Conventional Percutaneous Transluminal Angioplasty Research Articles

Cutting Balloon Versus Conventional Balloon Angioplasty in Short Femoropopliteal Arterial Stenoses

To compare midterm results of cutting balloon angioplasty (CBA) to conventional percutaneous transluminal angioplasty (PTA) for the treatment of short femoropopliteal arterial stenosis. Between February 2004 and June 2006, 84 consecutive patients (49 men; mean age 68.5 years, range 53-89) with a total of 142 focal (<3 cm), calcified femoropopliteal occlusive lesions underwent endovascular treatment via an antegrade approach: 40 patients (67 lesions) were treated with PTA and 44 patients (75 lesions) underwent CBA. Follow-up consisted of clinical examination and color duplex ultrasonography at intervals to 2 years. All treatments were technically successfully, without any major complication. In 4 (6%) of 67 lesions treated with PTA, a self-expanding stent was implanted due to a flow-limiting dissection; no patient treated with CBA had recoil, dissection, or arterial tears requiring stent placement. In the PTA group, primary and secondary patency rates, respectively, were 91.0% and 95.5% at 6 months, 83.1% and 92.4% at 12 months, and 66.6% and 76.5% at 2 years. In the CBA patients, the primary and secondary patency rates, respectively, were 93.2% and 95.9% at 6 months, 90.4% (p<0.001 versus PTA at same interval) and 94.5% at 12 months, and 79.7% (p<0.001) and 85.6% (p<0.001) at 2 years. CBA seems to be a valuable tool in the endovascular treatment of short femoropopliteal stenotic lesions, achieving better patency at midterm compared to conventional PTA.

De Novo Superficial Femoropopliteal Artery Lesions: Peripheral Cutting Balloon Angioplasty and Restenosis Rates—Randomized Controlled Trial

To prospectively determine, in a randomized controlled trial, whether cutting balloon angioplasty (CBA) yields superior morphologic and clinical outcomes at 6 months compared with the 6-month outcomes after conventional percutaneous transluminal angioplasty (PTA) in patients with short de novo superficial femoropopliteal artery (SFA) lesions. This study was approved by the ethics committees of the two participating centers, and informed consent was obtained from all patients. The authors randomly assigned 43 patients (26 men, 17 women; median age, 69 years) who had 5 cm or shorter de novo SFA lesions in association with intermittent claudication or chronic limb ischemia to undergo CBA or PTA. The patients were followed up clinically, and restenosis was assessed with duplex ultrasonography (US) at 6 months. chi(2) and Mann-Whitney U tests were used to compare data between the two treatment groups. The US-determined 6-month restenosis rate was 32% (seven patients) in the PTA group versus 62% (13 patients) in the CBA group (P = .048). Sixteen (73%) PTA group patients versus eight (38%) CBA group patients were asymptomatic at follow-up (P = .059). There was no significant difference in ankle-brachial index (median, 0.83 vs 0.77 for PTA vs CBA group, respectively; P = .56) or pain-free walking distance (median, >1000 m vs 600 m for PTA vs CBA group, respectively; P = .17) between the two groups. CBA did not prove to be superior to conventional PTA for treatment of short de novo SFA lesions and yielded increased restenosis rates at 6 months.

Cutting balloon angioplasty for resistant venous stenoses of dialysis access: Immediate and patency results

To evaluate the technical success, safety and patency of cutting balloon angioplasty for the treatment of resistant dialysis access stenoses. Cutting balloon angioplasty has been proposed to be useful in treating resistant dialysis access stenoses. However, they are based on experience with very limited cases and formal patency data is insufficient. The author retrospectively reviewed 896 percutaneous transluminal angioplasty (PTA) procedures for the treatment of dysfunctional or thrombotic dialysis access. Thirty-seven of 623 patients with native fistulas and 23 of 273 patients with synthetic grafts had residual stenoses of more than 30% after conventional PTA at an inflation pressure of 24 atm for 60 sec. In these 60 patients, additional cutting balloon PTA was performed. The overall technical success rate was 96.7% and clinical success rate was 98.3%. Only one patient experienced mild local extravasation. The postintervention primary patency rates for native fistula group (N = 37) were 100%, 86.4%, and 67.5% at 1-month, 3-month, and 6-month; the postintervention primary patency rates for synthetic graft group (N = 23) were 87.0%, 60.9%, and 34.2% at 1-month, 3-month, and 6-month respectively. For resistant venous stenoses of dialysis access, cutting balloon PTA is effective, safe, and seems to provide comparative primary patency as suggested by guidelines.

