Acute Angiographic Results Research Articles

Treatment of ostial lesions of the left anterior descending coronary artery with Palmaz-Schatz coronary stent

We evaluated acute and long-term clinical and angiographic results of elective Palmaz-Schatz coronary stent implantation for left anterior descending coronary artery (LAD) ostial stenosis in 23 consecutive patients. Eight patients had stable angina, 14 had unstable angina, and 1 had recent myocardial infarction. Sixteen patients had single-vessel, 5 had double-vessel, and 2 had triple-vessel disease. Clinical success without major complications (death, acute myocardial infarction, emergency coronary artery bypass grafting) was obtained in all cases and technical success in 20 cases (86.9%). After stenting, minimal lumen diameter increased from 1.05 ± 0.45 mm to 2.89 ± 0.52 mm ( p < 0.001), and percent diameter stenosis decreased from 65.49% ± 13.36% to 2.94% ± 19.93% ( p < 0.001). One case of subacute thrombosis and no major bleeding occurred. Twenty patients were followed-up for 6 months, during which no acute cardiac event (death, acute myocardial infarction) was observed. Eighteen patients were eligible for follow-up coronary angiography; restenosis (≥50% diameter stenosis) was observed in 4 (22.2%). Minimal lumen diameter was 1.77 ± 0.55 mm, percent diameter stenosis was 39.66% ± 17.62%, late loss was 1.01 ± 0.69 mm, net gain was 0.79 ± 0.55 mm, and loss index (late loss/acute gain) was 0.53 ± 0.37. This study suggests that elective Palmaz-Schatz stent implantation may be a safe and successful treatment of LAD ostial lesions and provides a large increase in lumen diameter.

Direct angioplasty and stenting of the infarct-related artery in acute myocardial infarction

The results of this study show that coronary stenting in the setting of acute myocardial infarction is feasible, and that acute and 1-month angiographic results after stenting seem superior to results after standard angioplasty alone.

The nitinol self expanding coronary stent: Acute angiographic and clinical results of the pilot registry

The nitinol self expanding coronary stent: Acute angiographic and clinical results of the pilot registry

Acute clinical and angiographic results with the new AVE Micro coronary stent in bailout management

To determine the feasibility and safety of deployment of this new stent, we deployed 28 AVE Micro stents in 23 native coronary artery lesions in 20 patients who developed acute or threatened closure after balloon angioplasty (BA). Ten stents were deployed in the left anterior descending artery, 10 in the circumflex, and 8 in the right coronary artery. Luminal dimensions were measured using a computer-based quantitative coronary angiographic analysis system (CAAS II). Stent deployment was successful in 27 of 28 attempts (96%). In 1 patient with a threatened closure of the left anterior descending artery associated with proximal vessel tortuosity, attempted stent deployment was unsuccessful. The clinical course of the other 19 patients in whom stent deployment was successful was free of coronary reintervention, bypass surgery, and death. A myocardial infarction was observed in 2 patients (10%), in 1 of whom the stent was implanted within 24 hours after the onset of acute myocardial infarction, and in the other acute vessel occlusion was present for 58 minutes before stent implantation. No subacute occlusion was observed. Event-free survival at 30 days after stent implantation was 85% (17 of 20 patients). Minimal luminal diameter was 0.85 ± 0.57 mm before and 1.19 ± 0.66 mm after BA, 2.61 ± 0.39 mm during balloon inflation, 3.26 ± 0.46 mm during and 2.74 ± 0.51 mm after stenting, 3.43 ± 0.52 mm during balloon inflation after stenting (Swiss Kiss), and 2.85 ± 0.48 mm after Swiss Kiss. Average percent diameter stenosis was reduced from 69% before through 56% after BA to 17% after stenting. During the initial stent implantation, stent recoil was 0.52 ± 0.30 mm (16 ± 9% of minimal luminal diameter during stent inflation). A Swiss Kiss was performed in 14 stents with an average pressure of 14 ± 4 atm, and residual stenosis was reduced from 2.55 mm (21% diameter stenosis) to 2.85 mm (15% diameter stenosis) in these lesions. Angiographic success (<30% residual diameter stenosis) was achieved in all stented lesions. The results of this early experience would indicate that the new AVE Micro stent may be deployed with a high procedural success rate and a minimal learning curve. Implantation of the stent for the bailout management of failed BA can be achieved with a low incidence of adverse cardiac events and a high angiographic success rate.

