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PubMedDate not supplied

Treatment of true bifurcation stenosis by elective stent implantation in parent vessel and non-stent dilatation of side branch: immediate and follow-up results.

Data of 67 consecutive patients who underwent stent implantation in the parent vessel and non-stent dilatation of the side branch of a true bifurcation stenosis was retrospectively analysed. The mean age was 53.2 +/- 9.7 years, with majority (89.6%) being males. Forty-seven (70.1%) lesions involved the bifurcation of left anterior descending artery and its major diagonal branch. The parent vessel was treated using balloon angioplasty in 50 (74.6%), rotational atherectomy in 15 (22.4%) and directional coronary atherectomy in 2 (3.0%) patients. All the patients subsequently received an intracoronary stent in the parent vessel. Depending upon the treatment strategy for the side branch, the patients were divided into two groups: (1) Percutaneous transluminal coronary angioplasty group, which included 37 patients in whom the side branch was dilated by plain balloon angioplasty, and (2) Debulking group, in which 30 patients underwent debulking of the side branch using rotablation or directional coronary atherectomy. Overall, the procedure was successful in 64 (95.6%) patients. One (1.5%) patient developed non-Q wave myocardial infarction during the hospital stay. There were no Q-wave myocardial infarction, need for emergency coronary artery bypass surgery or death. Clinical follow-up of at least six months was available in all patients with a mean duration of 9.5 +/- 3.2 months. Recurrence of symptoms developed in 19 (28.4%) patients. Fourteen (20.9%) patients required target vessel revascularisation, of which 11 (29.7%) belonged to the percutaneous transluminal coronary angioplasty group and 3 (10.0%) to the debulking group, the difference being statistically significant (p = 0.045). The freedom from target vessel revascularisation was 93.1 and 89.4 percent at 6 and 12 months in the debulking group, compared to 78.4 and 68.9 percent at the same time in the percutaneous transluminal coronary angioplasty group. This study thus demonstrates that percutaneous intervention for true bifurcation stenosis with stent implantation in the parent vessel and non-stent dilatation in the side branch provides favourable immediate and follow-up results. Debulking in comparison to plain balloon angioplasty of the side branch results in further improvement in clinical outcome and need for target vessel revascularisation on follow-up.

Adult↗
PubMed2005

Rotablator: a forgotten tool in limb ischemia?

The treatment of critical limb ischemia remains until now, and more and more, a very challenging topic for vascular surgeons. Among the tools available, the rotational atherectomy appears a useful alternative to surgical revascularisation, especially for the worst cases of infrainguinal arterial occlusive disease. The authors remind the basic principle of the atherectomy device, its history and how to work with it. The review of the literature and analysis of their results underscore on the usefulness of the rotational atherectomy for limb threatening arterial occlusive disease.

Aged↗
PubMed1993

[Intravascular ultrasound imaging as adjunct to vascular interventions: preliminary experience in patients with atherosclerotic disease].

Catheter-based intravascular ultrasound (IVUS) imaging is new, evolving technique in which a high-frequency transducer is attached to the tip of a catheter. In this study, we evaluated the usefulness of catheter-based IVUS in 11 patients with atherosclerotic disease as an adjunct to PTA or atherectomy. A 30-MHz ultrasound catheter was inserted through a 6 F sheath to obtain real-time and cross-sectional images. The IVUS images demonstrated a three-layered appearance of muscular arteries, intimal thickening and calcification. IVUS was performed in 11 patients undergoing percutaneous transluminal angioplasty (7 patients) or atherectomy (4 patients). The presence of dissection between the media and atheroma was observed after balloon angioplasty, while IVUS imaging demonstrated a smooth wall after atherectomy. There was a good correlation between IVUS and angiography in the quantitative assessment of luminal %diameter stenosis before vascular intervention, but a poor correlation was observed after angioplasty, probably due to the dissections from balloon dilatation that resulted in irregular crescentic pathways with unclear borders to the lumen on angiography. The results of our study illustrate the potential utility of IVUS as an adjunct to transluminal vascular intervention.

Aged↗
PubMed1995

[Ultrastructural characteristics of cellular reaction to experimental catheter-induced lesions of arterial blood vessels].

