ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00435.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The desire to extend the principle of balloon angioplasty to cardiac valve disease is Understundable and commendable. Aortic valvuloplasty is associated, however, with an excessive complication rate, as reported by the Mansfield Scientific Aortic Valvuloplasty Registry (20.5% overall, including a 4.9% death rate within 24 hours and an additional 2.6% rate within 7 days for a 7.5% 1‐week mortality). In contrast, the operative mortality for aortic valve replacement now ranges from 3%‐5%, with periopercitive complications far less than the one in five associated with valvuloplasty. Even if the two procedures had equivalent morbidity arid mortality rates, the high incidence of resteriosis (30%‐60% range at 6 months) for the balloon technique precludes its widespread use for aortic stenosis. Despite the poor mid‐ and long‐term results for balloon valvuloplasty, the procedure may have limited application in some clinical situations. Indeed, there are patients with concomitant systemic illnesses or advanced age (>80 years) who would not be good surgical candidates. In particular, valvular balloon dilation may be useful in bridging a seriously ill patient to a condition more favorable for replacement therapy. With few exceptions, however, valve replacement remains the gold standard, for treatment of adult aortic

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00436.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The results of an overview of early (90–240 min) and late (24 hours or more) patency and of stroke rates for each of the three commercially available thrombolytic agents, streptokinase, alteplase, and anistreplase are presented. Studies included in this analysis are all those published between 1985 and March 1992 and focus on the licensed dosage regimens of each agent. The rates of early and late patency for streptokinase were 64.7% and 80.8%; for alteplase, 66.6% and 73.7%; and for anistreplase, 72.1% and 84.5%. The rates of total and hemorrhagic stroke for streptokinase were 0.69% and 0.17%; for alteplase, 1.27% and 0.50%; and for anistreplase, 0.91% and 0.38%. These results provided evidence that the rates of early and late patency appeared to be greatest for anistreplase and that the rates of stroke are within “acceptable” ranges for all three thrombolytic agents with streptokinase affording the lowest

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00437.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Patients with diffuse coronary artery disease present a significant management problem. It has been proposed that diffuse coronary disease is unsuitable for balloon angioplasty and surgical treatment is not ideal either. We review the evidence that coronary balloon angioplasty is not a suitable treatment for diffuse coronary disease and examine the role of alternative interventional techniques. New techniques including long angioplasty balloon catheters and atherectomy devices have shown promise. If this is confirmed by prospective randomized trials then coronary angioplasty may yet prove an attractive treatment for diffuse coronary disease.

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00438.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Atherectomy with the transluminal extraction endarterectomy catheter (TEC) is a new approach for treatment of coronary artery disease, which continues to undergo FDA investigational studies, The major mechanism of the TEC device should be excision of plaque and its removal due to suction applied through an attached vacuum. We report about the acute results in 24 patients treated with TEC atherectomy in native vessels and the outcome of 18 patients who, until recently, underwent follow‐up catheterization after 6 months. The procedure was successful (residual stenosis<50%) in 7 of 24 patients with TEC atherectomy alone (29%); 15 of 24 patients (65%)required additional PTCA in order to achieve angiographic success (10 of 24) or to treat total occlusion (2 of 24) or distal embolization (3 of 24) following atherectomy. One TEC attempt failed due to guiding catheter problems, another major complication was a vessel perforation leading to a non‐Q wave infarction. The minimal residual diameter after passage of the stenosis (prior to additional PTCA) with the 5.5Fr catheter (n = 14) nsas 1.5 ± 0.2 mm, with the 6Fr catheter (n = 9) 1.8 ± 0.4 mm, and 2.2 ± 0.2 mm using the 7Fr catheter (n = 10). The histologic findings revealed intimal cells, fibrous tissue, and homogenate with no identifiable tissue in five cases (21%), whereas in 17 patients (72%) light microscopy could only assess blood cells. Restenosis was present in 9 of 18 patients (50%), occurred in 3 of 7 patients treated with TEC alone, and in 6 of 11 patients treated with TEC + PTCA. The primary underlying mechanism of TEC atherectomy seems to be mechanical dilatation while tissue excision proved to be inadequate to explain the angiographic result. Further studies should be designed to directly compare TEC atherectomy to PTCA in specific patient subgroups (e.g., bypass grafts, intraluminal thrombus, diffuse disease), in order to define the role of this

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00439.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

