Percutaneous Coronary Balloon Angioplasty Research Articles

Gender, racial and ethnic disparities in acute coronary syndromes with coronary in-stent restenosis

BackgroundCoronary in-stent restenosis (ISR) is a major clinical challenge of contemporary percutaneous revascularization and portends adverse cardiovascular outcomes. ObjectivesWe aimed to evaluate gender, race, and ethnicity related outcomes in acute coronary syndromes (ACS) with ISR. MethodsPrimary hospitalizations for ACS and ISR in the National Inpatient Sample database from 2016 to 2019 were included. Patients were stratified by gender, race, and ethnicity. The primary end points were all cause in-hospital mortality and coronary revascularization defined as composite of percutaneous coronary intervention (PCI), balloon angioplasty and/or coronary artery bypass grafting (CABG). ResultsDuring the study period, a nationally weighted total of 97,680 patients with ACS and ISR were included. There was substantial variation in comorbidities, with greatest burden among Black and Hispanic women. All-cause in-hospital mortality was 2.4 % in the study cohort, but significantly higher in women (2.1 % vs. 2.1 %; aOR: 1.282, 95 % CI: 1.174–1.4; p < 0.001) and revascularization rates were significantly lower in women (77 % vs 80.2 %; aOR: 0.891, 95 % CI: 0.862–0.921; p < 0.001). Compared to White men, all women except Hispanic women, had significantly higher likelihood of in-hospital mortality, while White women, Black men and women, and Hispanic men had lower odds of revascularization. ConclusionsThere are significant gender, racial, and ethnic related differences in revascularization practices and clinical outcomes in patients with ACS and ISR with an adverse impact on women, racial and ethnic minorities in the U.S.

Impact of impaired fractional flow reserve after coronary interventions on outcomes: a systematic review and meta-analysis.

BackgroundFFR is routinely used to guide percutaneous coronary interventions (PCI). Visual assessment of the angiographic result after PCI has limited efficacy. Even when the angiographic result seems satisfactory FFR after a PCI might be useful for identifying patients with a suboptimal interventional result and higher risk for poor clinical outcome who might benefit from additional procedures. The aim of this meta-analysis was to investigate available data of studies that examined clinical outcomes of patients with impaired vs. satisfactory fractional flow reserve (FFR) after percutaneous coronary interventions (PCI).MethodsThis meta-analysis was carried out according to the Cochrane Handbook for Systematic Reviews. The Mantel-Haenszel method using the fixed-effect meta-analysis model was used for combining the results. Studies were identified by searching the literature through mid-January, 2016, using the following search terms: fractional flow reserve, coronary circulation, after, percutaneous coronary intervention, balloon angioplasty, stent implantation, and stenting. Primary endpoint was the rate of major adverse cardiac events (MACE). Secondary endpoints included rates of death, myocardial infarction (MI), repeated revascularisation.ResultsEight relevant studies were found including a total of 1337 patients. Of those, 492 (36.8 %) had an impaired FFR after PCI, and 853 (63.2 %) had a satisfactory FFR after PCI. Odds ratios indicated that a low FFR following PCI was associated with an impaired outcome: major adverse cardiac events (MACE, OR: 4.95, 95 % confidence interval [CI]: 3.39–7.22, p <0.001); death (OR: 3.23, 95 % CI: 1.19–8.76, p = 0.022); myocardial infarction (OR: 13.83, 95 % CI: 4.75–40.24, p <0.0001) and repeated revascularisation (OR: 4.42, 95 % CI: 2.73–7.15, p <0.0001).ConclusionsCompared to a satisfactory FFR, a persistently low FFR following PCI is associated with a worse clinical outcome. Prospective studies are needed to identify underlying causes, determine an optimal threshold for post-PCI FFR, and clarify whether simple additional procedures can influence the post-PCI FFR and clinical outcome.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0355-7) contains supplementary material, which is available to authorized users.