730-2 Acute Angiographic, Intravascular Ultrasound and Clinical Results of Directional Atherectomy in the Optimal Atherectomy Restenosis Study

The Optimal Atherectomy Restenosis Study (OARS) is a 200 patient multicenter (4 sites) registry designed to assess an intravascular ultrasound (IVUS) guided “optimal” directional atherectomy (DCA) on acute angiographic results, in-hospital complications, and late outcomes. At present, preliminary acute results are available for 155 lesions in 146 consecutively treated patients. Baseline patient characteristics were age 58 ± 11 years, male gender 74%, LAD treatment vessel 54%, CCVS angina class III or IV 75%, diabetes 15%, and prior PTCA 23%. Pre-treatment target lesions were 7.9 ± 2.6 mm in length, 63% were eccentric, 13% were ulcerated, and 20% had either moderate or severe calcification. Overall, procedure success (&lt; 50% final stenosis without major complications) was achieved in 143 (98%) patients and there were in-hospital major complications in 3 (2.1%) patients including no deaths 10%). Q wave MI in 1 (0.7%), and emergency CABG in 2 (1.4%). Significant angiographic dissections ( ≥ grade C) after DCA were present in 9 (5.9%) patients and bailout stents were used to treat dissections in 4 (2.7%) without subsequent ischemic events. There was 1 perforation 10.7%) treated successfully with PTCA. Quantitative angiography was performed using an automated edge detection algorithm (CMS); reference diameter was 3.23 ± 0.48 mm and pre-treatment minimum lumen diameter (MLD) increased from 1.18 ± 0.44 mm to 2.74 ± 0.69 mm after DCA, and furtherto 3.14 ± 0.56 mm after adjunct PTCA (performed in 89% of treated lesions). Similarly, diameter stenosis was reduced from 63 ± 12% pre-treatment to 19 ± 19% after DCA to 7 ± 12% after adjunct PTCA. Sequential IVUS revealed an increase in lesion site cross-sectional area from 8.2 mm 2 following DCA to 9.0 mm 2 after adjunct PTCA (proximal reference area 10.5 mm 2 ). Despite the large final lumen dimensions (14% final cross-sectional area stenosis by IVUS). % cross-sectional narrowing (residual plaque burden) still averaged 57%. We conclude: (1) “optimal” DCA can be performed with high procedure success and few major in-hospital complications; (2) adjunct PTCA is usually required to achieve maximum lumen dimensions, and (3) despite these favorable angiographic results, IVUS reveals considerable residual plaque burden ( &gt; 50%) after “optimal” DCA.

710-3 Stent Placement is Safe and Effective in the Treatment of Older (>4 Years) Saphenous Vein Graft Lesions

Conventional balloon angioplasty (PTCA) in older (&gt;4 years) saphenous vein grafts (SVGs) is associated with reduced procedural success and less favorable late clinical outcomes. To determine if stent (S) implantation neutralizes the adverse effects of SVG age on clinical events, we analyzed the early and late results of 617 consecutive pts from the Palmaz-Schatz SVG S registry. In 69 pts (13.3%), SVG age was ≤4 (mean 2.1 ± 1.3) years and in 448 pts (86.7%), SVG age was &gt;4 (mean 9.9 ± 3.5) years. There were no significant differences in pt demographics and lesion characteristics between the 2 groups. Procedural success was defined as successful S deployment with &lt;50% residual stenosis without major complications (death/Q-wave MI/CABG). Follow-up angiograms were obtained in 63% of pts with SVG ≤ 4 years and in 60% of pts with SVG &gt; 4 years. MLD = minimal lumen diameter. SVG Age ≤ 4 years SVG Age &gt;4 years Angiographic Findings: Final MLD (mm) [% stenosis] 3.3 ± 0.7 [7 ± 12] 3.4 ± 0.6 [6 ± 10] Follow-up MLD [% stenosis] 2.1 ± 1.3 [42 ± 36] 2.3 ± 1.3 [33 ± 36] Restenosis (&gt;50% stenosis) 35.6 28.7 Clinical Results: 1%) Procedural success 97.1 97.0 In hospital death/O-wave MI/CABG 14/0/14 1.7/04/09 Follow-up target lesion CABG/PICA 57/143 54/9.5 12·month event free survival 73.0 77.0 All comparisons between the 2 groups were not statistically significant. After S placement, irrespective of SVG age, 1) acute and late angiographic results and restenosis rates were similar and 2) clinical results (i.e. procedural success, major complications, target lesion revascularization and 12-months event free survival) were comparable. Thus, unlike PTCA, in appropriate SVG lesions, the favorable early and 12-month clinical outcomes after S therapy are not diminished by advanced SVG age.

