Volume 15 - Issue 1 - January, 2004

Benefits of Cutting Balloon Before Stenting

1David G. Rizik, MD, 2Jeffrey P. Popma, MD, 3Martin B. Leon, MD, 4Gary S. Mintz, MD, 5Bonnie Weiner, MD, 6Eric Cohen, MD, 4Alexandra J. Lansky, MD, 7Antoine M. Adem, MD, Andre P. Bouhasin, MD, 7Carol Wojciechowski, RN, 8Neil J. Weissman, MD

Cutting balloon (CB) technology combines the features of microsurgical incision with balloon dilation to treat atherosclerotic lesions. The CB has a non-compliant dilation balloon with microsurgical blades (atherotomes) attached to the outer surface. The cutting blades serve to radially incise the atherosclerotic lesion prior to balloon expansion. Linear incisions made by the blades facilitate expansion of the atherosclerotic lesion at lower inflation pressures, resulting in less barotrauma-related injury to the vessel wall.1 In addition, the symmetric and orderly disruption of the plaque lesi...

Percutaneous Coronary Artery Stenting of an Anomalous Right Coronary Artery with High Anterior Takeoff Using Standard Size 7

*†Benjamin I. Lee, MD, ‡Herman C. Gist Jr., MD, †Edward I. Morris, MD

The anomalous right coronary artery (RCA) with high anterior takeoff is an uncommon, yet technically difficult vessel to cannulate, moreover to intervene upon. The high anterior location of the anomalous ostium is often difficult to reach with standard catheters and because of the immediate posterior direction of the vessel, percutaneous intervention requires more secure guiding catheter support compared to the normally located RCA. Several published case studies have described the technical difficulties associated with balloon angioplasty and stenting of anomalous RCAs and successful outcomes...

Influence of Frequency of Stenting on Acute and One-Year Follow-up Results

Haresh Mehta, MD, Renate Hotz, MD, Stephan Windecker, MD, Franz R. Eberli, MD, Bernhard Meier, MD

Stents were introduced as a bail-out therapy for threatened abrupt closure1–5 following plain balloon coronary angioplasty. They were subsequently demonstrated to lower the restenosis rates in selected patient populations.6–8 The smooth appearance of the vessel after stenting has seduced the interventionist. The stenting rates are reported to be approximately 70%9 and move toward 100%. Stenting, albeit an essential and effective tool, has downsides such as stent thrombosis (still a concern in spite of newer antiplatelet drugs) and intricate in-stent restenosis. The long and diffuse variety...

Editor's Message - November 2003

Richard E. Shaw, PhD, FACC

This issue of the Journal of Invasive Cardiology coincides with the Annual Scientific Sessions of the American Heart Association and includes original research articles, case reports, a special review, two CME offerings and articles from the journal special sections “the Electrophysiology Corner,” “Clinical Decision Making” and “Clinical Images.”

The first research article, submitted by Dr. Kenneth Mahaffey from the Duke Clinical Research Institute on behalf of the ATBAT investigators, is a report of a multicenter trial examining the role of bivalirudin as adjunct therapy for ...

Benefits of Cutting Balloon Before Stenting “Cut and Stent”

*Raoul Bonan, MD and †David Meerkin, MBBS

Neointimal hyperplasic response following angioplasty (PTCA), and especially stent implantation, is linked to overstretch injury, causing modulation of the vascular cytoskeleton and subsequent production of mediators.1 These result in smooth muscle cell migration and replication, and production of extra cellular matrix.2–7 These processes associated with vascular remodeling or lack of adequate vascular compliance result in restenosis. Stents have been demonstrated to affect a larger post-angioplasty lumen.8,9 This results in reduced restenosis, in spite of an increased neointimal response wh...

Provisional Stenting Versus Routine Stenting: Is it Worth the Price?

Manesh R. Patel, MD and Eric D. Peterson, MD, MPH

On September 16th, 1977, Andreas Gruentzig performed the first coronary angioplasty on a 38-year-old man with a discrete proximal left anterior descending artery lesion. The procedure was a success, and the field of interventional cardiology was born.1,2 Percutaneous coronary intervention (PCI) grew over the next 25 years to become the dominant mode of coronary revascularization with over 1 million annual procedures performed in the United States alone. Even with its success, PCI remains in a constant state of technological evolution. The challenge for the interventionalist is to decide when i...

Sensitivity and Specificity of QCA in Detecting Coronary Arterial Remodeling After Intracoronary Brachytherapy: A Comparison to

Ken Kozuma, MD, PhD, Evelyn Regar, MD, Nico Bruining, PhD, Willem van der Giessen, MD, PhD,
Eric Boersma, PhD, David P. Foley, MD, PhD, Pim J. de Feyter, MD, PhD, *Peter C. Levendag, MD, PhD, Patrick W. Serruys, MD, PhD

For more than a decade, quantitative coronary angiography (QCA) has been the gold standard for the assessment of coronary stenosis because of its accuracy and objectivity as compared to visual and hand-held caliper measurements.1–3 After the introduction of intracoronary brachytherapy, the QCA methodology for the assessment of irradiated coronaries had to be adjusted to this new mode of therapy because of the existence of new regions of interest: the target segment, injured segment, irradiated segment and vessel segment.4 In a recent report, lumen enlargement (negative late loss) was demonst...

Beta Radiation in Lesions > 15 mm: A START Subgroup

1Richard Heuser, MD, 2Warren Laskey, MD, 3Alexandra Lansky, MD, 4Jeffrey Popma, MD, 5Raoul Bonan, MD

While stents have reduced the risk of restenosis,1–3 they induce neointimal hyperplasia,4 and rates of in-stent restenosis following intervention may be as high as 60%,5 particularly in long lesions.6 Studies of gamma-radiation therapy following treatment for in-stent restenosis have demonstrated considerable reduction in the incidence of clinical and angiographic restenosis as compared with placebo.7–11 Late thrombosis has been a problem, and while its origin is poorly understood, it appears to be linked to the short duration of ticlopidine therapy, placement of new stents or the use of m...

Intracoronary Radiation for In-Stent Restenosis in Long Lesions: Too Much, Too Little, Too Late?

Luis Gruberg, MD and Rafael Beyar, MD, DSc

“It’s not enough if I succeed, everyone else should fail.”
- Atila the Hun

Since the introduction of stents almost a decade ago, they have become the mainstream for the treatment of patients with coronary artery disease. Nevertheless, restenosis following stent implantation has been the major limitation of stents. Serial intravascular ultrasound studies have shown that restenosis after conventional balloon angioplasty represents a complex interaction between elastic recoil, smooth muscle proliferation and vascular remodeling, whereas restenosis after stent deployment is d...

Utility of Intracardiac Echocardiography to Facilitate Transvenous Coronary Sinus Lead Placement for Biventricular Cardioverter-

Todd J. Cohen, MD and George Juang, MD

Recently, with the results of the MIRACLE and COMPANION trials, there has been an increase in the demand for implanting cardiac resynchronization devices. One of the initial hurdles that the implanter must overcome is to access the coronary sinus through its ostium. However, in approximately 1–5% of cases, the coronary ostia may be difficult to identify. Muscle bands, bridges, and valves may prevent the operator from entering the coronary sinus and thereby finding an appropriate left ventricular lateral branch. A number of tools have been utilized to facilitate these difficult implants. We d...

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