Correlation between serum hepatocyte growth factor level and percutaneous coronary balloon angioplasty: An alternative mechanism of reduction in restenosis with citostazol

Hepatocyte growth factor (HGF) is a potent endothelium specific growth factor and cilostazol reduces restenosis after percutaneous transluminal coronary balloon angioplasty (PTCA). To investigate the correlation between HGF and PTCA, values of serum HGF were serially examined by angiographic follow-up for 3 months in 100 patients who underwent PTCA, and for 1 week in 49 patients who underwent coronary angiography (CAG). Of the PTCA group, 36 patients received cilostazol (200 mg/day) and 64 were given aspirin (250 mg/day). Angiographic restenosis was defined as ≧50% diameter stenosis (DS) at follow-up angiography. Although HGF values did not change after CAG, they increased 2 days after PTCA (0.37±0.12 ng/mL; p<0.0001 vs. 0.32±0.11 at baseline, p=0.0004 vs. 0.30±0.09 ng/mL of the CAG group). The HGF values until 1 week after PTCA was similar between the cilostazol and aspirin sub-groups. However, the values 1 month and 3 months after PTCA were significantly lower in the cilostazol (0.29±0.08 vs. 0.34±0.10 ng/mL; p=0.012, and 0.31±0.09 vs. 0.35±0.10 ng/mL; p=0.037), than in the aspirin sub-group. Follow-up angiography revealed a significantly lower DS (37.2±16.2% vs. 45.6±18.5%; p=0.009) associated with a reduced restenosis rate (16.0% vs. 37.5%; p=0.008) in the cilostazol sub-group. These data suggest systemic HGF regulation is provoked after PTCA and the subsequent change in the serum HGF level is associated with restenosis.

Organizational Resiliency: How Top-Performing Hospitals Respond to Setbacks in Improving Quality of Cardiac Care

Despite substantial improvement in recent years in hospital performance in many quality measures for acute myocardial infarction (AMI), national performance lags in a key publicly reported quality indicator for AMI--door-to-balloon time, the period from patient (with ST-segment elevation myocardial infarction or STEMI) arrival to provision of percutaneous coronary intervention or balloon angioplasty. Previous research has elucidated distinguishing features of hospitals that routinely achieved recommended door-to-balloon times for patients with STEMI. However, what has not been fully explored is how top-performing hospitals handle setbacks during the improvement process. In this study, we used qualitative methods to characterize the range of setbacks in door-to-balloon improvement efforts and the strategies used to address these barriers among hospitals that were ultimately successful in reducing door-to-balloon time to meet clinical guidelines. Setbacks included (1) failure to anticipate and address implications of initial changes in door-to-balloon processes for the system as a whole; (2) tension between and within departments and disciplines, which needed to gain consensus about how to reduce door-to-balloon time; and (3) waning attention to door-to-balloon performance as a top priority after the perceived goal of reducing treatment times had been reached. Our findings demonstrate key aspects of technical capacity, organizational culture, and environmental conditions that were factors in maintaining improvement efforts despite setbacks and hence may be critical to sustaining top performance. Understanding how top-performing hospitals recognize and respond to setbacks can help senior management promote organizational resiliency, leading to an environment in which learning, growth, and quality improvement can be sustained.

Effect of Pre-Myocardial Infarction Angina Pectoris on Post-Myocardial Infarction Arrhythmias After Reperfusion Therapy