Cutting Balloon Angioplasty (CBA) Versus Conventional Balloon Angioplasty (PTA) in the Pre-Dilatation of Carotid Artery Stenosis: Our Preliminary Experience

A retrospective study was carried out to evaluate the efficacy and safety of cutting-balloon angioplasty (CBA) for the predilatation of tight fibrocalcified carotid stenosis before carotid artery stenting (CAS). We also compared the intraprocedural results of CBA with those of conventional percutaneous transluminal angioplasty (PTA) in terms of postdilatation rate. The study population was composed of 32 patients who underwent CAS requiring predilatation before stent implantation. In detail, predilatation was performed by using a conventional balloon (PTA) in 14 patients (group A) and a cutting balloon (CBA) in 18 patients (group B). Intraprocedural and periprocedural mortality, major and minor procedural and neurologic complications, arterial damage, and embolic debris found in the distal filter were recorded. We statistically compared the rate of postdilatation obtained in the two groups. Technical success was obtained in 100% of the cases. No death, major neurologic or periprocedural complications, or arterial damage were recorded in either group. Minor neurologic reactions were recorded in 1 patient from group A (4%) and in 1 patient from group B (3%). Embolic debris was found in the distal filter in 2 patients from group A (8%) and in 3 patients from group B (10%). Postdilatation was necessary in 14 patients from group A (100%) and in 9 patients from group B (50%) (p < 0.05). Although limited to a small number of patients, compared with PTA, CBA seems to be a safe and effective procedure for the predilatation of tight fibrocalcified carotid stenoses before stent placement and may decrease the need for postdilatation in this patient population.

Cutting Balloon Angioplasty in Dialysis Fistulas: Let Us Start to Ask the Right Questions

Bhat and coworkers [1] describe the use of cutting balloons in a larger cohort of dialysis fistulas. They found a high technical success and an acceptable follow-up patency compared to conventional balloon angioplasty. Moreover, the results are in line with a number of other publications stating the effectivity and technical safety of cutting balloon angioplasty in dialysis patients [2–6]. However, the more expensive technique of cutting angioplasty has an alternative: the use of high-pressure balloons, with pressures up to 30 atm [7]. Trerotola and coworkers showed, in their retrospective work, that by use of extreme pressures, a high technical success is achievable [7]. Evidence-based knowledge about the use of cutting balloons in dialysis fistulas is scarce, however. In a prospective trial, Karya and coworkers found no advantage of cutting balloons regarding primary patency except for graft-to-vein stenosis [8]. Vesely et al., on the contrary, did not find a significant benefit of cutting angioplasty over conventional balloon angioplasty in the treatment of graftto-vein anastomoses [9]. The author himself is a convinced user of cutting balloons in particular highly resistant stenoses ([20–25 atm) in dialysis fistulas. However, I must admit that there is not yet striking evidence published regarding when and why to use cutting balloons in dialysis fistulas, although my daily practice and gut feeling tell me that highly resistant lesions do benefit from them and the technique is safe. Cutting balloons, however, are expensive, difficult to manufacture, and not very easy to handle. To ensure that we will keep this interesting and—in the eyes of many—important interventional tool in our hands, we have, finally, to start to ask the right questions. It is not surprising that there is no statistical difference between cutting ballons and conventional balloons in a general cohort of dialysis lesions. Patency in these lesions is influenced by a large number of factors, and probably huge cohorts need to be investigated to find a statistical difference—if that is possible. What we need to focus on is determining whether the subgroup of lesions which are resistant to high pressures, 20 atm—which have to be considered technical failures of conventional percutaneous transluminal angioplasty—will benefit from cutting balloon angioplasty regarding patency and whether there is also a long-term advantage over extreme pressure balloon angioplasty. These results, which should be gained in a prospective, randomized, and multicenter fashion, are warranted to guarantee the further availability of the fascinating tool of cutting balloon angioplasty in our hands.

