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At least 1,135 records · Page 63Linked to original sources
PubMed1995

Primary mechanical recanalization of occluded coronary arteries without prior thrombolytic therapy in patients with acute myocardial infarction. A single-center study reporting acute results and complications.

This study reports on 261 consecutive patients admitted to the Wuppertal Heart Center with acute myocardial infarction (186 men, 75 women; average age: 58.2 +/- 11.6 years) and then treated by primary coronary artery angioplasty. Sixteen patients with cardiogenic shock were included, as well as 42 patients aged > or = 70 years, 51 patients with contraindications for thrombolysis, and 13 patients with prior coronary bypass surgery. All patients were treated between 12/89 to 6/94 and had not received prior thrombolytic therapy. The period of time between onset of pain and revascularization of the infarct-related vessel averaged 224 +/- 205 min. Half of the patients had multi-vessel disease, and about 31% had had a prior myocardial infarction. 100 patients suffered from an anterior wall infarction, 109 patients from an inferior wall infarction, 50 patients from a posterolateral infarction, and in two cases the infarct localization could not be determined from the ECG. Mean biplane left ventricular ejection fraction averaged 56 +/- 13%, left ventricular end-diastolic pressure 20 +/- 7 mm Hg. In about 50% of the patients collaterals to the infarct-related coronary artery could be documented. With the first contrast injection into the infarct-related vessel TIMI flow 0/I was demonstrated in 94.9%, TIMI flow II in 5.7% and TIMI flow III in 0.4%. Reopening of the infarct-related coronary artery with establishment of TIMI-flow III was primarily successful in 91.9%. Average time for coronary angiography and angioplasty in the cathlab was 69 +/- 28 min. In 29 patients an autoperfusion balloon catheter was used to treat manifest or threatening reocclusion. Thirty-day-mortality in the total study group was 3.4%. In patients aged > or = 70 years mortality raised to 14.3%; in patients in cardiogenic shock mortality increased to 18.7%, in patients with inferior wall infarction up to 5.5%, and in cases with multi-vessel disease up to 5.0%. The in-hospital and 30-day course were complicated by major peripheral bleeding in seven patients (2.7%) requiring blood transfusions and surgical femoral vascular repair, and in another two patients with a false aneurysm which was treated by surgical means. No hemorrhagic stroke occurred, but three ischemic strokes with complete restitutio ad integrum within the 30-day-observation period were registered. As major cardiac complication early re-occlusion of the initially reopened infarct-related coronary artery was diagnosed in 10 patients; 11 patients developed a re-infarction within the first 30-days, in three cases leading to a fatal outcome.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1994

[Mechanisms of transluminal mechanical coronary recanalization].

Coronary angioplasty (PTCA) represents one of the most diffuse technique for myocardial revascularization in coronary artery disease patients. The principal mechanisms, responsible for the luminal increment after successful balloon dilatation are stretching of the vessel wall and splitting of the plaque and its rearrangement in an increased cross section of the vessel. Soon after balloon deflation elastic recoil of the vessel wall might occur at different grades which result in a partial loss of the result achieved by balloon PTCA. This phenomenon seems to be one of the major factors influencing the acute and long-term results of PTCA. Balloon inflation is also followed by endothelial denudation and intramural hemorrhage and intramural thrombus apposition. Then, a proliferative process takes place which is characterised by intimal and smooth muscle proliferation and migration. This process, beside the elastic recoil of the vessel wall, might also contribute to restenosis following balloon PTCA. Other devices for myocardial revascularization were introduced in the clinical practice based on different mechanisms from that of conventional PTCA. Transluminal atherectomy (directional, rotational and rotational-ablation) is based on the removal of plaque material from the vessel, increasing the lumen and creating a smooth surface. By this mechanism of action, plaque splitting and vessel wall stretching might be avoided, thus acute and long-term results are supposed to be improved as compared to balloon angioplasty. Another device for the removal of plaque material is represented by laser angioplasty which utilizes laser energy for the evaporation of the atherosclerotic material and the increase of vessel lumen without vessel wall stretching and plaque splitting.(ABSTRACT TRUNCATED AT 250 WORDS)

Angioplasty, Balloon, Coronary↗
PubMed1994

[Coronary recanalization: rationale for stents].

Coronary stenting is a technique complementary to coronary angioplasty, because it is successful in the management of the two major limitations of conventional balloon dilation, i.e. the acute or threatened closure and the restenosis. The currently available intracoronary stents are far from being ideal, mainly for their thrombogenicity. During abrupt closure, the bailout stenting has, in most of the cases, offered a valuable alternative to emergency coronary artery bypass surgery. The major complications after stent insertion are the result of an inadequate stent placement, of persistence of intra and/or poststent obstruction and of the ineffective anticoagulant therapy. The mechanical support (scaffolding) provided by the stent after dilation significantly reduces the amount of elastic recoil, and, improving laminar flow, eliminates arterial wall shear stress that may contribute to an increase in intimal thickening. Moreover, the reduction of arterial cyclical stretching may reduce the rate of neointimal proliferation. By sealing the exposed subintimal spaces, stents may minimise the formation of local thrombi, and thus also limit their later organization and fibrous conversion into part of the restenotic lesion: two recently completed randomized trials (STRESS and BENESTENT) confirm the lower rate of restenosis in patients treated with single stent placement in de-novo lesions as compared with standard balloon angioplasty. The mechanism of stent benefit in reducing restenosis rate seems to be the wider initial lumen, which can accommodate a greater degree of intimal hyperplasia. In the near future, the improvements of the blood and tissue compatibility of the stents, may allow easier management.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary Disease↗
PubMed1994

[Rationale for coronary recanalization using transluminal atherectomy].