It has not been concluded whether there is a relation between pre-myocardial infarction angina pectoris (pre-MIAP) and reperfusion arrhythmia, although pre-MIAP has been reported to have a beneficial effect in preserving left ventricular function. Moreover, factors that are associated with reperfusion arrhythmias in patients with acute myocardial infarction (AMI) who have been successfully reperfused by reperfusion therapy are unknown. This study examined the predictive factors of reperfusion arrhythmias in patients with AMI who underwent successful reperfusion. The Japanese Intervention Trial in Myocardial Infarction study is a prospective, randomized trial that compares the outcome in patients with AMI who undergo intracoronary thrombolysis or primary percutaneous conventional coronary balloon angioplasty. One hundred ten consecutive patients with AMI who had been successfully reperfused in this study were categorized into 2 groups according to whether or not patients showed reperfusion arrhythmias. Multivariate logistic regression analysis was performed using 11 clinical factors to clarify the determinants of reperfusion arrhythmia. Reperfusion arrhythmias developed in 65 of 110 patients (59%). Multivariate logistic regression analysis confirmed that inferior AMI and pre-MIAP were independently associated with reperfusion arrhythmia. The odds ratio that predicted reperfusion arrhythmias was 2.37 (p = 0.0056) for inferior AMI. In contrast, the odds ratio was minimal at 0.24 for pre-MIAP (p = 0.036). In conclusion, pre-MIAP suppresses reperfusion arrhythmias, and inferior AMI is an independent factor for reperfusion arrhythmias.

13-year follow-up of the German angioplasty bypass surgery investigation

The German Angioplasty Bypass Surgery Investigation was designed to compare symptomatic efficacy and safety of percutaneous coronary balloon angioplasty (PTCA) with coronary artery bypass surgery (CABG) in patients with symptomatic multi-vessel disease. This follow-up study was performed to determine the long-term outcome of patients following these interventions. From 1986 to 1991, 359 patients with angina CCS class II-IV, age below 75 years, and coronary multi-vessel disease requiring revascularization of at least two major coronary vessels were recruited at eight German centres and randomized to PTCA or CABG. From 337 patients undergoing the planned procedure, 324 patients could be followed-up (96%). Baseline parameters were identical in both groups, 2.2+/-0.6 vessels were treated in CABG patients, whereas 1.9+/-0.5 vessels were treated in PTCA patients. Thirty-seven per cent of surgical patients received internal mammary artery grafts, while no stents were used in patients undergoing PTCA. At the end of the 13-year follow-up period, the degree of angina, the degree of dyspnea, and the utilization of nitrates were comparable in both groups. With a total number of 76 deaths, Kaplan-Meier analysis revealed a comparable distribution in both groups. Although time to first re-intervention was significantly shorter in the PTCA group, P<0.001, frequencies of re-intervention (CABG, n=94; PTCA, n=136) and crossover rates (CABG to PTCA, n=49; PTCA to CABG, n=51) were comparable in both groups. The results of our 13-year follow-up suggest that in patients with symptomatic multi-vessel disease, both PTCA and CABG are associated with a comparable long-term survival and symptomatic efficacy. How far these results may be altered by developments such as drug-eluting stents or off-pump surgery remains to be determined.

Hirudin in acute coronary syndromes.

Acute coronary syndromes are a major cause of morbidity and mortality in Western societies. The term describes a spectrum from unstable angina, the recently defined non-Q wave infarction (the Non ST-Elevation Myocardial Infarction [NSTEMI]), to acute transmural myocardial infarction. With regard to treatment, a series of recently published studies compared the specific direct thrombin inhibitor hirudin with standard unfractionated heparin. Initial small studies showed promising results and led to the initiation of large-scale clinical trials addressing patients with acute coronary syndromes. However, in these studies, an unacceptably high incidence of serious hemorrhagic complications prompted safety boards to stop trials. In those studies carried out according to the protocol, no significant clinical benefit of hirudin over standard heparin was proved. Here, hirudin has been shown to be equivalent to unfractionated heparin for the treatment of unstable coronary syndromes with or without ST elevation and as an adjunct to percutaneous coronary balloon angioplasty. Because of its narrow therapeutic window between clinical benefit and increased bleeding hazards, hirudin should be used cautiously. For patients with heparin-induced thrombocytopenia, hirudin is accepted as an important therapeutic alternative.