UNLABELLED: After angioplasty, restenosis remains the major drawback of the procedure with an incidence of between 20-40%. It is a matter of concern whether the cellular alterations start immediately after directional atherectomy (DA) and if they are dependent on the depth of the lesion. METHOD: Cellular alterations immediately after DA were investigated using peripheral atherectomy in normal vessels of 30 pigs (A. femoralis, A. carotis communis). DA was used to remove material. The arteries were assigned to two groups according to the depth of vessel injury. (Group 1: lesions to the intima; Group 2: lesions to the media.) 68 arteries with 41 intimal and 27 media lacerations were excised 4 to 24 hours later and processed for transmission electron microscopy, histology and immunohistochemistry. RESULTS: Immediately after DA, thrombus formation at the site of the altered segment was found. A transient infiltration of polymorphonuclear leukocytes (PMN) occurred, especially if the media was lacerated, followed by the transformation of contractile smooth muscle cells (SMC) into the synthetic subtype. A marked myoproliferative response was found in Group 2 whereas only moderate tissue hyperplasia was seen in Group 1. CONCLUSION: The present data provides evidence that cellular alteration of the atherectomized vessel begins immediately after atherectomy. Subsequent to the initial temporary PMN infiltration, an activation of local SMC occurs at a very early stage. These effects and, in particular, a myoproliferative response were found lesions injured the internal elastic membrane, while only minor effects were seen when the lesion affected the intimal layer.

Animals↗
PubMed1992

Atherosclerotic saphenous vein grafts treated with different interventional procedures assessed by intravascular ultrasound.

Intravascular ultrasound imaging of saphenous vein grafts may enhance the angiographic interpretation of results following transcatheter interventions. We used intravascular ultrasound to study 18 patients with stenotic vein grafts following balloon angioplasty, atherectomy, or stent placement. In real-time imaging the three-layer appearance was rarely seen, calcification was infrequent (11% of patients), and atheroma were usually mildly echogenic ("soft"). Despite excellent angiographic results (reduction in percent diameter stenosis from 90 +/- 8% to 17 +/- 8%) and concordant improvement in lumen area by ultrasound regardless of the intervention, there was usually significant retained atheroma at the treatment site. Following balloon angioplasty, ultrasound showed multiple superficial fissures and fractures without discrete dissections. Atherectomy caused a smooth lumen surface without deep dissections or resections, but significant retained atheroma was observed with each one of the atherectomy procedures. Endovascular stents were concentric in the vein with reflective struts above compressed atheroma and an outer echogenic adventitia. Stent expansion was asymmetric axially and longitudinally and evidence of stent recoil was present. Thus intravascular ultrasound may be an important adjunct to angiography in characterizing postintervention results in saphenous vein grafts.

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PubMed1992

Novel approach to the analysis of restenosis after the use of three new coronary devices.

Restenosis after coronary intervention has remained a vexing problem despite the introduction of nearly 24 newer coronary interventional devices. To more clearly evaluate the potential impact of three such new devices on restenosis, coronary lumen diameters were measured before, immediately after and at 6 months after intervention, and restenosis was analyzed using continuous geometric techniques. Lumen diameters were measured before and immediately after intervention in 223 coronary vessels treated with one of three new devices: a single Palmaz-Schatz stent (n = 87), directional atherectomy (n = 125) and laser balloon angioplasty (n = 11); 184 (83%) of the patients underwent follow-up angiography 6 months after treatment. The immediate increase in lumen diameter produced by the intervention (acute gain) and the subsequent reduction in lumen diameter between the time of intervention to 6 month follow-up study (late loss) were examined. For each of the three interventions, the restenosis rate at follow-up study was analyzed using a traditional dichotomous definition (greater than or equal to 50% diameter stenosis), as well as a novel graphic technique. Although the apparent restenosis rates differed significantly among the three interventions (19% for stents, 31% for atherectomy and 50% for laser balloon angioplasty; p = 0.02), late loss among the three interventions was equivalent (average 1 mm; p = 0.91). There were, however, marked differences in the acute gain achieved by the three interventions: 2.6 mm for stents, 2.2 mm for atherectomy and 2 mm for laser balloon angioplasty; p less than 0.001). It was these differences in acute gain rather than late loss that explained the observed differences in restenosis rate.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Laser↗
PubMed1998

Beyond stents: third-generation coronary devices.