Angioplasty of Long Venous Stenoses in Hemodialysis Access: At Last an Indication for Cutting Balloon?

To compare the postintervention primary patency rates of cutting balloon angioplasty (CBA) with those of conventional percutaneous transluminal angioplasty (PTA) in the treatment of hemodialysis-related stenoses at least 2 cm long. This retrospective and controlled study included 29 patients with a hemodialysis-related stenosis at least 2 cm long. From August 2002 to August 2003, nine patients (PTA group, six upper-arm and three forearm fistulas) were treated with a conventional balloon (5-8 mm, 4 cm long). From September 2003 to December 2005, 20 patients (CBA group, 12 upper-arm and seven forearm fistulas; one polytetrafluoroethylene hemodialysis graft) were treated with a cutting balloon (5-7 mm, 1 cm long). The median follow-up was 22.1 months for the CBA group and 15.6 months for the PTA group. The Kaplan-Meier method was used to calculate the primary cumulative patency rates, and the log-rank test was used for comparison. Multivariate Cox models were generated by combining three variables: patient age, stenosis length, and treatment type (CBA or PTA). In the CBA group, the postintervention primary patency was 85% +/- 16 at 6 months, 70% +/- 20 at 1 year, and 32% +/- 26 at 18 months. In the PTA group, the postintervention primary patency was 56% +/- 32 at 6 months and 21% (range, 0%-53%) at 1 year. When comparing PTA versus CBA with the log-rank test, there was a statistically significant difference (P = .009). With the multivariate Cox models, treatment was again a statistically significant (P = .007) determinant of primary patency; patient age and stenosis length were not. The use of a cutting balloon as the first-line treatment for stenoses at least 2 cm long significantly improves the postintervention primary patency rate.

Primary Patency with Cutting and Conventional Balloon Angioplasty for Different Types of Hemodialysis Access Stenosis

To compare primary patency rates of cutting balloon percutaneous transluminal angioplasty (PTA) (hereafter, cutting PTA) and conventional balloon PTA (hereafter, conventional PTA) in the treatment of different types of hemodialysis access stenosis. The institutional review board approved this study. Written informed consent was obtained for the prospective component of this study and waived for the retrospective component. Patients in whom treatment with cutting PTA alone or conventional PTA alone was clinically successful formed the two study groups. Primary patency for the lesion was defined as uninterrupted patency of the treated site after balloon PTA. A site was no longer considered patent when the patient underwent treatment for hemodialysis access failure due to restenosis of the treated site. Primary patency rates for lesions were calculated with the Kaplan-Meier method according to the type of stenosis. We compared the two groups by using the log-rank test to determine statistical significance. In the cutting PTA group, 62 patients with 77 stenoses (32 men, 30 women; mean age, 65.5 years +/- 10.1 [standard deviation]) achieved clinical success. In the conventional PTA group, 52 patients with 68 stenoses (23 men, 29 women; mean age, 61.9 years +/- 10.2) achieved clinical success. In patients with autogenous venous stenosis, no significant difference in the primary patency rate was noted between groups (P = .369). In patients with graft-to-vein anastomotic stenosis, the primary patency rate was significantly higher for cutting PTA than for conventional PTA (P = .39). In patients with intragraft stenosis, no significant difference in the primary patency rate was noted between groups (P = .379). In patients with in-stent restenosis, no significant difference in the primary patency rate was noted between groups (P = .923). Primary patency rates are significantly higher for cutting PTA in the treatment of graft-to-vein anastomotic stenosis; however, no significant differences in primary patency rates exist between these PTAs in the treatment of autogenous venous stenosis, intragraft stenosis, or in-stent restenosis.