Correlation Between Serum Hepatocyte Growth Factor Level and Percutaneous Coronary Balloon Angioplasty: An Alternative Mechanism of Reduction in Restenosis with Citostazol

Correlation Between Serum Hepatocyte Growth Factor Level and Percutaneous Coronary Balloon Angioplasty: An Alternative Mechanism of Reduction in Restenosis with Citostazol

Intracoronary Brachytherapy in the Porcine Model

Since the introduction of percutaneous coronary balloon angioplasty, restenosis has remained the most challenging problem facing interventional cardiologists. Stenting has reduced the need for clinically driven repeat revascularization, but has far from eliminated it. As early as 1989, intravascular brachytherapy was proposed as a means to ameliorate the proliferative component of restenosis after angioplasty. After promising results in early animal studies, brachytherapy was introduced as a treatment for the prevention of restenosis in clinical trials.1,2 This treatment was directed primarily at the very challenging subgroup of patients with in-stent restenosis. See p 2459 In the present issue of Circulation Coussement et al3 describe an unfavorable 6-month outcome after catheter-based β-irradiation in a porcine coronary model. The results described may provide some insights into the biology of restenosis inhibition with brachytherapy, or they may be a finding limited by the idiosyncrasies of this particular animal model and not directly relevant to humans. In this study, normal pig coronary arteries exposed to 20 or 30 Gy of β-irradiation delivered by a 186Re-liquid filled balloon after overdistension balloon injury demonstrated greater neointimal areas and thrombosis at 6 months compared with nonirradiated vessels. On the basis of the discrepancy between the 6-month outcomes in clinical trials and these animal data, the investigators have proposed that the “direct extrapolation of the long-term outcome of endovascular irradiation in the pig coronary artery preparation of restenosis to the human setting is not appropriate.” Before we cast aside the utility of the various animal models of restenosis, we should explore the possible differences between pigs and humans, which may have produced these divergent results. One obvious explanation is that humans have an underlying atherosclerotic process, which usually manifests in the fifth or sixth decade of life, whereas balloon injury in the pig, as in the …

Correlation between serum hepatocyte growth factor level and percutaneous coronary balloon angioplasty: An alternative mechanism of reduction in restenosis with citostazol

Correlation between serum hepatocyte growth factor level and percutaneous coronary balloon angioplasty: An alternative mechanism of reduction in restenosis with citostazol

The Changes of Ventricular Activation Time According to Acute Myocardial Ischemia

Background and Objectives:In acute myocardial ischemia, the conduction velocity of the action potential is decreased by several electrophysiological and physical factors. The ventricular activation time (VAT) is a time duration of electrical impulse propagating from the endocardium to the epicardium. The goal of this study is was to determine whether the reduction in conduction velocity in acute myocardial ischemia can lead to a change in VAT. Materials and Method:Thirty patients, 18 males and 12 females, who had received percutaneous balloon coronary angioplasty (PTCA) were enrolled. The mean age was 59 years old. A twelve lead surface electrocardiogram (ECG) was obtained before, during, and at 1, 5 and 10 minutes after the PTCA as digitized data by using Cardiolab EP 4.1 program. The magnitude of the QRS wave was amplified 3 to 4-fold and the speed was increased to 200 mm/sec in order to obtain the VAT easily and accurately. The data represents the mean of three consecutive VATs. The number of vessels treated with PTCA included the left anterior descending artery (12), left circumflex artery (9), and right coronary artery (9). Among twelve chronic stable angina, sixteen unstable angina, and two acute myocardial infarction patients, twenty six had single and four had two vessel diseases. Results:The significant increase in VAT during PTCA as compared to measurements before PTCA was observed in eight of 12 leads. In addition, the significant decrease in VAT of at 1, 5, and 10 minutes after PTCA as compared to that seen during PTCA was noted. Furthermore, 10 minutes after PTCA, VAT decreased significantly as compared to that measured before PTCA. The leads did not show a significant change of VAT depending on the target vessels. The ECG of 16 patients showed changes of the ST segment during PTCA. The changes of VAT were not related to the ST segment change. Conclusion:The conduction delay from the endocardium to the epicardium in acute myocardial ischemia was presented as a prolongation of VAT in surface ECG. In addition, the conduction delay was recovered within 5 minutes follwoing relief of ischemia. Therefore, the changes of VAT may possibly be used as one of the noninvasive parameters of myocardial ischemia. (Korean Circulation J 2001;31(3):317-326)