The vasoreactivity and thrombogenicity of laser‐thermal angioplasty were examined and compared with those of balloon angioplasty in an atherosclerotic rabbit iliac artery. Eight rabbits underwent laser‐thermal angioplasty with a 1.7‐mm hot‐tip probe activated at 7 W with a probe temperature of 126 ± 19°C in one iliac artery. The other iliac artery was treated with balloon angioplasty irsing a 2.0mm balloon. Angiographic luminal diameter increased from 0.19 ± 0.15 to 1.54 ± 0.35 mm by laser and from 0.29 ± 0.22 to 1.84 ± 0.20 mm by balloon (P<0.0001. respectively). However, it decreased to 1.34 ± 0.42 for laser and 0.45 ± 0.39 for balloon 60 minutes later (P<0.0001 vs immediately post). Both iliac arteries were visualized using angioscopy, which revealed thrombotic obstruction of 91% stenosis in the ballooned artery and 8% stenosis in the lased artery. Vasoreactivity of treated vessels was also investigated. Segments 3‐mm long were obtained from either treated artery or control artery and examined for noradrenaline (10−7M) contraction. The segments were then mounted isotnetrically with 1 g tension in Krebs‐bicarbonate buffer. Developed tension was 0.13 ± 0.21 g for laser thermal and 2.33 ± 0.4 g for its control (P<0.0001), and 0.15 ± 0.16 g for balloon dilatation and 2.12 ± 0.43 g for its control (P<0.0001). Neither acetylcholine at 10−6M or papaverine at 10−4M induced relaxation of treated segments. Histology showed slight thermal injury at thermally‐treated sites without thrombus, and intimal and medial dissection with thrombus formation at balloon dilated site. In conclusion: (1) neither a laser‐thermal recanalized or a balloon dilated obstructed artery is vasoreactive to constrictive or relaxant agents; and (2) laser‐thermal angioplase results in less thrombogenicity than balloon angioplas

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00440.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

Sixteen patients with a mean age of 65.4 ± 9.8 years and suffering from peripheral vascular disease underwent peripheral atherectomy using a new mechanical device—the BARD Rotary Atherectomy System (BRAS). The BRAS is an “over the wire” system that consists of a spiral guidewire and a handheld motor drive unit, which rotates at 1,500 rpm. Prior to the procedure angiography demonstrated the presence of 18 obstructions (1 tibial, 2 popliteal, 15 superficial femoral arteries) with a mean stenosis of 95.7 ± 8%. Successful atherectomy was achieved in 16 of 18 lesions and resulted in an 89% immediate success rate and a significant (P<0.01) reduction of stenosis to 37.8 ± 12.5%. There were no significant complications. The excised and removed material embedded over the spiral guidewire demonstrated the presence of fibrotic tissue, fatty lesions, and calcium deposits. Medial or adventitial layers were not present in the removed atherosclerotic material. Mean ABI was significantly (P<0.01) increased from 0.38 ± 0.17 to 0.55 ± 0.21 following atherectomy. Angiographic follow‐up obtained in ten patients 8.8 ± 5.2 months following the procedure demonstrated restenosis in six of those ten patients. The ABI at this time remained unchanged. These results demonstrated that the new BRAS mechanical atherectomy system is feasible and safe for recanalization of severely stenosed arteries in patients with peripheral vas

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00441.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

We performed percutaneous coronary angioscopy in 35 patients to study the surface morphology of coronary artery lesions. Twenty‐five patients had angioscopy performed in conjunction with PTCA, including 20 patients with de novo lesions (16 patients with unstable angina, four patients with stable angina), and five patients with restenosis lesions. Ten cardiac transplant patients had angioscopy performed in conjunction with annual follow‐up angiography in an attempt to identify accelerated atherosclerotic lesions. There were no complications of angioscopy in any patient. There were no intracoronary thrombi seen either by angiography or angioscopy in the stable angina patients. In the unstable angina group, angiography identified thrombus in 2 out of 16 (12.5%) versus 15 out of 16 (94%) (P<0.001) with angioscopy. Following angioplasty, dissections were seen angiographically in 7 out of 16 (44%) of patients versus 16 of 16 (100%) of the patients by angioscopy (P<0.01). Restenosis lesions were characterized by a white, fibrous appearance instead of the usual yellow color of primary atherosclerotic lesions. In the ten cardiac transplant patients, angioscopy appeared to be more sensitive than angiography for the detection of atherosclerosis. Yellow (atherosclerotic) and white (fibrotic) plaques were seen in the transplant patients, which often were not detected by angiography. In summary, angioscopy is an excellent tool for visualizing the surface morphology of coronary artery lesions. The clinical indications for angioscopy remain undefined at present. Possible applications for angioscopy include intracoronary thrombolytic therapy, stratification of high risk angiographic results after angioplasty (“hazy” artery), and, finally, as an adjunct to interventional procedures such as stem impla

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00442.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

摘要:

An ultrasonic thrombolysis device designed for intracoronary use was developed and evaluated in vitro to assess efficacy in achieving clot ablation without deleterious effects, such as heat generation and production of large particles during clot ablation. Studies on 31 samples with a bench‐top version demonstrated that clot ablation was rapid (typically 2 mL in under 2 minutes) and no macroscopic particles were released. The fluid produced did not reclot. Studies with a clinical version of the device that can be passed through a IOFr PTCA guiding catheter confirmed that clot ablation was rapidly achieved. Little particulate material was produced and the maximum temperature achieved did not exceed 52°C. The device functions well in vitro, releasing little particulate material and causing limited local heating. It seems suitable for intracoronary use and will undergo further in vivo testi

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00443.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY

ISSN:0896-4327    

DOI:10.1111/j.1540-8183.1993.tb00444.x

出版商:Blackwell Publishing Ltd    

年代:1993

数据来源: WILEY