Despite extraordinary growth in percutaneous transluminal coronary angioplasty (>400,000 cases in United States in 1997) patients are still routinely referred for bypass grafting in large numbers. Why? Second-generation devices (directional coronary atherectomy, high-speed rotational atherectomy [Rotablator], and stents) have expanded the application of percutaneous catheter treatment of coronary disease. Specifically, highly eccentric lesions in large vessels, heavily calcified lesions, and coronary dissections can be effectively treated with these devices. Stents have substantially reduced the incidence of restenosis, but this benefit is largely confined to vessels more than 3 mm in diameter and stenoses less than 20 mm in length. A third generation of coronary devices has evolved in the late 1990s in response to continuing failures of conventional balloon angioplasty, atherectomy, and stenting. The failures of the 1990s were (1) restenosis, including in-stent restenosis, (2) chronic total occlusions, (3) diffuse small-vessel disease, and (4) aged vein graft disease. In response to these challenges novel devices are being developed: (1) for restenosis, intracoronary radiation therapy (brachytherapy); (2) for chronic total occlusions, Prima Laser wire; (3) for diffuse small-vessel disease, percutaneous myocardial laser revascularization; and (4) for aged vein grafts, antiembolization devices. Each of these new catheter technologies will need to be economically and clinically reconciled with the multitude of minimally invasive surgical revascularization techniques that are rapidly evolving.

Angioplasty, Balloon, Coronary↗
PubMed1990

Percutaneous intravascular US as adjunct to catheter-based interventions: preliminary experience in patients with peripheral vascular disease.

Catheter-based ultrasound (US) transducers may be introduced into the vascular system to record high-resolution images of the vessel wall and lumen. The potential advantages and existing liabilities of percutaneous intravascular US as an adjunct to transluminal vascular recanalization were investigated. A 6.6-F braided, polyethylene catheter enclosing a rotary drive shaft with a single-element, 20-MHz transducer at the distal tip was used in 17 patients undergoing percutaneous transluminal (balloon) angioplasty (PTA) alone (10 patients), PTA with implantation of an endovascular stent (two patients), atherectomy alone (two patients), or laser angioplasty with PTA and/or atherectomy (three patients). The arteries treated and examined included the common iliac in five patients, the external iliac in two, the superficial femoral in nine, and a vein graft-arterial anastomosis in one. In 14 cases PTA was employed as sole or adjunctive therapy; plaque cracks were clearly delineated with intravascular US in all 14 (100%) and dissections were observed in 11 (78%). Plaque-arterial wall disruption was less prominent in the arteries treated with mechanical atherectomy. The results of laser angioplasty reflected the adjunctive modality employed. After stent implantation, serial intravascular US documented effacement of PTA-induced plaque cracks and/or dissections. Intravascular US also aided in the quantitative assessment of luminal cross-sectional areas after the procedures (19.0-51.8 mm2). The observations recorded in this preliminary group of 17 patients illustrate the potential utility of intravascular US as an adjunct to conventional angiography in patients undergoing percutaneous revascularization.

Aged↗
PubMed1996

Angiographic Results and Late Clinical Outcomes Utilizing a Stent Synergy (Pre-Stent Atheroablation) Approach in Complex Lesion Subsets.

To investigate the strategy of ÒdebulkingÓ in complex lesions before stent implantation (stent synergy) to improve procedural safety and achieve optimal acute and long-term results, we reviewed our experience in 389 patients with 504 lesions undergoing a combined stent procedure (45% rotational atherectomy, 24% laser angioplasty, 20% directional atherectomy, and 11% transluminal extraction atherectomy before stent implantation). Procedural success was achieved in 94.5%, with 4% major ischemic complications (1.1% death, 1.9% Q-wave myocardial infarction, and 2.3% emergency coronary artery bypass surgery). Overall, subacute stent thrombosis occurred in 1.5% of patients. Target-lesion revascularization during follow-up was required in 9.8% of the patients. We conclude that a strategy of selective pre-stent atheroablation in complex lesion subsets results in excellent procedural outcomes with acceptable complications and favorable long-term results.

Journal Article↗
PubMed2003

Clinical outcome of patients with left anterior descending artery ostial lesions treated with percutaneous coronary intervention: case-matched comparison with bypass surgery.