Perceived Health over 3 Years after Percutaneous Coronary Balloon Angioplasty

The magnitude of the benefit of percutaneous transluminal coronary angioplasty (PTCA) in terms of quality of life depending on baseline and outcome clinical variables is not sufficiently understood because of the restrictive inclusion criteria of randomized clinical trials. The present study was designed to assess perceived health outcome at 3 years and its association with clinical variables after successful elective PTCA in a tertiary hospital throughout a prospective cohort study. Questionnaires were administered on the day before the procedure and 1 month and 3.4 years later (as mean follow-up) to 106 patients recruited during a 15-month period. Mean perceived health scores improved significantly for the population as a whole 1 month after PTCA, and improvement was maintained at the end of follow-up. The magnitude of the effect was different depending on clinical subgroups: (a) It was greatest in patients free from angina, myocardial infarction, or new revascularization procedures at the end of follow-up; (b) It was moderately reduced in patients with comorbidity; (c) Patients who reported to have dyspnea or angina at rest after the latest revascularization procedure did not improve, with poor final perceived health scores. Elective PTCA is associated with a significant improvement in perceived health, which varies depending on the clinical outcome. Comorbidity and initial perceived health influence outcome but do not preclude improvement.

Coronary artery stents: appropriate use of adjunctive pharmacotherapy to prevent stent thrombosis.

In 1986, the first metallic stent was implanted inside a human coronary artery in order to reduce the incidence of abrupt vessel occlusion and restenosis after percutaneous coronary balloon angioplasty. Little was known at that time regarding the adequate anticoagulation regimen needed and the initial enthusiasm was soon marred by a high rate of thrombotic stent closure that usually occurred 2 days to 4 weeks after stent implantation. Antithrombotic drugs such as heparin, aspirin (acetylsalicylic acid), low molecular weight heparins, dextran, dipyridamole and warfarin (coumadin) were incorporated in a series of trials which reduced the risk of stent thrombosis, but increased substantially the rate of bleeding complications and the length of hospitalisation. The greatest breakthrough came with the improvement in stent deployment techniques using intravascular ultrasound-guided, high-pressure balloon inflation inside the stent, and the understanding of the central role of platelet activation in stent thrombosis. These 2 factors have led to 'optimal stent deployment' with high-pressure ballooning after stent deployment and the simultaneous use of more potent antiplatelet agents in conjunction with aspirin. Newly developed selective inhibitors of the platelet glycoprotein IIb/IIIa receptor and new stent designs have also recently been integrated into clinical practice and are currently being evaluated in clinical trials.

Time-Sequencing Morphometric Changes of Target Vessel Immediately after Percutaneous Coronary Balloon Angioplasty