Results of a Peripheral Cutting Balloon Prospective Multicenter European Registry in Hemodialysis Vascular Access

To report initial experience with the Peripheral Cutting Balloon (PCB) in treatment of failing hemodialysis shunts. A total of 190 patients (95 men, 95 women; average age 64.4 +/- 11.9 years, range 32-87 years) who were treated with the PCB for pressure-resistant stenosis, restenosis or failed percutaneous transluminal angioplasty (PTA) in the venous limb of an arteriovenous shunt were followed in seven European centers using a simple registry. The group consisted of 109 de novo lesions (57%) and 79 restenotic lesions (43%). Technical success was achieved in 88.9% of cases. Primary patency was as follows (the results for whole group and simultaneous results for de novo lesions and restenoses are presented): 1 month (140 patients followed): 94%, 98%, and 93%; 3 months (116 patients followed): 93%, 98%, and 92%; 6 months (40 patients followed): 85%, 92%, and 79%; 12 months (27 patients followed): 74%, 87%, and 48%. No complication occurred. Patients experienced an equal or lower level of pain during the procedure compared with conventional PTA. The PCB proved to be successful in dilating pressure-resistant stenoses. We cannot conclude whether PCB angioplasty can lower the restenosis rate in hemodialysis access lesions, but the long-term patency for de novo lesions is high. A further randomized study is advisable.

Cryoplasty — Where is the Evidence ?

Cryoplasty has been proposed as a more effective alternative to conventional percutaneous transluminal angioplasty in the management of peripheral vascular disease. In this review, we critically evaluate the current evidence to determine both the clinical efficacy and the technical issues with cryoplasty.

Percutaneous transluminal cutting-balloon angioplasty for hemodialysis access stenoses resistant to conventional balloon angioplasty

To examine the value of cutting-balloon percutaneous transluminal angioplasty (PTA) for hemodialysis access with residual stenosis after conventional balloon PTA. Angioplasty with conventional balloons was performed on 48 hemodialysis access stenoses in 28 patients. If the balloon waist still remained at the rated burst pressure, the balloon was reinflated up to three times. Fifteen of 48 stenoses had residual stenoses of more than 30% after conventional balloon PTA. In these 15 stenoses, additional cutting-balloon PTA was performed. The mean residual percent diameter stenoses before and after conventional balloon PTA were 77.6+/-3.4% and 48.6+/-8.5%, respectively. Additional cutting-balloon PTA decreased the mean residual percent diameter to 27.9+/-10.0%, and the cutting balloon was completely inflated without complication. In 12 patients, the 6-month primary patency rate (+/-SE) was 90.0% (9.5), and the 1-year primary patency rate (+/-SE) was 25.0% (14.8). Additional cutting-balloon PTA was found useful for reducing residual stenosis.

Cutting Balloon Angioplasty for the Treatment of In-Stent Restenosis in Diabetics: A Matched Comparison of 6 Months' Outcome With Conventional Balloon Angioplasty

Ranging from 24% to 55%, angiographic in-stent restenosis (ISR) rates in diabetics are higher than the 17% to 28% rates observed in nondiabetics. There are controversies regarding optimal treatment for ISR. Recently, cutting balloon angioplasty (CBA) emerged as a tool in management. The authors assessed the hypothesis that CBA has advantages over conventional percutaneous transluminal balloon angioplasty (PTCA) in treatment of ISR in diabetics. CBA or PTCA was applied to 165 diabetics (267 ISR lesions) in their institution. With a computer algorithm, an attempt was made to match each lesion in the CBA group with a corresponding lesion in the PTCA group. The lesion pairs should match with respect to the patients' age and gender, type of target vessel and stent, reference vessel diameter, and baseline minimal lumen diameter (MLD). Following the matching process, 55 ISR lesion pairs were identified. Baseline patient characteristics were similar among the groups (p = NS). There was no difference in the in-hospital major adverse cardiac events (MACE) between the groups, whereas MACE at follow up was significantly lower in the CBA group compared to the PTCA group (CBA, 20.0% vs PTCA, 43.6%, p<0.05). The recurrent ISR rate was significantly lower in the CBA group compared to the PTCA group (CBA, 27.3% vs PTCA, 49.1%; p < 0.05). Also, a diffuse pattern of recurrence was more common in lesions treated with PTCA, whereas a focal pattern of recurrence was more common in the CBA group. The minimal luminal diameter at follow-up, the acute gain, and net gain were significantly higher in the group of lesions treated with CBA than in the PTCA group. In addition, a significantly higher late loss and loss index at follow-up were observed in the PTCA group compared to the CBA group. CBA has advantages over PTCA in treatment of diabetic patients with ISR, with better immediate and follow-up angiographic outcomes, and better follow-up clinical outcome.

