Mayo Clinic cardiac catheterization laboratory data base of patients having single-segment coronary intervention during a recent 46-month period were retrospectively analyzed. Of 897 patients studied, 646 underwent balloon angioplasty, 138 directional coronary atherectomy (42 with adjunctive balloon angioplasty), 76 excimer laser angioplasty (50 with adjunctive balloon angioplasty) and 37 placement of an intracoronary stent (16 emergencies). RESULTS: Duration of fluoroscopy during balloon angioplasty was 24 +/- 18 min, which was longer than with directional atherectomy (18 +/- 8 min; p = 0.001). Fluoroscopy time was 25 +/- 17 min with laser angioplasty and 29 +/- 15 min with elective stent placement (neither time was significantly different from that with balloon angioplasty). When atherectomy or laser angioplasty was performed with adjunctive balloon angioplasty or if emergency intracoronary stent placement was performed, the duration of fluoroscopy was significantly prolonged compared with balloon angioplasty alone. CONCLUSIONS: Fluoroscopy duration is not prolonged with the use of new interventional coronary devices compared with conventional angioplasty unless adjunctive balloon angioplasty is used or emergency stent placement is required.

Aged↗
PubMed1996

Increased incidence of Chlamydia species within the coronary arteries of patients with symptomatic atherosclerotic versus other forms of cardiovascular disease.

OBJECTIVES: The objectives of this study were to test prospectively for an association between Chlamydia and atherosclerosis by comparing the incidence of the pathogen found within atherosclerotic plaques in patients undergoing directional coronary atherectomy with a variety of control specimens and comparing the clinical features between the groups. BACKGROUND: Previous work has suggested an association between Chlamydia pneumoniae infection and coronary atherosclerosis, based on the demonstration of increased serologic titers and the detection of bacteria within atherosclerotic tissue, but this association has not yet been regarded as established. METHODS: Coronary specimens from 90 symptomatic patients undergoing coronary atherectomy were tested for the presence of Chlamydia species using direct immunofluorescence. Control specimens from 24 subjects without atherosclerosis (12 normal coronary specimens and 12 coronary specimens from cardiac transplant recipients with subsequent transplant-induced coronary disease) were also examined. RESULTS: Coronary atherectomy specimens were definitely positive in 66 (73%) and equivocally positive in 5 (6%), resulting in 79% of specimens showing evidence for the presence of Chlamydia species within the atherosclerotic tissue. In contrast, only 1 (4%) of 24 nonatherosclerotic coronary specimens showed any evidence of Chlamydia. The statistical significance of this difference is a p value < 0.001. Transmission electron microscopy was used to confirm the presence of appropriate organisms in three of five positive specimens. No clinical factors except the presence of a primary nonrestenotic lesion (odds ratio 3.0, p = 0.057) predicted the presence of Chlamydia. CONCLUSIONS: This high incidence of Chlamydia only in coronary arteries diseased by atherosclerosis suggests an etiologic role for Chlamydia infection in the development of coronary atherosclerosis that should be further studied.

Aged↗