1
|
Adams MR, Orford JL, Blake GJ, Wainstein MV, Byrne JG, Selwyn AP. Rescue percutaneous coronary intervention following coronary artery bypass graft--a descriptive analysis of the changing interface between interventional cardiologist and cardiac surgeon. Clin Cardiol 2006; 25:280-6. [PMID: 12058791 PMCID: PMC6654698 DOI: 10.1002/clc.4960250607] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Despite decreasing rates of acute and subacute complications of percutaneous coronary intervention (PCI), these procedures are generally only performed in centers where it is possible for failed PCI to be treated by rescue coronary artery bypass graft (CABG). Case reports and case series have documented successful PCI following failed CABG. We sought to confirm this decrease in the need for rescue CABG following failed PCI and to examine trends in the utilization of rescue PCI following failed CABG. HYPOTHESIS The interface between interventional cardiologist and cardiac surgeon is characterized by changing practice patterns and resource utilization. METHODS We examined the medical records of all patients admitted to the Brigham and Women's Hospital over a 7-year period and identified 169 patients who required both PCI and CABG during the same hospital admission. We describe and compare three predetermined groups of patients defined by the sequence of, and indication for, the relevant myocardial revascularization procedures. RESULTS In all, 100 patients required CABG for failed PCI, 46 patients had planned hybrid procedures involving both CABG and PCI, and 23 patients required PCI following failed CABG. There was a decrease in the need for rescue CABG following failed PCI, both in total numbers and as a percentage of total cases (2.5% in 1994 and 0.22% in 1999). There was a simultaneous increase in the utilization of rescue PCI following failed CABG (0% in 1994 and 1.6% in 2000). Hybrid procedures were identified as a source of innovative solutions to a variety of challenging clinical problems. CONCLUSIONS Changing patterns of resource utilization should be considered when planning hospital facilities and patient triage, and these patients undergoing percutaneous or surgical revascularization may benefit from close cooperation between the cardiac surgeon and the interventional cardiologist.
Collapse
Affiliation(s)
- Mark R. Adams
- Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - James L. Orford
- Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Gavin J. Blake
- Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Marco V. Wainstein
- Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - John G. Byrne
- Department of Cardiothoracic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Andrew P. Selwyn
- Department of Cardiology, Brigham and Women's Hospital, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Zheng H, Pentousis D, Corcos T, Favereau X, Guérin Y, Ouzan J, Toussaint M. Bilateral internal mammary angiography through a right radial approach: a case report. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1998; 45:188-90. [PMID: 9786401 DOI: 10.1002/(sici)1097-0304(199810)45:2<188::aid-ccd18>3.0.co;2-h] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This case report demonstrates that bilateral internal mammary angiography through a single right-radial approach is feasible and convenient. It avoids double-brachial or radial artery puncture, is adapted to the variable characteristics of right internal mammary artery origin, and may be considered when the femoral approach is contraindicated.
Collapse
Affiliation(s)
- H Zheng
- Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing
| | | | | | | | | | | | | |
Collapse
|
3
|
Ishizaka N, Ishizaka Y, Ikari Y, Isshiki T, Tamura T, Suma H, Yamaguchi T. Initial and subsequent angiographic outcome of percutaneous transluminal angioplasty performed on internal mammary artery grafts. Heart 1995; 74:615-9. [PMID: 8541165 PMCID: PMC484116 DOI: 10.1136/hrt.74.6.615] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE To estimate the initial outcome and incidence of restenosis of angioplasty of internal mammary artery grafts in a retrospective study. METHODS The study population consisted of 46 patients (48 lesions) who underwent first balloon angioplasty within the internal mammary artery graft. Most (37/48) were at the distal anastomosis. A few (8/48) were in the graft body. Six patients with the evidence of angiographic restenosis underwent a second angioplasty. RESULTS The success rate and the restenosis rate of the first angioplasty was 73% and 30% respectively. Of the 34 patients (35 lesions) with a successful first angioplasty, 30 underwent follow up angiography with a restenosis rate of 30% (9/30). A second angioplasty was performed on six of the nine restenotic lesions, with a success rate of 83% and no restenoses. The percent diameter stenosis of the recipient native coronary artery was significantly greater in the restenosis group, at 75 (SD 27)% v 89 (17)%, p < 0.05. CONCLUSIONS First angioplasty of 46 patients (48 lesions) within an internal mammary artery graft was performed with a success rate of 73% and a restenosis rate of 30% (follow up rate of 88%). The extent of the stenosis of the recipient native coronary artery may affect the restenosis rate.
