ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb00787.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

From 1988 to 1990 chronic coronary occlusions were treated with a newly developed slowly rotating angioplasty system (ROTACS), which is designed for atraumatic passage of arterial obstructions. In all 152 patients (mean age 55 years, ranging from 29 to 78 years) attempts to recanalize the coronary occlusion with conventional guidewire systems had failed. In 74/152 patients the age of the occlusion could be estimated because of a previous angiogram or clinical event. It ranged from 1–192 months (median 6 months, mean value 14 months; in 20% of patients it was 1–3, in 37% 4–6, in 28% 7–12, and in 15%>12 months). The occlusion was localized in the right coronary artery (RCA) in 86 cases, in the left anterior descending coronary artery (LAD) in 37 cases, and in the circumflex branch of the left coronary artery in 17 cases. Eleven bypass occlusions were treated. One patient had a LAD and RCA occlusion. Out of 152 patients 84 could be recanalized. The success rate rose with experience from 30% to 60%. It was 55% in the LAD, 52% in the RCA, 70% in the circumflex branch, and 63% in bypass grafts. The success rate in relation to the age of the occlusion was 93% in occlusions of 1–3 month duration, 74% in occlusions of 4–6 months duration, 52% in occlusions of 6–12 months duration, and 8% in occlusions older than 12 months. Seventy‐six of the successfully treated patients underwent follow‐up angiography after 4 months. In 56/76 (74%) the vessel remained open. Twenty‐two patients (29%) had restenosis that was successfully dilated in 21 patients. Twenty patients (26%) had reocclusion. Thus, the angiographically determined long‐term success rate was 72%. Emergency operation was necessary in two patients in whom reopening of the LAD was attempted although the occlusion was located directly at the take‐off of the LAD from the left main. Since this type of occlusion was consequently considered a contraindication, no further serious complications occurred. There was one myocardial infarction, no death, no vessel wall perforation or other complications in the 152 patients. It is concluded that low speed ROTACS is a safe technique that can be applied in chronic coronary occlusions even if the duration of occlusion exceeds 6 months. (J Interven

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb00788.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Glove perforation during catheter laboratory procedures exposes the operator to potentially infected fluids and the patient to wound infection. To assess the extent of this problem, 200 consecutive pairs of surgical gloves worn during cardiac catheterization, percutaneous transluminal coronary angio‐plasty (PTCA), or permanent transvenous pacemaker (PPM) insertion were examined for perforations by a water distension test. The overall puncture rate for pairs of gloves was 18%. The rate of glove puncture differed between cardiac catheterization, PPM implantation, and PTCA (21.4%, 25.6%, and 4.8%, respectively; P = 0.018). The incidence of glove damage at cardiac catheterization was significantly higher when arterial access was obtained by a brachial cut‐down rather than by the Seldinger technique (25.7% and 11.3%, respectively; P = 0.015) and was independent of operator experience. Glove perforation is common. Operators should be aware of the problem and be particularly vigilent during brachial arteriotomy and PPM implantation, especially when operating on potentially infected patients. (J Interven Cardiol 1991; 4:167

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb00789.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Excimer lasers are being extensively used for coronary angioplasty along with multifiber over‐the‐wire catheters. To determine whether another wavelength could be an alternative, the laser‐tissue interaction and the clinical usefulness of an infrared laser were studied. The laser consisted of a Holmium YAG pulsed laser coupled into a multifiber catheter. Experimental data from our laboratory showed that this solid stale laser had the ability to cut calcified tissue, to be preferentially absorbed by atheroma, and to ablate tissue even when the catheter tip was positioned at a distance from the target. These results were obtained with only minimal thermal effects. After assessment of the efficacy and safety of this technique, laser angioplasty was performed in 53 consecutive patients with totally occluded (40%) or stenosed (mean percent 94) coronary arteries with a mean length of 6 mm. The primary laser and the procedure success rate were 64% and 94%, respectively. Failures were due to inability to advance the catheter against the lesion or to cross the obstruction. Stand‐alone laser therapy could be achieved in only 18% of patients. In previous dilatation failures, laser irradiation allowed for subsequent balloon angioplasty to be successfully performed at a lower inflation pressure than that used in the failed dilatation. Complications included abrupt (during the procedure) and early (within 24 hours) vessel closure in 19% of cases, dissection without hemodynamic consequence in 28% and spasm. Reoccluded arteries could all be recanalized with dilatation. There was no death, myocardial infarction, and no urgent coronary artery bypass surgery (CABG). Thus, infrared laser angioplasty is effective in difficult lesions for dilatation. The results are obtained with a reliable, easy to use and to maintain laser

