Volume 14 - Issue 1 - January, 2003
Safety and Efficacy of Cutting Balloon Angioplasty: The Mayo Clinic Experience
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There have been rapid improvements in percutaneous coronary intervention since its introduction. However, complex lesions unsuitable for routine angioplasty continue to pose a significant problem. A number of alternative devices have been developed in an attempt to facilitate treatment of resistant stenoses, including laser, rotational and directional atherectomy catheters. Unfortunately, all have their limitations, not the least of which are cost and technical complexity. Cutting balloon angioplasty combines conventional balloon angioplasty with microsurgical technology in an attempt to minim
Cutting Balloon Angioplasty: To Cut is to Cure?
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The Cutting Balloon is an interventional device with 3–4 sharp microtome metal blades mounted longitudinally on the balloon surface. The microsurgical blades on the cutting balloon allow a more controlled dissection with lower inflation pressures within the coronary lesion compared to conventional balloon angioplasty. Cutting balloon angioplasty (CBA) is approved by the Food and Drug Administration for the treatment of “resistant” coronary lesions, and small studies have demonstrated some potential benefit for its application in small vessels, ostial lesions, calcified lesions and bifurc
Immediate Ambulation Following Diagnostic Coronary Angiography Procedures Utilizing a Vascular Closure Device (The Closer™)
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Achieving arterial hemostasis is a major factor limiting ambulation and hospital discharge among patients undergoing diagnostic cardiac catheterizations. Historically, manual or mechanical compression for 15–30 minutes coupled with an extended bed rest of 3–6 hours has been the standard of practice.1–8 Some studies support shorter ambulation times when 4, 5 or 6 French sheaths are utilized.4,9–12 Manual compression has been the standard by which recently introduced vascular hemostasis devices are judged with regard to efficacy, cost, complications and patient comfort.3,7,13–21 Manual
Immediate Ambulation: Closing in on the True Outpatient Catheterization
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Crocker et al., in this issue of the Journal, have demonstrated a close to 90% success rate with immediate (< 10 minute) ambulation in selected patients after diagnostic cardiac catheterization. The authors address a question
See Crocker et al. on pages 728–732
repeatedly raised by skeptics of vascular device closure: why expose the patient to potential additional risk and the hospital to additional cost if the management algorithm is not substantially changed by these devices? The skeptics will point out that these patients were kept in the recovery area for 4 hours, so the pr
Treatment of Coronary Bifurcation Lesions by Stent Implantation Only in Parent Vessel and Angioplasty in Sidebranch: Immediate a
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Treatment of bifurcation lesions still remains a challenge for interventional cardiologists and is still associated with a high rates of complications (8–22%) and restenosis (30–65%).1–5 The presence of a large plaque burden at the site of the bifurcation, even without significant stenosis at the orificium of the sidebranch, is often associated with a plaque shift (“snow plow”) after dilatation. The risk of sidebranch occlusion during main vessel angioplasty is high (12–41%)1,6 and may be associated with myocardial infarction. Although this risk may be tolerable for small sidebranc
Safety and Efficacy of a 6 French Perclose Arterial Suturing Device Following Percutaneous Coronary Interventions: A Pilot Evalu
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Arterial access site management after percutaneous coronary intervention (PCI) is a matter of increasing importance in this era of more complex procedures with frequent use of potent antiplatelet pharmacotherapy.1 The morbidity associated with post-catheterization groin complications, such as bleeding, large hematoma, pseudoaneurysm and other complications, is not frequently life threatening; however, it is often associated with profound discomfort, prolonged hospital stay, need for vascular repair, blood transfusion and increased cost.2 The Prostar suture-mediated closure device (Perclose™,
Comparison of In-hospital Outcomes Following Early or Delayed Angioplasty for Acute Myocardial Infarction
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Rapid reperfusion with fibrinolytic drugs following acute myocardial infarction (AMI) is associated with increased myocardial salvage and improved survival.1,2 However, the efficacy of these agents begins to diminish when they are administered more than six hours after symptom onset and little benefit can be demonstrated after 12 hours.2–4 In contrast, studies of primary percutaneous transluminal coronary angioplasty (PTCA) for treatment of AMI have not appeared to demonstrate a reduction in efficacy as a function of time to treatment.5–7 However, these studies were not population-based an
Intentional Internal Iliac Artery Occlusion in Endovascular Repair of Abdominal Aortic Aneurysms
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EDITORIAL NOTE — The authors have succeeded in providing a complete and yet concise summary of all the important issues concerning occlusion/exclusion of hypogastric arteries (HA) in the context of endovascular repair of aorto-iliac aneurysms. It is hard to find anything to disagree with, attesting to their vast experience and complete understanding of the subject matter.
Our own experience now exceeds 100 cases of unilateral or bilateral coil embolization, using a staged approach in virtually every instance. We have not had any serious or catastrophic ischemic complications, and
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