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Invited commentary

The role of endoluminal therapy in the treatment of peripheral arterial disease is dramatically expanding.1Anderson P.L. Gelijns A. Moskowitz A. et al.Understanding trends in inpatient surgical volume vascular interventions, 1980–2000.J Vasc Surg. 2004; 39: 1200-1208Abstract Full Text Full Text PDF PubMed Scopus (129) Google Scholar Skeptics of endovascular therapy oft opine that PTA [percutaneous transluminal angioplasty] works best for those least in need of intervention, thus suggesting that PTA is reasonable for claudicants with focal lesions but has little to offer patients with critical limb ischemia (CLI). Ahn et al report a 10-year experience with a cohort of CLI patients managed by endoluminal therapy. Over the study period, 111 patients (128 limbs; 63% of total) with CLI were treated by PTA alone, whereas 76 limbs (37%) required open surgery. Technical success was 96%, clinical success was 93%, 30-day mortality was 0.9%, and long-term limb salvage was 89%. At first glance, these results in CLI patients after PTA are quite comparable to those of open surgery and seem astonishing. However, the devil is in the details. The mean follow-up was short (14.7 months) and likely reflected not only a shift toward less invasive approaches in recent practice, but also the sobering reality that patients with CLI do not live long (5-year series mortality of 56%). Many malignancies have superior survival rates. In addition, 45% of patients had rest pain without tissue loss, and 33% required only iliac PTA. It is no surprise that PTA for hemodynamic iliac lesions often resolves ischemic rest pain. Results were predictably worse in patients with tissue loss and multiple, distal, or TransAtlantic Inter-Society Consensus D lesions. Primary patency was low (31% at 5 years), but secondary patency was 76%; this implies the necessity for reintervention. The authors do not provide the frequency, morbidity, or costs of repeat interventions. Primary patency, however, may not be the ultimate objective of CLI treatment. A 5-year clinical improvement rate (defined by Society of Vascular Surgery category) of 80% and a 6-year limb salvage rate of 89% are more meaningful end points. What are the implications of this report? First, it is imperative that vascular surgeons become facile with thrombolysis, conventional PTA, subintimal angioplasty, newer technologies such as cutting balloons, and stent placement. These evolving therapies are applicable to an increasing percentage of our patients. Second, treatment outcomes require redefinition. Long-term patency should not be the Holy Grail of outcome assessment, particularly for CLI, in which symptom relief, lesion healing, and limb salvage, with minimal morbidity, are more critical end points. Open surgery offers excellent patency rates, but morbidity is significant.2Goshima K. Mills J.L. Hughes J.D. A new look at outcomes after infrainguinal bypass surgery traditional reporting standards systematically underestimate the expenditure of effort required to attain limb salvage.J Vasc Surg. 2004; 39: 330-335Abstract Full Text Full Text PDF PubMed Scopus (140) Google Scholar Finally, it is clear that as the proportion of peripheral arterial disease patients effectively treated by endoluminal therapy expands, the numbers of open cases for practicing vascular surgeons and resident trainees will continue to wane. A recent report identified the difficulty in providing adequate numbers of open distal reconstructions for vascular surgical trainees because of the shift toward subintimal angioplasty.3Nasr M.K. Taylor P.J. Horrocks M. Vascular training in the UK femorodistal bypass, an index procedure?.Eur J Vasc Endovasc Surg. 2003; 25: 135-138Abstract Full Text Full Text PDF PubMed Scopus (2) Google Scholar New clinical training paradigms for residents and changes in the residency review committee case volume and distribution (open vs PTA) requirements will need to be rapidly implemented. Although there will be a role for tibial bypasses and complex, open reconstructions for the foreseeable future, “admit that the waters, around you have grown … for the times they are a changin’.”4Dylan B. The. Columbia Records, New York1964Google Scholar The effectiveness of percutaneous transluminal angioplasty for the treatment of critical limb ischemia: A 10-year experienceJournal of Vascular SurgeryVol. 41Issue 3PreviewTo determine the efficacy, safety, and long-term results, including continued clinical improvement and limb salvage, of percutaneous transluminal angioplasty (PTA) in patients with critical limb ischemia (CLI). Full-Text PDF Open Archive

