Reduction of Early Elastic Recoil by Cutting Balloon Angioplasty as Compared to Conventional Balloon Angioplasty
Background. Restenosis after successful balloon angioplasty remains problematic. Early elastic response after angioplasty is significant when considering the possible development of restenosis. The purpose of this study was to compare early elastic recoil within 10 minutes after successful percutaneous transluminal coronary angioplasty and early lumen loss at 24 hours after angioplasty in a cutting balloon group and a conventional balloon group. Methods. Extent of early elastic recoil was quantitatively measured as the difference of mean balloon diameter at maximal inflation pressure and minimal luminal diameter after angioplasty in 82 cutting balloon-treated lesions and 51 conventional balloon-treated lesions. Results. Reference diameter and balloon/artery ratio were similar between the cutting balloon and conventional balloon groups (2.89 ± 0.47 mm vs. 2.88 ± 0.60 mm; 1.19 ± 0.11 vs. 1.19 ± 0.13, respectively). Early elastic recoil after angioplasty was significantly smaller in the cutting balloon than the conventional balloon group (0.96 ± 0.40 mm vs. 1.12 ± 0.37 mm, respectively; p = 0.04). Also, the mean amount of lumen loss from 10 minutes after angioplasty to 24 hours after was significantly smaller in the cutting balloon than the conventional balloon group (0.08 ± 0.28 mm vs. 0.20 ± 0.33 mm, respectively; p = 0.02). Conclusion. There is significantly less early elastic recoil in the cutting balloon angioplasty than in the conventional balloon angioplasty group. The efficacy of cutting balloon continues 24 hours after angioplasty.
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Long-Term Cardiac Function and Outcome in Patients Receiving Primary Angioplasty for Acute Myocardial Infarction at a Community Hospital Without On-Site Surgical Back-Up
Background. Short- and long-term comparative follow-up studies of patients receiving primary angioplasty or thrombolytic therapy for acute myocardial infarction show higher 30-day survival, and sustained benefits in mortality, reinfarction and ejection fraction in patients treated with primary angioplasty. Long-term benefits of primary angioplasty on cardiac function performed in community hospitals without surgical back-up have not been fully assessed. Methods. Sixty-one patients who underwent primary angioplasty were compared with patients receiving thrombolytic therapy who were matched for age, gender and location of acute myocardial infarction. Clinical information, reviewed through August 2000, was provided by retrospective analysis of healthcare databases and office and hospital charts. Mortality data were confirmed by the social security death index. Results. Of the original 61 primary angioplasty patients, two died during initial hospitalization. Of the 59 surviving patients, fifty-four (92%) had complete follow-up averaging 57 months. Of the original 61 thrombolytic therapy patients, three died during initial hospitalization. Of the 58 surviving patients, fifty-two (90%) had complete follow-up averaging 46 months. At follow-up, averaging 57 months, ejection fraction was significantly higher in the primary angioplasty group, as compared with the thrombolytic therapy group (51.4% versus 45.8%, respectively; p = 0.038). There was no statistical difference between the two groups regarding reinfarction, revascularization at >= 6 months after the initial presentation or cardiac death. Conclusions. Primary angioplasty performed in a community hospital without surgical back-up results in improved cardiac function when compared to thrombolytic therapy. These results are similar to those reported from large tertiary centers with on-site surgical back-up, and provide an explanation for the improved long-term outcome that is observed in patients with acute myocardial infarction treated with primary angiopla
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Cutting Balloon to Treat Carotid In-Stent Stenosis: Technical Note
Carotid artery in-stent stenosis, a possible long-term complication of carotid angioplasty and stenting, is currently treated by inflation of a non-compliant angioplasty balloon. Better initial results and less recurrence of stenosis have been documented in the coronary literature with the use of the Cutting Balloon (CB, Boston Scientific Interventional Technologies, San Diego, California) for angioplasty, in comparison with traditional balloon angioplasty. We report our collective experience with the use of the CB to treat carotid in-stent stenosis in three patients. Excellent angiographic and clinical results were achieved. No complications occurred. The lesions in two patients were successfully treated with the CB alone; adjunctive stent placement was required in a third patient. Our experience demonstrates the feasibility and safety of the CB for the treatment of carotid in-stent stenosis in three patients. Due to the less traumatic nature of this balloon, its use may result in a lower occurrence of in-stent stenosis as compared to a conventional angioplasty balloon. To our knowledge, this is the first report of the use of the CB for carotid in-stent stenosis.