Although balloon angioplasty represented a significant advance in the treatment of coronary artery disease, this procedure is limited by acute occlusion and late restenosis. Among the new devices proposed to overcome the limitations of balloon catheters, Simpson's atherocath has the unique property of removing the atherosclerotic plaques from the coronary wall. Size and stiffness of the terminal portion limit the use of the atherocath to the proximal, non tortuous portion of coronary vessels more than 2.5 mm in size. Studies comparing atherectomy with balloon angioplasty have demonstrated a greater acute luminal gain with atherectomy but have failed to prove a clinical advantage from this better initial results. Atherectomy however is a rapidly evolving technology: better devices and more aggressive dilating strategies could significantly modify the conclusions of the earlier studies. In the meantime atherectomy is providing a unique opportunity to study vascular wall pathology.

Angioplasty, Balloon, Coronary↗
PubMed1994

[Assessment of the results during and after coronary recanalization procedures].

PTCA and new-device angioplasty have dramatically altered the management of patients with symptomatic coronary artery disease. Concurrent with the technical improvement in coronary angioplasty, the methods used to evaluate procedural outcome during and after revascularization have also become more sophisticated. Quantitative coronary angiography, angioscopy, and intravascular ultrasound are the most important methods for decision making, monitoring the procedure and document the final results. However despite their overall research value, these qualitative and quantitative techniques may be of limited value to the clinical interventional cardiologist and are often complementary or redundant. If a choice of these techniques is necessary, on-line quantitative coronary angiography, and intravascular ultrasound are certainly the most helpful methods in a Cath Lab to evaluate procedural outcome.

Angioplasty, Balloon, Coronary↗
PubMed1994

[Recanalization of chronic occlusions and myocardial infarction occurring during reocclusion. Apropos of 2 cases].

Although recent techniques have significantly improved the frequency of disobliteration of chronic occlusions, the potential complications in terms of mortality, emergency bypass surgery and myocardial infarction seem as common as in angioplasty of stenosis. Of these complications, the occurrence of infarction during reocclusion at the site of angioplasty has not been described and even been refuted by some authors. We report two cases of acute infarction, one of which was transmural, occurring during late reocclusion after disobliteration of a chronically occluded artery.

Aged↗
PubMed1995

[Drug thrombolysis and mechanical recanalization in recent femoro-popliteal arterial occlusions].

Acute femoro-popliteal occlusions (native arteries or bypass grafts) were treated by medical and surgical treatment. Despite improvement in surgical technique, patient mortality was high and limb loss remained frequent. Percutaneous endoluminal treatment of such lesions is feasible using in situ fibrinolysis and/or thromboaspiration singly or in association with balloon angioplasty. Those techniques are effective and are currently the first intention treatment of many of those acute femoro-popliteal occlusion. The advantages and disadvantages of those techniques are discussed, as well as their respective indications, and particularly their place compared to surgical techniques. New devices such as mechanical thrombectomy may increase effectivity and indications of endovascular treatment however such devices need to be better evaluated.

Arterial Occlusive Diseases↗
PubMed1994

[Recanalization of occluded coronary arteries with percutaneous transluminal coronary angioplasty].

Percutaneous transluminal coronary angioplasty (PTCA) was attempted in 56 totally occluded coronary arteries. The occlusions were estimated to be between two weeks to six months old, less than 4 cm long and accessible to PTCA. Primary technical success was achieved in 40 cases (71%) with best results if the time from AMI to PTCA was less than six months. Twenty-six patients were without recurrence in the follow-up period which was longer than six months. In the follow-up period eight patients had re-PTCA performed and six had coronary artery bypass grafting (CABG). There were significantly more patients in the group of failed PTCA who had CABG than in the group of successful PTCA. At clinical follow-up examination 23 patients (41%) were free of symptoms and seven (13%) had less pain than before PTCA. One patient died in heart failure (mortality 1.8%) within 24 hours after failed PTCA. PTCA of totally chronically occluded coronary arteries is a method with acceptable good primary success, especially if the occlusion is not too old. There is a good symptomatic effect if the PTCA is successful. The procedure reduces the need for CABG and is associated with few complications in stable angina pectoris. PTCA is cheaper and less traumatic for the patients and with much shorter recovery period compared to CABG. PTCA is considered indicated in total chronic occlusions in selected cases.

Angioplasty, Balloon, Coronary↗
PubMed1994

[Coronary angioplasty in chronic occlusion of 9 and half years. Use of laser with a new catheter for recanalization].

A chronic total occlusion lasting 9.5 years, was successfully treated with a Prima (TN) Laser catheter, of Spectranectics. The authors report a case of a fifty seven year old male that suffered an inferior myocardial infarction 9.5 years ago. Although the morphological characteristics of the lesion seemed easy to pass through the obstruction with the guide wire, the balloon dilatation was not possible because of the hardness of a chronic lesion lasting that long. The intervention was concluded successfully in another opportunity using the laser catheter with certain facility. This case, reported as the first one in Latin America, rises new possibilities and increases the success rate of coronary angioplasty of total chronic occlusions. We hope that in the following cases we will be able to reach the same result, widening the indications of coronary angioplasty.

Angioplasty, Balloon, Coronary↗