Cutting Balloon Angioplasty for Resistant Renal Artery In-Stent Restenosis

A 76-year-old woman presented with recurrent arterial hypertension 6 months after uncomplicated primary renal artery stent placement. Diagnostic arteriography revealed severe renal artery in-stent restenosis. On repeat intervention, the lesion was resistant to attempted conventional percutaneous transluminal angioplasty (PTA) with unchanged systolic pressure gradients across the stent. Cutting balloon angioplasty (CBA) was performed with use of a 4-mm cutting balloon (IVT, San Diego, CA). CBA successfully reduced the pressure gradient to below the level of significance. Subsequent conventional PTA enhanced the lumen diameter inside the stent. The arterial hypertension reverted to normal values and duplex ultrasonography (US) at 10-month follow-up demonstrated normal renal artery hemodynamics without stenosis. CBA for potential use in renal artery in-stent restenosis and other peripheral neointimal hyperplasia is discussed.

頸部頸動脈狭窄に対するステント留置術

We present the results of percutaneous transluminal angioplasty (PTA) with/without stenting for cervical internal carotid artery (ICA) stenosis. A total of 36 high-grade stenoses (> 70%) in 31 patients were treated, in which 25 lesions in 20 patients were treated with PTA and 11 lesions in 11 patients were treated with stenting. All patients were successfully treated and no adverse events occurred during procedures. Postprocedural angiography showed that significantly larger diameters were obtained in stenting group than in PTA group. Dissection occurred in 6 (24%) patients in the PTA group, whom 1 patient was subsequently treated with carotid endarterectomy and 2 with stenting. In contrast, no dissection was observed in the stenting group. Restenosis occurred in 4 (16%) in the PTA group, but not in the stenting group. As postoperative complications, ischemic neurological deterioration was observed in 1 patient in the PTA group, and 1 ipsilateral subcortical hemorrhage and 1 myocardial infarction were observed in the stenting group. No stent deformation was observed during follow-up period. These results suggest that stenting provides a lower rate of dissection and restenosis than conventional PTA as a treatment for cervical ICA stenosis. Stenting may be a promising method to treat these lesions. Appropriate stents for carotid stenosis and brain protection system should be developed.

Laser angioplasty of peripheral arteries after unsuccessful recanalization of the superficial femoral artery.

AIM: To demonstrate the range of applying laser angioplasty after unsuccessful recanalization of the superficial femoral artery (SFA) with conventional interventional techniques. MATERIALS AND METHODS: In a prospective trial in 94 cases with occlusion of the SFA and formerly unsuccessful conventional percutaneous transluminal angioplasty, laser angioplasty for recanalization was applied. The average occlusion length of the SFA was 17.5 cm (range 4-36 cm). The recanalization attempt was made using the crossover technique in 78 patients, in eight patients with the antegrade technique and in another eight patients using the transpopliteal technique. The primary recanalization attempt was performed with Terumo wires (curved and straight) as well as different catheters (Multipurpose/Vertebralis/Cobra). After the unsuccessful recanalization attempt the laser catheter was applied. RESULTS: The application of laser angioplasty demonstrated a successful recanalization of the SFA in 76/94 patients (80.9%). In 18 patients (19.1%) the recanalization was not possible even with percutaneous transluminal laser angioplasty (PTLA). The reason for the unsuccessful PTLA was in 10 cases due to obstructing calcified material, which was resistant to PTLA application. In four cases obstructing calcifications caused the laser catheter to be positioned in subintimal tissue, resulting in perforation of the SFA. In another four patients there was an aberrant anatomy of the SFA which resulted in a direct vessel injury after advancing the laser catheter. After a follow-up period of 12 months primary, primary-assisted and secondary patency rates were 50.0%, 65.8% and 73.7%, respectively. DISCUSSION: In primarily unsuccessful recanalization of the SFA, PTLA allows in 80% of cases a successful recanalization of the SFA. The technical success rate and the patency rate support the application of PTLA.

Adenovirus-mediated gene transfer to lower limb artery of patients with chronic critical leg ischemia.