Collapse
Affiliation(s)
- N Ishizaka
- Division of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan
| | | | | | | | | | | | | |
Collapse
|
4
|
Hadjimiltiades S, Gourassas J, Louridas G, Tsifodimos D. Stenting the distal anastomotic site of the left internal mammary artery graft: a case report. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1994; 32:157-61. [PMID: 7914832 DOI: 10.1002/ccd.1810320211] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The major problem associated with the long-term patency of the internal mammary artery graft is the early occurrence of stenosis usually at its distal anastomotic site; its management by balloon angioplasty has been associated with a high success rate. We report the case of an unsuccessful balloon angioplasty of an anastomotic stenosis of a left internal mammary artery graft that was successfully managed by stenting with one-half of a Palmaz-Schatz stent.
Collapse
|
5
|
Mishkel GJ, Willinsky R. Combined PTCA and microcoil embolization of a left internal mammary artery graft. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1992; 27:141-6. [PMID: 1446337 DOI: 10.1002/ccd.1810270214] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Internal mammary arteries are increasingly common conduits for coronary revascularization. Although infrequent, cardiologists are faced with a number of technical failures. We describe a case of combined PTCA to a LIMA insertion stenosis, along with coil embolization of a large unligated intercostal side branch. A complication of embolization is described along with angiographic follow-up.
Collapse
Affiliation(s)
- G J Mishkel
- Division of Cardiology, Sunnybrook Health Science Center, Toronto, Canada
| | | |
Collapse
|
6
|
Brown RI, Galligan L, Penn IM, Weinstein L. Right internal mammary artery graft angioplasty through a right brachial artery approach using a new custom guide catheter: A case report. ACTA ACUST UNITED AC 1992; 25:42-5. [PMID: 1348212 DOI: 10.1002/ccd.1810250109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Angioplasty of right internal mammary artery grafts may present problems because of the variable origin of the mammary artery and its angulation from the subclavian artery. We report a case of successful angioplasty using a custom designed guide catheter, after failed attempts using conventional guide catheters.
Collapse
Affiliation(s)
- R I Brown
- Division of Cardiology, Victoria Hospital Corp., London, Ontario, Canada
| | | | | | | |
Collapse
|
7
|
Dimas AP, Arora RR, Whitlow PL, Hollman JL, Franco I, Raymond RE, Dorosti K, Simpfendorfer CC. Percutaneous transluminal angioplasty involving internal mammary artery grafts. Am Heart J 1991; 122:423-9. [PMID: 1858621 DOI: 10.1016/0002-8703(91)90995-t] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
With the increasing use of the internal mammary artery as the conduit of choice in coronary bypass surgery, it is anticipated that an expanding patient population will have stenosis, usually at the site of internal mammary-to-coronary artery anastomosis. In our series 31 patients underwent dilatation at either the site of anastomosis (24), the native coronary artery beyond the anastomosis (4), or both (3) with no mortality, myocardial infarction, or need for emergency coronary artery bypass surgery. Angiographic and clinical success was achieved in 28 patients (90%). There were two internal mammary artery dissections with both patients requiring elective coronary bypass surgery. Of the patients in whom dilatation was successful, 22 (79%) have been followed for longer than 6 months and 19 (86%) have had sustained functional improvement at a mean of 35 months after angioplasty. One patient is to undergo repeat coronary bypass surgery. No patient has had a myocardial infarction or died during follow-up. Although percutaneous transluminal coronary angioplasty of the internal mammary artery has inherent difficulties because of the anatomic characteristics of the vessel, it can be performed with a high degree of primary success and a low incidence of complications and can provide long-term clinical improvement.
Collapse
Affiliation(s)
- A P Dimas
- Department of Cardiology, Cleveland Clinic Foundation, OH 44195-5066
| | | | | | | | | | | | | | | |
Collapse
|
8
|
Watson LE, Schoolar EJ. PTCA of gastroepiploic bypass. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1991; 22:193-6. [PMID: 2013084 DOI: 10.1002/ccd.1810220309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
A technique for percutaneous transluminal coronary angioplasty (PTCA) of gastroepiploic bypass is described using standard PTCA devices. Severe spasm of gastroepiploic bypass occurred. Modification of guide catheter position is suggested to avoid inducing gastroepiploic bypass spasm.
Collapse
Affiliation(s)
- L E Watson
- Division of Cardiology, Scott and White Clinic, Temple, TX 76508
| | | |
Collapse
|
9
|
Spaccavento LJ, Breisblatt WM. Use of femoral artery guiding catheters via the left brachial artery for transluminal coronary angioplasty. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1990; 20:182-4. [PMID: 2364416 DOI: 10.1002/ccd.1810200306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Percutaneous transluminal coronary angioplasty using the right brachial artery has been described using either a cutdown and arteriotomy or a percutaneous entry. Each method requires the use of a brachial artery guiding catheter (Stertzer guiding catheter; (USCI). This communication reports the use of percutaneous entry of the left brachial artery and coronary angioplasty performed with femoral guiding catheters. In this manner coronary angioplasty has been successfully performed in 42 of 47 patients (90%) without major complications.