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Sidebranch Compromise During Percutaneous Coronary Interventions
Justified concerns exist about coronary balloon angioplasty and stent deployment when a sidebranch is within the vicinity of the interventional site. Assessment of the jeopardized sidebranch for the risk of compromise can be made by evaluating the sidebranch diameter, the myocardial territory supplied, the relationship to the parent vessel lesion and the presence of ostial disease. This can help in the decision-making process of the proposed intervention, allowing a strategy to be pre-planned in the event of sidebranch compromise. Sidebranch compromise associated with flow reduction in a branch vessel that is of medium or large diameter and serving moderate or large territory is often associated with a cardiac enzyme rise. It is now recognized that any cardiac enzyme rise after intervention is associated with increased long-term risk and such compromised sidebranches may be considered for re-opening to help preserve the myocardium. A variety of balloon angioplasty and stenting techniques are described for sidebranch compromise with some short-term success. Long-term outcomes and effect of sidebranch intervention have not yet been fully evaluated.
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Parameters of Left Ventricular Diastolic Function 48 Hours After Coronary Angioplasty and Stent Implantation
Introduction. It has been reported that stent implantation results in an earlier and more pronounced improvement of coronary flow reserve in comparison to conventional balloon angioplasty. Whether this phenomenon translates into hemodynamic changes of left ventricular systolic and diastolic function has not been investigated. This study was designed to determine whether stenting leads to greater changes in measures of diastolic dysfunction than plain angioplasty alone. Methods. Parameters of diastolic function were ascertained by Doppler echocardiography in 194 patients with single-vessel disease before and 48 hours after elective coronary angioplasty. A total of 116 patients were initially successfully treated with coronary angioplasty. In 78 patients, stents were used to improve an inadequate result after coronary angioplasty. The parameters of left ventricular diastolic function were evaluated before and 48 hours after coronary intervention by Doppler echocardiography. Ejection fraction was determined and used to characterize systolic left ventricular function. Results. Both patient groups (116 patients with coronary angioplasty, 78 patients with combined coronary angioplasty and stent implantation) showed no relevant differences concerning sex, age, atherosclerotic risk factors, exercise capacity and results of exercise electrocardiography. All patients who underwent stent implantation showed an early improvement of left ventricular diastolic function 48 hours after intervention. Surprisingly, there was no significant short-term improvement (48 hours) of diastolic function in patients with initially successful angioplasty. Conclusion. Stent implantation results in improved left ventricular diastolic function in comparison to conventional balloon angioplasty. This has to be attributed to a more immediate and increased antiischemic effectiveness due to the scaffolding properties of stents.
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Controlled Balloon Inflation Reduces Long-Term Restenosis After Percutaneous Transluminal Coronary Angioplasty
Purpose. The trauma induced by balloon angioplasty has an impact on the outcome of coronary interventions, such as stent procedures. However, balloon inflation for PTCA is not yet standardized even though procedural and long-term outcomes might be affected. Methods. During routine PTCA, a total of 454 patients [mean age, 60.9 ± 9.0 years; 162 (35.7%) with 1-vessel disease; 159 (35%) with 2-vessel disease; 133 (29.3%) with 3-vessel disease] were allotted to computer-assisted dilatation (CAPS) with a pressure slope of 0.2 bar/s (CAPS 0.2; n = 149 patients), 1.0 bar/s (CAPS 1.0; n = 154 patients) or to standard inflation with a hand-driven pump (n = 151 patients). Angiographic follow-up rates after 4.1 ± 3.2 months were 88.1% for the hand-driven pump, 94% for CAPS 0.2 and 87.7% for CAPS 1.0. Results. Flow reducing (1.3?2.0%) and non-flow reducing (12.6?14.9%) dissections were equally distributed among all groups as were major adverse cardiac events (2.6?4.0%). The stent rate was 1.3% with the hand-driven pump, 0.7% with CAPS 0.2 and 1.3% with CAPS 1.0. Angiographic restenosis rate was 48.9% with the hand-driven pump, 44.3% with CAPS 0.2 and 32.6% with CAPS 1.0. (hand-driven pump versus CAPS 1.0, p < 0.007; CAPS 0.2 versus CAPS 1.0, p < 0.049). Conclusions. The pressure slope during balloon inflation in PTCA has a significant impact on restenosis. The impact on stent procedures has yet to be determined.