Arterial gene transfer offers a promising new approach for the treatment of vascular disorders. However, no data are available about the gene transfer efficiency in human arteries in vivo. The aim of this study was to evaluate the safety and feasibility of catheter-mediated adenoviral gene transfer in human peripheral arteries. Ten patients (8 females, 2 males, mean age 80 +/- 8 years) suffering from chronic critical leg ischemia with a prior decision for amputation were recruited in the study. Gene transfer was performed in eight patients in conjunction with a conventional percutaneous transluminal angioplasty, using a perfusion coil balloon catheter. Two patients served as controls. Increasing concentrations of replication-deficient adenoviruses (titers from 1 x 10(8) to 4 x 10(10) PFU) containing a nuclear-targeted beta-galactosidase marker gene were administered into the arteries over 10 min via the catheter. Amputations were performed 20 to 51 hr after the procedures and gene transfer efficiency was evaluated in the transduced arteries using X-Gal staining for beta-galactosidase activity. Beta-galactosidase gene transfer was well tolerated and no adverse tissue responses or systemic complications were observed in any of the patients. Gene transfer was successful in six of the eight patients. Gene transfer efficiency varied between 0.04 and 5.0% of all arterial cells. Transgene expression was detected in smooth muscle cells, endothelial cells, and macrophages and in tunica adventitia. However, transgene activity was not evenly distributed in the arterial wall and no transgene activity was found beneath advanced atherosclerotic lesions. The safety and feasibility of in vivo gene transfer by adenoviral vectors to human peripheral arteries were established. Although improvements are still required in gene transfer efficiency, these findings suggest that adenoviruses can be used to deliver therapeutically active genes into human arteries.

Comparison of Conventional Angioplasty with the Palmaz Stent in the Treatment of Abdominal Aortic Stenoses from the STAR Registry

To retrospectively compare the safety and short-term efficacy of conventional percutaneous transluminal angioplasty (PTA) and PTA with the Palmaz balloon-expandable intravascular stent for the treatment of infrarenal abdominal aortic atherosclerotic stenoses. The records of 25 patients with infrarenal aortic stenoses treated by means of percutaneous techniques were retrieved from the SCVIR Transluminal Angioplasty and Revascularization (STAR) Registry and analyzed. Thirteen patients were treated with PTA alone and 12 were treated with the Palmaz intravascular stent. Technical success was achieved in 92% of patients treated with PTA alone and in 100% of those treated with the Palmaz stent. Significant improvements in lesion morphology, hemodynamics, clinical status, and ankle arm indexes were shown in both groups. There was no statistically significant difference in percent stenosis reduction, decrease in trans-stenotic gradient, or initial clinical outcome between the group treated by means of PTA and the group treated by means of PTA with the Palmaz stent. PTA and intravascular stent placement of atherosclerotic stenoses involving the infrarenal aorta are both safe and efficacious therapeutic modalities. At present, it does not appear that primary stent placement confers any short-term benefits over technically successful PTA in aortic stenoses.

Hemodialysis fistulas and grafts: use of cutting balloons to dilate venous stenoses.

To evaluate percutaneous transluminal angioplasty (PTA) with a cutting balloon performed in stenosed hemodialysis fistulas and grafts, 19 venous lesions in 15 patients were treated with a cutting balloon with an inflated diameter of 3-6 mm. The grade of stenosis ranged from 40% to 90% (mean, 65% +/- 15 [standard deviation]). Cutting PTA was performed before conventional PTA in seven patients and was followed with conventional PTA with larger balloons in seven patients. The balloon expanded completely in all patients, and no balloon waist remained. The mean grade of stenosis decreased to 14% +/- 9. Cutting PTA increased the technical success of balloon dilation of hemodialysis fistulas and grafts.

A study of the radiological use of laser angioplasty in Britain

Laser recanalization was introduced and developed in Britain in the 1980s in an attempt to deal with the limitations associated with the conventional technique of percutaneous transluminal angioplasty (PTA). Since then, the use of this technique has decreased. This paper reports the findings of a comprehensive literature survey and interviews with a representative sample of British interventional radiologists on the reasons for this decline, and suggests the likely future direction for this technology. It has been determined that the main reasons for the decline are improvements in conventional guidewire and catheter technology, the high cost of the laser system, and the lack of evidence of any improvement in results compared with conventional PTA. However, despite current disenchantment, the majority of radiologists questioned felt that lasers could have a future role to play and that development of these systems should continue.