Collapse
Affiliation(s)
- L J Spaccavento
- Cardiology Service/SGHMMC, Wilford Hall USAF Medical Center, Lackland AFB, TX 78236-5300
| | | |
Collapse
|
10
|
Morrison DA. Coronary angioplasty for medically refractory unstable angina in patients with prior coronary bypass surgery. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1990; 20:174-81. [PMID: 1973073 DOI: 10.1002/ccd.1810200305] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Percutaneous transluminal coronary angioplasty (PTCA) has been applied with good results to selected patients with unstable angina and to selected patients who have had prior bypass surgery. The population with prior bypass and unstable angina has not been specifically evaluated. This report reviews the results of angioplasty of 45 vessels in 34 patients with medically refractory unstable angina and at least one prior bypass heart surgery. Of these 34 patients, 32 had rest angina; 14 had resting electrocardiographic changes, all 34 were on aspirin 325 mg QD, 31 were on a calcium blocker, 22 were on a beta blocker, 9 were on intravenous nitroglycerin, and 5 required intraaortic balloon counterpulsation for temporary stabilization. Angioplasty of a vein graft was attempted in 17 patients; the left internal mammary was attempted in 4 patients; 24 native coronary arteries in 15 patients were attempted; 3 of the native arteries were protected left main arteries. Of the LIMA angioplasties, 3 were successful; in the 1 unsuccessful case, the occluded anterior descending artery was opened. Of the 17 vein grafts, 16 were successful: 1 had an acute occlusive syndrome and went to surgery with a balloon pump and bail out catheter; his recovery was uneventful. Of the 24 native artery angioplasties, 22 were successful: one patient was technically unsuccessful in the only vessel attempted; he went to semiemergent surgery and recovered uneventfully. In the other, a right coronary lesion was successfully dilated, but an occluded anterior descending artery was not opened. There were no deaths or in-hospital myocardial infarctions.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- D A Morrison
- Department of Cardiology, Denver Veterans Administration Medical Center, CO 80220
| |
Collapse
|
11
|
Kuntz RE, Baim DS. Internal mammary angiography: a review of technical issues and newer methods. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1990; 20:10-6. [PMID: 1971523 DOI: 10.1002/ccd.1810200104] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Up to 90% of coronary bypass operations in some centers now include at least one IMA graft. In parallel with the increased use of IMA grafts, our catheterization laboratory records for 1986-7-8 demonstrate a progressive increase in IMA angiography, both absolutely (11, 28, 48 cases/yr) and as a percent of restudy procedures performed after prior bypass (14, 25, 43%). Unfortunately, these records also show that cannulation of the right and left IMAs may involve substantial technical hurdles, resulting in a mean time of 19 +/- 19 min from catheter insertion to selective IMA angiography. Based on this experience, we review a standard technique for IMA angiography using preformed catheters, and describe alternative methods (including use of PTCA guidewires with or without super-selective catheters, and non-selective angiography utilizing a specially designed balloon occlusion catheter).
Collapse
Affiliation(s)
- R E Kuntz
- Charles A. Dana Research Institute, Beth Israel Hospital, Boston, MA 02215
| | | |
Collapse
|
12
|
Avedissian MG, Killeavy ES, Garcia JM, Dear WE. Percutaneous transluminal coronary angioplasty: a review of current balloon dilatation systems. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1989; 18:263-75. [PMID: 2691101 DOI: 10.1002/ccd.1810180416] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
The interventional cardiologist is faced with an expanding armamentarium for performing percutaneous transluminal coronary angioplasty (PTCA). Because of rapid advances in technology, new devices are produced on a regular basis, making it difficult to maintain a working knowledge of what is available. Although several excellent textbooks about PTCA have been written, descriptions of available equipment are usually obsolete by the time publication occurs. In order to provide succinct specifications of equipment, we have documented data on balloon catheters, guiding catheters, and guidewires. This information may be useful in the selection of appropriate equipment for PTCA procedures. In addition, the publication of such data in a monthly periodical may provide a more current overview of equipment; information may be occasionally updated as new equipment is released.