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb00790.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

This study was performed to evaluate the importance of the duration of balloon inflation during PICA, by comparing two common inflation durations. Patients were randomized to a 30‐second inflation protocol (group I, 83 procedures, 109 lesions), or a 60‐second protocol (group II, 83 procedures, 115 lesions). There were no differences in baseline characteristics between the two groups, and no subsequent differences in mean inflation number (3.4 ± 1.6 vs 3.1 ± 1.6), residual stenosis (34%± 17% vs 33%± 16%), presence of dissection (29% vs 34%), or clinical success (89% vs 84%), group I versus group II, respectively. The 30‐second inflations caused significantly less chest pain score (147 ± 239 vs 399 ± 516, P<0.001), and ST segment alteration (75 ± 94 seconds vs 136 ± 163, P<0.05). These results indicate that 60‐second inflations do not produce a superior result to 30‐second inflations. Furthermore, shorter inflations are much

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb00791.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Although laser thermal angioplasty (LTA) with a laser heated metal probe has been tolerated in diseased human coronary arteries, definition of a safety threshold is lacking. Determination of safer operation parameters for coronary LTA using a new “over the wire” 1.3‐mm laser probe catheter was attempted in seven normal pigs in which platelets were labeled with indium‐III. Argon laser power of 10 watts was used for 1, 2, 3, and 5 seconds. Macroscopic findings, platelet deposition and histologic changes were compared between the laser treated coronary segments and controls, the nonheated laser probe, and the wire alone segments. After 1‐second LTA, there was no vessel perforation or occlusive thrombi and only infrequent nonocclusive thrombi; platelet deposition was minimal; and histologic alterations rare and superficial. These findings were comparable to controls, the nonheated laser probe, and the wire alone segments. In contrast, vessels treated for 2, 3, and 5 seconds had more frequent perforation, and occlusive and nonocclusive thrombi that was accompanied by platelet deposition significantly greater than vessels treated with LTA for I second. A deep histologic injury was present in most of these segments. Additionally, the safety of laser delivery of I second repeated for five times was tested in two additional pigs. On macroscopic and histologic analysis the incidence of vessel perforation, occlusive and nonocclusive thrombi appeared slightly less when compared to the 2‐, 3‐, and 5‐second LTA groups, and more than the 1‐second LTA group. Platelet deposition was lower than the 2‐, 3‐, and 5‐second LTA groups, and higher than the 1‐second pulse group. Thus, 1‐second pulses are the threshold for safe application of LTA in normal swine coronary arteries. LTA for longer periods of energy delivery is accompanied by significant platelet deposition and high rates of thrombi formation focclusive and nonocclusive) and vessel wall perforation. Repetitive short 1‐second periods of laser energy delivery do produce an accumulative injury but to a less extent than single pulses. This mode of laser energy delivery could possibly imp

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb00792.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

Intimal dissection and disruption with closure of a tortuous right coronary artery during elective coronary angioplasty can be especially difficult to address. We describe the use of the Probing CatheterTM, in conjunction with the GlidewireTM, to recross a postcoronary angioplasty dissection and occlusion in an elderly female who was considered not to be a candidate for coronary bypass surgery.

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb00793.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

摘要:

The present report describes a patient with severe mitral stenosis and coronary artery disease who was successfully treated by combined percutaneous mitral valvuloplasty and coronary angioplasty. A few days following these procedures, the patient, probably as a result of thrombus embolization in the LAD artery, developed signs of an evolving anterior myocardial infarction and was successfully treated with intravenous thrombolytic therapy. This case demonstrates the feasibility of the combined appliance of interventional techniques in selected patients as an alternative to cardiac surgery.

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb00794.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb00795.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1991.tb00796.x

出版商:Blackwell Publishing Ltd    

年代:1991

数据来源: WILEY