OBJECTIVE: To assess the immediate and late clinical outcome of left anterior descending artery ostial lesions treated with percutaneous coronary intervention. METHODS: Seventeen patients (6 females and 11 males) treated with percutaneous coronary intervention for ostial left anterior descending artery stenoses have had clinical follow-ups over 12 months. Clinical events were defined as an occurrence of death, myocardial infarction, recurrent angina, and requiring repeat revascularization (either by angioplasty or by surgery). A matched population treated with coronary bypass surgery was selected based on the similarities in age, left ventricular ejection fraction and the number of diseased vessels. Kaplan-Meier event-free survival curves were generated and the matched comparison was done using the Chi-square test (Mc Neimar method). RESULTS: In the catheter-based angioplasty group, the patients' mean age was 63 +/- 8 years. One patient was treated with directional atherectomy plus balloon, 6 with rotational atherectomy plus balloon, 7 with stent and 3 with rotational atherectomy plus stent. Glycoprotein IIb/IIIa antagonist was used in 4 cases. Initial procedural success without major complications was achieved in all cases. The mean reference diameter was 2.90 +/- 0.48 mm. The minimum lumen diameter increased from 1.05 +/- 0.30 mm to 2.40 +/- 0.45 mm, and the diameter stenosis decreased from 64% +/- 7% to 8% +/- 13%. During the follow-up period, adverse events requiring repeat revascularization occurred in 8 patients. The event-free probability was 0.42 +/- 0.14 in a two-year period. In a matched population treated with bypass surgery (single mammary graft), only one event occurred, and the difference in event-free survival in two-year period between the two patient groups was significant. CONCLUSIONS: Percutaneous coronary intervention for left coronary descending artery ostial lesion is technically feasible and safe, leading to an optimal early success rate, but has a higher risk of late restenosis and greater need for repeat revascularization than coronary bypass surgery.

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PubMed1996

Intracoronary stents.

Interventional cardiology has undergone exciting changes since the first percutaneous transluminal coro-_ nary angioplasty was performed by Andreas Gruentzig in 1977.' Over the last several years, a variety of techniques have been developed which provide the interventional cardiologist with a range of options to treat coronary stenoses. In addition, the indications for intervention have radically changed since the original work by Gruentzig, who limited treatment to patients with a single focal stenosis in a large vessel. Advances in balloon angioplasty, as well as the development of new techniques such as directional atherectomy, laser angioplasty, rotational atherectomy, extraction atherectomy, and now intracoronary stents have given the interventional cardiologist the ability to treat multivessel disease, increasingly complex lesions, and less stable patients."

Journal Article↗
PubMed2005

Creativity, ingenuity, serendipity.

Some of the earliest experiences of invasive cardiology centred on studying the physiology of congenital heart disease in a series of ongoing attempts to understand pathophysiology and anatomy, and then devising strategies to treat the lesion. Tremendous growth in the field and rapid advances in patient care have become possible due to the collaboration of early investigators, including pediatric cardiologists, cardiovascular pathologists, embryologists, physiologists and cardiovascular surgeons. This group has expanded to include radiologists, vascular biologists and engineers. Mason Sones' serendipitous encounter with a patient led to the thought that one patient's 'complication' might lead to another therapy and, as a result, studies were conducted. Early equipment was bulky, rigid and inflexible. Andreas Gruentzig was instrumental in the development of several new techniques. Throughout the development of invasive cardiology, great attention has been paid to the evaluation of both successful and failed outcomes. Over the intervening years, multiple advances in technology have improved procedures by making invasive cardiology easier, safer and more predictable and have expanded the patient population that could benefit from it. These advances included new devices, such as atherectomy transluminal extraction catheters, as well as with directional coronary atherectomy, rotational atherectomy and laser-based techniques. Interventional cardiology has soared with single-centre and multicentre randomized trials. Intracoronary stents have completely revolutionized therapy, becoming smaller, more flexible and more easily deliverable. With the introduction of drug-eluting stents, restenosis rates have been dramatically reduced. However, chronic total occlusion continues to be a problem in interventional cardiology due to increased risk of early and late complications and increased restenosis rates. New areas continue to be developed, combining the inventions and designs of collaborators. An increased knowledge of the basic pathophysiology of cardiovascular disease, combined with creative technology and imaginative operators, will continue to advance the field.

Angioplasty, Balloon, Coronary↗
PubMed1991

[The treatment of obliterating arteriopathy of the lower limbs with Simpson's Atherocath].