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Influence of Frequency of Stenting on Acute and One-Year Follow-up Results
Background. There has been a continuous increase in the frequency of stenting, with recent reports suggesting performing stenting in all coronary angioplasty interventions. The aim of this retrospective investigation was to study the in-hospital and 1-year event rates of the most and the least avid stent user (both highly experienced) at our institution. Methods. A total of 322 consecutive patients undergoing coronary angioplasty at our institution were retrospectively studied. Post-intervention CK, CK-MB and troponin T values and information of major in-hospital cardiac events were obtained from the charts. Events during a 1-year follow-up were collected. Comparisons were made between patients treated by the most generous (operator 1: 71% stenting) and the most frugal (operator 2: 49% stenting) stent user. Results. The 2 groups were comparable. Post-intervention CK max (418 ± 744 versus 427 ± 1250; p = 0.33), CK-MB (105 ± 159 versus 239 ± 263; p = 0.07) and troponin T (149 ± 326 versus 282 ± 380; p = 0.3) values were similar in both groups. In-hospital (2% versus 1.8%; p = 1) and 1-year follow-up cardiac events (21% versus 18%; p = 0.58) between both groups were also comparable. Conclusions. Stenting is a useful tool for selected patients. However, a higher frequency of stenting does not beneficially influence in-hospital or 1-year cardiac events. These findings recommend provisional stenting rather then elective stenting.
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Severe Aortic Coarctation in Infants Less Than 3 Months: Successful Palliation by Balloon Angioplasty
The optimal management strategy of the neonate and young infant with native aortic coarctation (AC) is controversial. We reviewed our experience with balloon angioplasty (BA) in neonates and infants <= 3 months to test our thesis that BA provides successful palliation, defined as avoidance of surgery for >= 4 weeks along with control of presenting symptoms. We also compared the results of the transumbilical arterial (UA), transfemoral arterial (FA) and transfemoral venous anterograde (FVA) approaches we have used to accomplish BA. During a 6.5-year period ending June 2001, fifty-one neonates and infants <= 3 months presenting with heart failure, hypertension or both underwent UA (n = 16), FA (n = 26) and FVA (n = 9) balloon coarctation angioplasty. Immediate and follow-up results were evaluated. Acute reduction of peak-to-peak gradients across the coarctation (40 ± 17 mmHg vs. 5 ± 6 mmHg; p < 0.001), increase in diameter of the coarcted segment (2.2 ± 0.5 mm vs. 5.6 ± 0.8 mm; p < 0.001) and improvement in symptomatology occurred following BA. Surgical relief of aortic obstruction was required in 4 infants at 5, 21, 24 and 28 days after the procedure. Effective palliation was thus achieved in the remaining 47 infants (92%). During intermediate-term follow-up, twenty-two infants (50%) developed recoarctation requiring repeat balloon (n = 14) or surgical (n = 8) intervention 2?10 months (median, 3 months) after initial BA. The indication for reintervention was hypertension in all patients. At a median follow-up of 3 years (range, 0.5?5.5 years), blood pressures remained low (98 ± 11 mmHg) with an arm/leg blood pressure gradient of 4 ± 6 mmHg. Comparison of the groups revealed similar effectiveness both immediately and at follow-up. However, femoral artery complications were seen in only the FA group. Based on these data, we conclude that effective palliation is achieved with BA in all 3 groups, femoral artery complications are seen only in the FA group and BA is an excellent alternative to surgical intervention in
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Laser Angioplasty and Laser-Induced Thrombolysis in Revascularization of Anomalous Coronary Arteries
Acute coronary syndromes such as unstable angina and myocardial infarction are attributed to a pathophysiologic process that involves rupture of atherosclerotic plaque and subsequent thrombosis. Percutaneous intervention of anomalous coronary arteries in patients who present with acute coronary syndromes impose unique technical challenges related to the specific anatomic course and morphology of these vessels. Selection of appropriate guiding catheter configuration, choice of supportive guidewire, and proper delivery and activation of debulking devices and stents are important steps toward achieving adequate results. Excimer laser angioplasty is a debulking technology for removal of atherosclerotic plaque and associated thrombi. To date, application of laser angioplasty in anomalous coronary arteries is unreported. We herein present clinical data and discuss technical aspects related to performance of excimer laser angioplasty in three symptomatic patients with acute coronary syndrome, two having an anomalous right coronary artery and one with an anomalous circumflex artery. The delivery of laser energy in these cases resulted in rapid thrombolysis of an occlusive thrombus, successful debulking of the underlying atherosclerotic plaque, facilitation of adjunct balloon angioplasty and stenting, and ultimately, improved clinical condition.