Collapse
Affiliation(s)
- M G Avedissian
- Department of Adult Cardiology, Texas Heart Institute, St. Luke's Episcopal Hospital, Houston
| | | | | | | |
Collapse
|
13
|
Holmes DR, Cohen HA, Vlietstra RE. Optimizing the results of balloon coronary angioplasty of nonideal lesions. Prog Cardiovasc Dis 1989; 32:149-70. [PMID: 2528173 DOI: 10.1016/0033-0620(89)90023-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Affiliation(s)
- D R Holmes
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905
| | | | | |
Collapse
|
14
|
Bell MR, Holmes DR, Vlietstra RE, Bresnahan DR. Percutaneous transluminal angioplasty of left internal mammary artery grafts: two years' experience with a femoral approach. Heart 1989; 61:417-20. [PMID: 2525399 PMCID: PMC1216693 DOI: 10.1136/hrt.61.5.417] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Percutaneous transluminal angioplasty via the femoral approach was attempted through internal mammary artery grafts in 11 patients who presented with distal anastomotic stenoses or distal native coronary artery stenoses and angina pectoris. The procedure was technically successful in 10 patients and no major complications occurred. During follow up there was one late death, but all 10 surviving patients showed functional improvement. Percutaneous transluminal angioplasty seems to be a safe and effective treatment for stenoses of internal mammary artery grafts. This is an effective technique for treating the increasing number of patients who are likely to present with stenoses of these grafts.
Collapse
Affiliation(s)
- M R Bell
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
| | | | | | | |
Collapse
|
15
|
Pinkerton CA, Slack JD, Orr CM, Vantassel JW, Smith ML. Percutaneous transluminal angioplasty in patients with prior myocardial revascularization surgery. Am J Cardiol 1988; 61:15G-22G. [PMID: 2966560 DOI: 10.1016/s0002-9149(88)80027-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Direct myocardial revascularization surgery using either the saphenous vein or internal mammary artery has become the definitive surgical treatment for coronary artery occlusive disease. Certain patients who have undergone these procedures, however, have recurrent myocardial ischemia due to progression of disease in unbypassed vessels, to obstruction in the arteries distal to the insertion of the bypass conduit, or to disease of the conduit itself. Balloon angioplasty may be used to relieve myocardial ischemia in these situations; however, initial studies suggested a low primary success rate coupled with excessive mortality and morbidity. Improvements in patient selection, equipment and technical expertise now allow angioplasty to be performed in this patient population with results comparable to that in the general coronary angioplasty population. Of the 3,016 angioplasty procedures performed between September 1980 and June 1987, 236 patients had previously undergone revascularization surgery. The primary success rate was 93% (390 of 419 stenoses successfully dilated). Overall, clinical restenosis was observed in 39%, including a 43% restenosis rate in patients undergoing only saphenous vein graft angioplasty. This did not differ appreciably from the restenosis rate in postbypass patients undergoing angioplasty of only native vessels (37%) or internal mammary arteries (42%). Emergency revascularization surgery was required in 7 of 236 patients (3%), each of whom had myocardial infarction. One of 236 patients (0.4%) died. Thus, angioplasty may be used to relieve recurrent myocardial ischemia in patients with prior direct myocardial revascularization procedures with a high initial success rate and acceptable risk. Early (less than 6 months) restenosis is not infrequent and remains the largest obstacle to a satisfactory clinical outcome.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- C A Pinkerton
- Indiana Heart Institute, St. Vincent Hospital and Health Care Center, Indianapolis 46260
| | | | | | | | | |
Collapse
|
16
|
Klein AL, Marquis JF, Higginson LA. Percutaneous transluminal angioplasty of a surgically obstructed left internal mammary artery graft. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1988; 14:46-8. [PMID: 2964905 DOI: 10.1002/ccd.1810140111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
We describe a case of an angioplasty of left internal mammary artery. This case had had a recent surgery and was found to have a stenosis at the site of a surgical clip. This was successfully dilated, and the patient became asymptomatic. Follow-up at one year revealed continual improvement.
Collapse
Affiliation(s)
- A L Klein
- University of Ottawa Heart Institute, Ottawa Civic Hospital, Ontario, Canada
| | | | | |
Collapse
|
17
|
Pinkerton CA, Slack JD, Orr CM, VanTassel JW. Percutaneous transluminal angioplasty involving internal mammary artery bypass grafts: a femoral approach. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1987; 13:414-8. [PMID: 2891445 DOI: 10.1002/ccd.1810130612] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Percutaneous transluminal coronary angioplasty is an effective technique for the treatment of selected patients with ischemic heart disease due to coronary artery stenosis. Successful angioplasty in saphenous vein bypass grafts has been documented, but little experience has been reported using angioplasty in internal mammary artery to coronary artery bypass grafts. Nine of ten patients with stenosis in the internal mammary artery to coronary artery anastomosis or in the coronary vessel distal to the anastomosis site were successfully treated with angioplasty. One patient developed restenosis 1 month after the procedure, and a repeat angioplasty was successful. In one patient, the balloon catheter could not be advanced through the left internal mammary artery to the stenosis site. Technical features of internal mammary artery angioplasty are discussed, including the use of specially designed guiding wires, guiding catheters, and balloon catheters that facilitate angioplasty involving internal mammary arteries from the femoral approach.
Collapse
Affiliation(s)
- C A Pinkerton
- St. Vincent Hospital and Health Care Center, Indianapolis, Indiana
| | | | | | | |
Collapse
|