Percutaneous transluminal angioplasty is limited by a high percentage of restenosis in the medium and long runs. Other arterial recanalization systems to be combined with or to be used in alternative to angioplasty are under investigation. Atherectomy with Simpson's catheter (Atherocath) allows mechanical removal of the atheromatous plaque, leaving a smooth lumen, and vessel dilatation with the same effects as those of angioplasty and coaxial Dotter catheters. A Hundred and ten atherectomies with Atherocath were performed by the authors in 103 patients for the treatment of 77 stenoses and 33 total occlusions. All patients had 36 months' follow-up. Immediate and medium patency rates are encouraging in femoropopliteal arteries; the actual role of the method in iliac arteries is still to be demonstrated. Atherectomy with Aterocath can be useful not only in the treatment of arterial stenoses, but also in complete obstructions, in combination with angioplasty. Other relevant indications are the removal of partially or totally obstructive intimal flaps complicating angioplasty, and treatment of such ulcerated lesions as the blue-digit syndrome.

Adult↗
PubMed1993

Role of the different percutaneous revascularization techniques in single and multivessel coronary artery disease.

Over the past 16 years coronary angioplasty has become an established therapy for coronary artery disease. Advances in technology and growing operator experience have improved initial success rates, lowered the complications associated with coronary angioplasty and expanded the indications of percutaneous revascularization to include large numbers of patients with complex lesions. The mechanisms of coronary angioplasty include plaque fracture, intimal atherosclerotic flaps, localized medial dissection and stretching of plaque-free segments. The problems and limitations of coronary angioplasty are: unfavourable lesion morphology which may preclude complete revascularization or increase the risk of major complications, "high-risk" patients requiring pharmacological or mechanical support, acute coronary occlusion, and restenosis, the 2 latter problems being related to the very mechanisms of coronary angioplasty. Recently, new interventional devices have been introduced: intracoronary stents, directional coronary atherectomy, rotational atherectomy, transluminal extraction atherectomy, excimer laser coronary angioplasty. A multidevice lesion-specific approach integrated with balloon angioplasty may optimize procedural results in a growing number of patients with complex coronary lesions. However, restenosis occurring within 6 months after successful angioplasty remains the "Achilles' heel" of coronary interventional procedures and erodes the potential advantages angioplasty holds over coronary bypass surgery. These 2 forms of myocardial revascularization are currently compared for the treatment of multivessel disease in randomized trials.

Angioplasty, Balloon, Coronary↗
PubMed1995

[Multi-instrumental revascularization adjusted to coronary lesions (MIRACLE). Current role of new technologies].

Several new techniques have been developed to get round the limitations of conventional coronary angioplasty. Most entail ablation of the atheromatous plaques by mechanical (atherectomy) or photochemical (laser excimer) means, whilst others (stents) shore up the vascular walls. Their use with conventional coronary balloon angioplasty optimises the results of treatment of complex lesions. This report describes the authors' experience in 1,266 patients (1,668 lesions) treated between January 1992 to December 1993. The new techniques were used in 33% of patients and 30% of lesions (rotational) atherectomy: 20%; stents: 5%; directional atherectomy: 3%; laser excimer: 2%) because of the defavourable angiographic characteristics of the lesions (eccentricity, calcification, bifurcation, length, chronic total occlusion, thrombosis, ostial stenosis, ulceration, saphenous vein graft). The primary success rate was 91% in the whole group (94 to 97% for the patients treated by the new techniques). The global major complication rate was 1.7%. The multi-instrumental revascularization adjusted to the coronary lesions (MIRACLE) gives a high primary success rate in patients with coronary lesions difficult to treat by conventional angioplasty. Randomised trials will be necessary to determine the precise indications of each technique with respect to the morphological characteristics of each lesion.

Aged↗
PubMed1996

Deposition of PG-M/versican is a major cause of human coronary restenosis after percutaneous transluminal coronary angioplasty.