730-1 Angioscopy Guided Simpson Atherectomy – New Insights into Early Directional Coronary Atherectomy Results

Restenosis and acute complication rate in angioplasty are closely related to acute angiographic results. Short and longterm outcome after Simpson atherectomy (DCA) has not yet yielded better results than PTCA. We used angioscopy guided atherectomy to further improve atherectomy results and to gain new insights into discrepancies between excellent angiographic results and considerable complication and restenosis rate. 100 DCAs were performed in 97 pts in 63 LAD, 23 RCA, 12 CX, 1 diagonal branch and 1 bypass graft lesions. In 80 pts 83 elective, preplanned procedures and in 17 pts rescue procedures were performed. Initial angiographic success was achieved in 86% with DCA and in 90.4% with DCA plus adjunctive PTCA. Coronary angiography after DCA revealed the large size, smooth contour lumina that are known for this procedure. The table shows results in the elective DCA procedures. Angiographic results pre DCA atter DCA atter DCA + PTCA % diameter stenosis 71.1 25.5 21.1 MLD(mm) 0.91 2.37 2.63 In 63 of these pts DCA was combined with angioscopy before andlor after DCA and adjunctive PTCA in a total of 169 angioscopic procedures. Baxter 4.5-Fr. angioscopy catheters were used. Angioscopy post DCA revealed highly irregular lumina with typical grooves, large protrusions of atherosclerotic material and considerable residual luminal narrowing. The distribution of the grooves into diverse directions of the 360° vessel lumen explains the smooth endoluminal surface found in coronary angiography, which contrasts with the angioscopic results. Post DCA PTCA markedly improves angioscopic results with smoother surface and enlarged lumina. Angiographic findings after DCA are misleading. Angioscopically highly irregular surfaces with significant residual stenoses are found. Angioscopy guided atherectomy and PTCA after DCA lead to better results.

Acute angiographic and clinical results of long balloon percutaneous transluminal coronary angioplasty and adjuvant stenting for long narrowings

Historically, long coronary artery stenoses undergoing percutaneous transluminal coronary angioplasty (PTCA) are reported to have reduced procedural and clinical success in comparison with shorter lesions. The efficacy of long balloons (30 or 40 mm) in long lesions was evaluated. Eighty-two patients had 84 PTCA procedures with a primary long balloon. In all, 86 lesions were available for analysis. Data were collected prospectively on standard PTCA procedure forms. Coronary angiograms were reviewed and measured with digital calipers. Hospital charts were examined for complications. PTCA was performed in the left anterior descending artery in 44 cases (51%), the right coronary artery in 29 (34%) and the circumflex artery in 13 (15%). With the use of a modified classification system, 47 lesions (55%) were class C, 24 (28%) were class 132 and 15 (17%) were class B1. Mean lesion length was 22 ± 11 mm (range 10 to 72), and 38 lesions (44%) were ≥20 mm. Twelve patients received an intracoronary stent. The long balloon alone produced angiographic success (<50% residual stenosis) in 77 lesions (90%). Anglographic success was achieved ultimately in all stenoses, using a stent in 7 patients and a short balloon in 2. There were 2 deaths (2%) and 1 Q-wave myocardial infarction (1%). One patient needed coronary artery bypass surgery. Clinical success without death, Q-wave infarction or bypass surgery was achieved in 83 of 86 procedures (97%). In conclusion, the use of long PTCA balloons with adjuvant stenting produced excellent results in these long stenoses. Lesion length was not a precursor of poor angiographic or clinical outcome.

The Influence of Balloon Inflation Duration on the Acute Angiographic Result of Percutaneous Transluminal Coronary Angioplasty

This study was performed to evaluate the importance of the duration of balloon inflation during PTCA, 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 less than 0.001), and ST segment alteration (75 +/- 94 seconds vs 136 +/- 163, P less than 0.05). These results indicate that 60-second inflations do not produce a superior result to 30-second inflations. Furthermore, shorter inflations are much better tolerated.

Acute angiographic results of excimer laser assisted balloon angioplasty versus conventional balloon angioplasty in stable angina

Acute angiographic results of excimer laser assisted balloon angioplasty versus conventional balloon angioplasty in stable angina