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Primary Angioplasty Without On-site Surgical Back-up: The First Experience with Mobile Catherization Facility
Background and objectives. The aim of the present study is to assess the safety and efficacy of performing primary angioplasty in a center without on-site surgical back-up, and compare the data with the literature. Methods. Seventy-eight consecutive primary angioplasty procedures, performed in our center from January 2001 to February 2003, were followed prospectively. Clinical and demographic characteristics of the patients, procedural success, early and late outcomes of the patients were taken into account. The safety of angioplasty was assessed by the analysis of in-hospital complications (death, urgent need for repeat revascularization, AMI with or without ST-elevation and stroke). The angioplasty procedures were considered effective when the post-procedural residual stenosis did not exceed 50% with the distal Thrombolysis in Myocardial Infarction (TIMI) grade III flow. Results. The device success rate was 92.3%. Angiographic success rate was 88.8%. In hospital mortality rate was 4.1 %. These patients were admitted with cardiogenic shock; 1 died during the procedure and the other 2 died during hospital follow-up. One patient died suddenly and another developed acute MI during the 6-month follow-up period. No patients developed stroke or were referred for urgent surgery. Four patients (5.5%) underwent repeat angioplasty during follow-up. Conclusions. Primary angioplasty can be safely performed in centers without on-site surgery. The efficacy and safety requirements of angioplasty, performed in a center without on-site surgical back-up using a mobile catheterization facility were similar to the data obtained from the literature.
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 Electrophysiologic Perspective on the BIPOLAR RF EPICARDIAL ABLATION Procedure for Atrial Fibrillation
Complimentary Accredited Breakfast Symposium
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Location: The St. Regis San Francisco
125 3rd Street
San Francisco, CA 94103
3rd and Mission Streets
Gallery Ballroom, 2nd floor
This activity is supported by an educational grant from AtriCure, Inc.
This program is not part of the Heart Rhythm 2008 Official Scientific Sessions as planned by the Heart Rhythm Society Scientific Sessions Committee. This event is neither sponsored nor endorsed by the Heart Rhythm Society.
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 Newest Perspectives on Drug-Eluting Stents
Complimentary CME Accredited Dinner Meetings Click Here for More Info.
Miami, FL - Date: Friday, April 4, 2008 6:00pm EST -8:00 pm EST
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This activity is supported by an educational grant from Abbott Vascular.
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 CLINICAL EXPERIENCE WITH A NEW HYBRID CORONARY WIRE
On Demand Web Archive
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This activity is supported by an educational grant from Terumo Medical Corporation.
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 Pharmacoinvasive Management of Acute Coronary Syndrome: Incorporating the 2007 ACC/AHA Guidelines
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This activity is supported by an educational grant from Sanofi-Aventis.
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 Varicose Veins: Causes, Symptoms, Diagnosis and Treatment of Chronic Venous Insufficiency
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This activity is supported by an educational grant from Diomed, Inc.
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 Create a Successful Vena Cava Filter Practice
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This activity is supported by an educational grant from Cook Incorporated and has been designed for Interventional Cardiologists, Vascular Surgeons, Fellows and Interventional Cardiovascular Nurses and Technologists.
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 Achieving Optimal Outcomes in Carotid Stenting: Lessons Learned from Recent Clinical Trials
Complimentary Accredited ON DEMAND Webcast
Topics
1. EVA-3S & Space-Bumps in the road
2. CAPTURE 3500-Lesion morphology & Predictors for Stroke
3. CAPTURE II vs. EXACT 1500-Does open or Closed Cell Stent design really matter?
This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Neurologists, Interventional Nurses and Technologists with an interest in the diagnosis and treatment of peripheral artery disease. |
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 Anticoagulation Techniques for Peripheral Vascular Interventions
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This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Podiatric Physicians, Endovascular Allied Professionals, Endocrinologists, Wound Care Specialists, Directors of the Wound Care Clinic, and Primary Care Physicians, Pharmacists, Nurses and Technologists.
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 New Treatment Strategies for the Endovascular Approach to Critical Limb Ischemia: ADVANCEMENTS IN LIMB SALVAGE MEDICINE
Complimentary Accredited ON DEMAND Webcast
This activity has been developed for Interventional Cardiologists, Vascular Surgeons, Interventional Radiologists, Podiatric Physicians, Endovascular Allied Professionals, Endocrinologists, Wound Care Specialists, Directors of the Wound Care Clinic, and Primary Care Physicians, Pharmacists, Nurses and Technologists.
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 Reducing the Incidence of CIN during Cardiac Catheterization and PCI
Complimentary Accredited ON DEMAND
Educational Web Archive
This activity has been developed for nurses and technologists. |
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March 2007 Supplement
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Release Date: December 8, 2006