Transluminal Extraction Coronary Atherectomy

Immediate and chronic results of cutting balloon angioplasty: a matched comparison with conventional angioplasty

BACKGROUND

At the initial stages of percutaneous transluminal coronary angioplasty (PTCA), several studies reported on the feasibility of coronary artery incision and dilatation leading to the extension of the PTCA technique.

HYPOTHESIS

This study was designed to determine the immediate and chronic results of cutting balloon (CB) angioplasty.

METHODS

This procedure was performed on 127 lesions in 110 patients (male 83%, age 61.8 +/- 9.3 years).

RESULTS

The overall procedural success rates for the CB were 93.7% (119 lesions) and 92.7% (102 patients), while solitary CB without pre- and/or postdilatation was 76.4% (91 lesions). There was one major in-hospital complication (Q-wave myocardial infarction, 0.9%), but there were no deaths or emergency coronary artery bypass graftings. Significant angiographic dissections (> or = grade C) occurred in four patients, and coronary perforation occurred in one. The successfully treated CB group (95 lesions) was matched with the successful conventional angioplasty group (PTCA group) for chronic result assessment in regard to reference vessel size and lesion characteristics. In the CB group, postprocedural minimal luminal diameters were significantly larger and the percentage of stenosis at the stenotic site was significantly lower compared with the PTCA group. Restenosis occurred in 22 lesions (23.1%). This showed a significantly lower restenosis rate compared with the PTCA group (42.1%). In addition, the restenosis rate of the CB without inclusion of the pre- and/or postdilatation-treated lesions was 19.7%.

CONCLUSIONS

(1) Cutting balloon angioplasty procedures can be performed with high success rates with few major inhospital events. (2) The restenosis rate in the CB group was significantly lower compared with the PTCA group.

Elevated levels of pro-inflammatory cytokines in coronary artery thrombi

To validate the hypothesis that artery sites occluded with thrombi release pro-inflammatory cytokines, we measured concentrations of interleukin (IL)-6 and IL-8 in infarct-related coronary artery thrombi and atherosclerotic plaque specimens obtained with a transluminal extraction catheter (TEC) from cases of acute myocardial infarction (MI). Fifteen patients (group I) were enrolled in the study and four sets of samples were obtained (taken from the right atrium both before and after angioplasty, from infarct-related coronary artery thrombi and atherosclerotic plaque aspirated with a TEC and from the thoracic aorta aspirated with a TEC). Ten patients undergoing elective TEC served as controls (group II). IL-6 and IL-8 were measured in all patients by means of an enzyme-linked immunosorbent assay. Both IL-6 and IL-8 levels of infarct-related coronary artery samples in group I were significantly higher than in group II (mean +/- SEM, 15.3+/-4.5 vs. 3.8+/-1.2 pg/ml; P<0.01 and 44.0+/-2.4 vs. 15.6+/-0.6 pg/ml; P<0.01, respectively). The results suggest that pro-inflammatory cytokines originate from occluded coronary arteries in acute MI.