To clarify the mechanisms of restenosis, restenotic human tissue specimens obtained by directional coronary atherectomy (DCA) in 43 patients were immunohistochemically analysed for cell proliferation and deposition of PG-M/versican, an important extracellular matrix proteoglycan of the vessel wall. The patients were classified into five groups according to the period after percutaneous transluminal coronary angioplasty (PTCA): 0-1 month (N = 6), 1-3 months (N = 12), 3-6 months (N = 11), more than 6 months (N = 6) and de novo lesions (N = 8). The tissue specimens were of 35 restenotic lesions following PTCA and eight primary stenotic lesions with no prior PTCA. Total cell numbers in the atherectomy specimens increased significantly up to 3 months after PTCA. Most cells were alpha-smooth muscle actin (alpha-SMA)-positive. To evaluate cell proliferation, the specimens were immunostained for Ki-67 antigen (clone MIB-1). A significant increase in the positive ratio was observed up to 1 month after PTCA, although the labelling index was less than 1 per cent at every stage. The deposition of PG-M/versican, as analysed by immunohistochemistry, was greatest during the period 1-3 months after primary angioplasty, when restenosis detected by angiography progresses most actively. These results suggest that the peak of cell proliferation in the neointima occurs earlier than angiographic restenosis and that the deposition of PG-M/versican may be a major factor in restenosis following angioplasty.

Aged↗
PubMed1996

Neovascularization in human coronary atherosclerotic lesions.

Neovessels within human coronary atherosclerotic lesions are frequently observed, but their pathophysiological significance is still subject to debate. Also, the origin of these vessels and their pathways in the arterial wall are not well-known. In this study, we describe the transmural pathway and the frequency of neovessels both in vivo and in autopsy cases. Atherosclerotic coronary arteries were obtained during autopsy in 10 subjects without previous cardiovascular symptoms. In 25 patients undergoing percutaneous intervention for either stable or unstable angina, plaque fragments were retrieved by directional coronary atherectomy. In the autopsy study, at least one coronary artery in each case showed some degree of neointimal proliferation, characterized by smooth muscle cells in a dense extracellular matrix. A neovascularization process was seen in 17.5% of the 40 samples analyzed. In 2 cases, the transmural pathway of the neovessels could be tracked: serial sections revealed the emergence of an arteriole from the adventitia of the coronary artery, its transmedial course as a capillary, and its opening into the coronary arterial lumen. In symptomatic patients who underwent atherectomy, neovessels were found in 1 of 9 patients with stable angina (11%) and in 8 of 16 patients with unstable angina (50%, P < 0.05). Mostly, the neovessels appeared as capillaries cut in their short axis. In 2 cases, however, the capillary was seen in its longitudinal axis, and its pathway could be traced through the atherosclerotic lesion to its opening in the coronary lumen, as in the autopsy study. Therefore, neovessels frequently develop in the atherothrombotic plaque, both in asymptomatic and anginal patients. In the latter group, the proliferation of neovessels is more frequent in acute coronary syndromes. These findings have several implications, in particular for percutaneous coronary angioplasty and related procedures, such as local drug delivery.

Adult↗
PubMed1998

New devices enhance hospital results of coronary angioplasty.

After rigorous screening by means of registries and controlled trials, various atherectomy devices, excimer laser catheters, and endoluminal stents were approved for general clinical use. Few data are available describing their safety and effectiveness after approval. This analysis was undertaken to assess the impact on patient outcomes of the unrestricted clinical application of new transcatheter devices for coronary angioplasty. Thirty-six cardiologists performed 3,113 transcatheter procedures during 1995. Each chose the transcatheter modality best suited to the clinical and angiographic features of the patient. Baseline clinical and angiographic data and initial outcome were recorded by cardiac catheterization laboratory personnel. In-hospital events were obtained by independent chart review. Balloon angioplasty alone was employed in 1,089 (35.0%) patients. A stent was deployed after balloon angioplasty in 1,029 (33.1%) patients. An atherectomy or laser device was used without stent support in 631 (20.3%) patients, and stent support was added in an additional 364 (11.7%) patients. In all three new device categories the angiographic success (final luminal narrowing <50%) rate was better than in balloon angioplasty for type-C lesions and for chronic occlusions. The frequency of adverse events in the aggregate was not increased with device use, but the frequency of coronary artery bypass surgery was reduced with stent use. The frequency of non-Q-wave myocardial infarction was greater with devices than with balloon angioplasty alone. After adjustment for the differences in baseline clinical and angiographic variables by means of multivariate analysis, each of the three new device categories was independently associated with an increased chance of angiographic and procedural success compared to balloon angioplasty. The availability of new transcatheter devices for clinical practice enhances patient outcomes during hospitalization for the procedure.

Aged↗