Background:Plaque compression(and/or redistribution) and vessel expansion are important mechanisms of percutaneous coronary balloon angioplasty. We investigated the mechanisms of balloon angioplasty according to plaque characteristics by intravascular ultrasound and assessed the time-sequencing morphometric changes of target vessels after balloon dilation without catheter change using intravascular ultrasound balloon catheter. Methods:We studied balloon angioplasty in 10 patients(eight male, average age of 55.3 years). Quantitative coronary angiography and intravascular ultrasound images were attained at baseline and at timed intervals of 0sec, 60sec and 180sec post-balloon angioplasty. The following categories were attained:reference diameter, minimal lumen diameter, cross sectional area(CSA) of lumen(L), external elastic membrane(EEM), and plaque+media(P+M). We also assessed the plaque morphology of target lesions and classified them into two groups according to intravascular ultrasound imaging: a soft plaque group versus a group characterized by fibrous and/or mildly calcified plaque. Results:The proportion of plaque compression in the total luminal gain was 80% in the soft plaque group and 70% in the other;the absolute amount of plaque compression was 26.9% in soft plaque and 24.0% in the other group. The time sequencing changes of target lesion EEM CSA of both groups were 14.4±2.9mm, 14.3±3.8mm(baseline), 15.1±2.5mm, 15.4±3.7 mm(immediate), 15.0±2.8mm, 14.5±3.9mm(180sec), those of P+M CSA(target lesion) were 10.4±3.3mm, 10.7 ±2.4mm(baseline), 7.6±2.7mm, 8.1±2.4mm(immediate), 7.9±2.9mm, 8.5±3.4mm(180sec). Target lesion lumen CSA were 4.0±1.1mm 2, 3.6±2.0mm(baseline) 7.5 ±1.1mm, 7.3±3.2mm (immediate) 7.1±1.3mm, 6.0±1.7mm(180sec) respectively. Conclusions:Plaque compression(and/or redistribution) is the predominant mechanism of luminal

Refractory angina pectoris in end-stage coronary artery disease: Evolving therapeutic concepts

Refractory angina pectoris in coronary artery disease is defined as the persistence of severe anginal symptoms despite maximal conventional antianginal combination therapy. Further, the option to use an invasive revascularization procedure such as percutaneous coronary balloon angioplasty or aortocoronary bypass grafting must be excluded on the basis of a recent coronary angiogram. This coronary syndrome, which represents end-stage coronary artery disease, is characterized by severe coronary insufficiency but only moderately impaired left ventricular function. Almost all patients demonstrated severe coronary triple-vessel disease with diffuse coronary atherosclerosis, had had one or more myocardial infarctions, and had undergone aortocoronary bypass grafting (70% of cases). We present three new approaches with antiischemic properties: long-term intermittent urokinase therapy, transcutaneous and spinal cord electrical nerve stimulation, and transmyocardial laser revascularization. (Am Heart J 1997;134:587-602.)

Magnum Wire for Percutaneous Coronary Balloon Angioplasty in 800 Total Chronic Occlusions

The experience in consecutive procedures with 800 recanalization attempts of chronic total coronary occlusions using the Magnum wire was analyzed from a prospectively constituted computerized database. The data confirm that the Magnum wire, generally used as a primary intervention for occlusive angioplasty at our centers, is competitive with conventional systems in this setting.

An explanation for discrepancy between angiographic and intravascular ultrasound measurements after percutaneous transluminal coronary angioplasty

This study attempted to determine why there is a discrepancy between angiographic and intravascular ultrasound measurements after coronary balloon angioplasty. Previous studies have shown a poor correlation between angiographic and intravascular ultrasound measurements after percutaneous coronary balloon angioplasty. After successful balloon angioplasty, 91 lesions in 84 patients were studied by intravascular ultrasound. Plaque morphology on intravascular ultrasound was classified as demonstrating a superficial injury if there was either no fracture or only a small tear that did not extend to the media versus a deep injury defined as the presence of a plaque fracture that reached the media. Measurements of minimal lumen diameter were compared between angiography and intravascular ultrasound. On ultrasound imaging, a superficial injury pattern was observed in 44 lesions, whereas a deep injury was seen in 47 lesions. There were no statistical differences at baseline in patient or lesion characteristics. In the superficial injury group there was a significant correlation between angiography and intravascular ultrasound for minimal lumen diameter (r = 0.67) and lumen cross-sectional area (r = 0.69). In the deep injury group there was a poor correlation for minimal lumen diameter (r = 0.05) and lumen cross-sectional area (r = 0.28). After balloon angioplasty, the angiographic appearance showed a normal contour in 34%, the presence of dissection in 38% or a hazy appearance in 23%. On ultrasound imaging after angioplasty, the superficial injury group comprised 65% of lesions with a normal angiographic appearance and 67% of lesions with a hazy appearance, whereas 77% of lesions with an angiographic diagnosis of dissection were in the deep injury group by ultrasound (p = 0.0005). These observations suggest that the discrepancies between angiographic and ultrasound measurements are due to differences in plaque morphology created by balloon dilation. Superficial injuries demonstrate similar results by angiography or ultrasound, whereas a deep injury to the plaque produces a difference in measurements between angiography and ultrasound. When angiography reveals a dissection, there is a high probability that intravascular ultrasound will demonstrate a plaque fracture extending to the media.

