Progressive coronary dilation: an angioplasty technique that creates controlled arterial injury and reduces complications

Drug-eluting balloons for treatment of SFA and popliteal disease - A review of current status

The endovascular treatment of atherosclerotic disease of the infra-inguinal arteries has changed significantly over the last decades. In an attempt to overcome the high restenosis rates that characterize plain balloon angioplasty and stenting using bare mate stents drug-eluting balloon technology has been applied in the treatment of lesions of the superficial femoral and popliteal artery. This paper will give an overview of the rationale and the technology of drug-eluting balloons and will review currently available data from registries and randomized controlled trials.

Focused force angioplasty: theory and application

Focused force angioplasty is a technique in which the forces resulting from inflating an angioplasty balloon in a stenosis are concentrated and focused at one or more locations within the stenosis. While the technique has been shown to be useful in resolving resistant stenoses, its real value may be in minimizing the vascular trauma associated with balloon angioplasty and subsequently improving the outcome.

Oscillating balloon angioplasty: does pressure oscillation reach the balloon?

Oscillating pressure inflations may minimize trauma to the coronary artery during coronary angioplasty. We measured in vitro diameters of polyolepin copolymer compliant angioplasty balloons (as a surrogate for pressure) during pressure oscillation at the inflator to determine if pressure oscillations at the inflator were conducted to the balloon. Balloon diameter oscillation increased as cycle length and inflator pressure amplitude increased. Currently practiced oscillating inflation (cycle length 2-3 sec, amplitude 2-3 atm) did not effectively transmit oscillation to the balloon. Clinically feasible optimal balloon oscillation was achieved at a cycle length of 6 sec and pressure amplitude of about 3 atm.

Directional coronary atherectomy and progressive coronary dilatation: a comparative analysis of acute outcome

To evaluate the acute results and in-hospital complications of directional atherectomy (DCA) as compared to progressive coronary dilatation (PCD), we retrospectively analyzed the acute outcome of DCA with PCD in age-, sex-, vessel-, and lesion morphology-matched groups of patients during the same time span. There was a total of 73 matched patients (77 lesions) in each group. Angiographic success on the basis of intent to treat was 85% in the DCA cohort versus 97%. The preprocedural mean diameter stenosis was similar between the two groups (87% vs 84%; p = n.s.). The mean postprocedural stenosis was significantly lower with DCA than with PCD (11.2% vs 19.7%; p < or = 0.05). Complications including death, myocardial infarction, and need for emergency bypass surgery were not statistically different in either group. In conclusion, PCD offers an alternative method of coronary intervention in patients with "atherectomy anatomy" with a significantly higher success rate. It can also be used successfully when DCA fails or cannot be performed because of technical factors.

Clinical and lesion morphologic determinants of coronary angioplasty success and complications: current experience

OBJECTIVES

This study evaluated the validity of the American College of Cardiology/American Heart Association ABC lesion classification scheme and its modifications.

BACKGROUND

With the continued refinement in angioplasty technique and equipment evolution, the lesion morphologic determinants of immediate angioplasty outcome have changed significantly. Hence, the validity of the classification scheme has been questioned.

METHODS

We assessed the lesion morphologic determinants of immediate angioplasty outcome in 729 consecutive patients who underwent coronary angioplasty of 994 vessels and 1,248 lesions.

RESULTS

Angioplasty success was achieved in 91% of lesions, and abrupt closure occurred in 3%. Success was achieved in 96%, 93% and 80% of type A, B and C lesions, respectively (A vs. B, p = NS; B vs. C, p < 0.001; A vs. C, p < 0.001; A vs. B1, p = NS; A vs. B2, p = 0.03; B1 vs. B2, p = 0.02; B2 vs. C, p < 0.001; C1 vs. C2, p = NS). Abrupt closure occurred in 2.1%, 2.6% and 5% of type A, B and C lesions, respectively (A vs. B, B vs. C, A vs. C and A vs. B1, all p = NS; B1 vs. B2, p = 0.01; B2 vs. C1, p = NS; C1 vs. C2, p = 0.04). Type B characteristics had a success rate ranging from 74% to 95% and an abrupt closure rate ranging from 2.2% to 14%. Type C characteristics had a success rate ranging from 57% to 88% and an abrupt closure rate ranging from 0% to 16%. Longer lesions, calcified lesions, diameter stenosis of 80% to 99% and presence of thrombus were predictive of a lower success rate. Longer lesions, angulated lesions, diameter stenosis of 80% to 99% and calcified lesions were predictive of an abrupt closure.

CONCLUSIONS

The previously proposed classification schemes are outdated and need to be changed for application in current angioplasty practice. Analyzing specific lesion morphologic characteristics rather than applying a simple lesion classification score when evaluating angioplasty outcome may be more useful because it provides a more precise profile of the lesion and allows better patient stratification and selection.

Dual-balloon progressive coronary dilatation catheter: design and initial clinical experience

As newer interventional devices continue to enter the marketplace, balloon angioplasty remains the standard by which all devices are judged with regard to both safety and efficacy. It has been observed that predilating a stenosis with a small balloon followed by dilatation with an optimally sized larger balloon creates a more controlled arterial injury, reduces complications, and thus improves success rates. Exchanging two balloons for each lesion, however, increases the complexity and cost of the procedure in addition to increasing the amount of time required and the amount of radiation exposure. Therefore an "over-the-wire" dual-balloon catheter was developed with a small distal balloon and a larger proximal balloon on a 2.9F shaft to allow progressive coronary dilatation with a single device, without necessitating a balloon catheter exchange. The device was used successfully in 45 of 47 patients (78 lesions). The two failures were related to an inability to cross the lesion in one and failure of the device in the other. Twenty-one patients (47%) underwent a multivessel procedure. There were 29 left anterior descending/diagonal, 17 circumflex/marginal, 20 right coronary artery/posterior descending artery, and 10 vein graft lesions. The device was successfully delivered in the native anatomy to 12 distal, 27 mid, and 27, proximal lesions of which nine were osteal, for a procedural success rate of 97%. The mean stenosis was reduced from 80.7 +/- 11.5% to 15.2 +/- 11.9%. There were no major dissections, only 9 (11.2%) minor dissections, and no myocardial infarctions.(ABSTRACT TRUNCATED AT 250 WORDS)