Interventional cardiology in Chile.

In Chile the first experiences with cardiac catheterization began very shortly after Forssmann's first studies. Percutaneous coronary balloon angioplasty (PTCA) was first performed in 1982. Despite a progressively great interest and training of physicians in invasive cardiology there are still restrictions in its development. Most private institutions have modern facilities but their caseloads, ever increasing, are still limited because they take care of only 35% of the population. Public institutions are limited because of funding, and some are just developing PTCA. The situation has improved recently because of deals between the private and public systems. Experience with newer devices is even more limited.

Transradial artery coronary angioplasty

This study explored the feasibility and safety of percutaneous coronary balloon angioplasty (PTCA) with miniaturized PTCA equipment via the radial artery. Coronary angioplasty (PTCA) via the femoral or brachial arteries may be associated with rare vascular complications such as bleeding and damage to the artery and adjacent structures. It was postulated that PTCA via the radial artery with miniaturized angioplasty equipment is feasible and that no major puncture site—related complications occur because hemostasis is obtained easily and because no major structures are near the radial artery. With double blood supply to the hand, radial artery occlusion is well tolerated. In 100 patients with collateral blood supply to the right hand, PTCA was attempted with 6F guiding catheters and rapid-exchange balloon catheters for exertional angina (87 patients) or nonexertional angina (13 patients). Angioplasty was attempted in 122 lesions (type A n = 67 [55%], Type B n = 37 [30%], and type C n = 18 [15%]). Pre- and post-PTCA computerized quantitative coronary analysis was performed. Radial artery function and structure were assessed clinically and with Doppler and two-dimensional ultrasound on the day of discharge. Coronary catheterization via the radial artery was successful in 94 patients (94%). The 6 remaining patients had successful PTCA via the femoral artery ( n = 5) or the brachial artery ( n = 1). Procedural success (120 of 122 lesions) was achieved in 92 patients (98%) via the radial artery and in 98 patients of the total study population. Minimal luminal diameter increased from 0.9 ± 0.3 (0 to 1.8) to 2.0 ± 0.5 (0.6 ± 3.6) mm, and diameter stenosis was reduced from 74% ± 11% to 24% ± 11%. In 3 patients a coronary stent was implanted via the radial artery because PTCA results were suboptimal. Of 98 patients with a successful PTCA, four (4%) had acute myocardial ischemia 1 to 24 hours after the procedure. In these patients an emergency second PTCA procedure via the femoral artery was performed successfully, but in 2 patients a myocardial infarction could not be prevented. No other major cardiac complications were encountered. No major entry site—related complications were seen, and no patient required vascular surgery or blood transfusions. In 10 patients radial artery pulsations were absent at discharge, and all 10 were asymptomatic. Of these 10 patients, late recanalization was evident in 5, and in 3 patients pulsations remained absent. PTCA via the radial artery is effective and safe and minimizes major puncture site—related complications.

Percutaneous Balloon Coronary Angioplasty in the Elderly

Percutaneous Balloon Coronary Angioplasty in the Elderly