Regional myocardial dysfunction during coronary angioplasty: Evaluation by two-dimensional echocardiography and 12 lead electrocardiography
Daniel WohlgelernterMichael ClemanH. Ainsley HighmanRobert C. FettermanJames S. DuncanBarry L. ZaretC. Carl Jaffe
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It is generally believed that balloon angioplasty of diffuse, long-segment aortic coarctation is not effective. In this report, we describe two neonates with diffuse, long-segment coarctation in association with complex congenital heart defects in whom we were successful in effectively treating coarctation with transumbilical artery balloon angioplasty. Based on this experience, it may be concluded that balloon angioplasty of long-segment coarctation in neonates is feasible and effective, but confirmation in a larger group of patients may be necessary prior to general adoption of this concept.
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Abstract Laser balloon angioplasty with Nd:YAG energy has been proposed as a method to seal intimal dissection and prevent elastic recoil after balloon angioplasty. To better define the vessel response to laser balloon angioplasty, its effects on luminal diameter, Indium‐111 labelled platelet deposition, and histology were studied in 10 atherosclerotic rabbits. Balloon angioplasty was performed in both iliac arteries and was followed by laser balloon angioplasty in only one iliac artery. The nonlased artery served as a control. Single (15–35 W for 20 sec) or repetitive laser pulses (12–25 W for 20 sec × 3) were used. Platelet deposition was quantified 2 hr after the intervention. Lumen diameter (mm) increased following balloon angioplasty from 0.99 ± 0.47 (mean ± SD) to 1.92 ± 0.43 and 0.89 ± 0.46 to 1.99 ± 0.57 in the balloon and laser‐treated arteries, respectively ( P < 0.001 for both groups for comparisons to baseline, P = NS for between groups comparison). Laser balloon angioplasty resulted in a further increase in luminal diameter to 2.42 ± 0.53 ( P < 0.02) when compared to the post balloon angioplasty diameter. Platelet deposition (10 6 /cm vessel) was higher following laser balloon angioplasty (26.9, 10.2–189; median range) than after balloon angioplasty (10.6, 3.4–30), P < 0.001. Histologic evidence of laser “sealing” was present in only one artery. Thus although laser balloon angioplasty results in an improved lumen diameter, it is accompanied by increased platelet deposition. In the atherosclerotic rabbit model, abolition of vascular recoil rather than “sealing” seems to be the most important advantage of laser balloon angioplasty over conventional balloon angioplasty. © 1994 Wiley‐Liss, Inc.
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Objective:To study the different effects on C\|reactive protein(CRP),interleukin\|6(IL\|6) and soluble intercellular adhesion molecule\|1(sICAM\|1) between cutting balloon angioplasty and conventional balloon angioplasty.Method:Patients with isolated left anterior descending coronary artery disease were divided into two groups,one group accepted cutting balloon angioplasty,the other group accepted coventional balloon angioplasty.Serum levels of CRP,IL\|6 and sICAM\|1 were measured before,1,6,24,48 hours after angioplasty.Result:The clinic and lesion characteristics were similar in both groups.The levels of CRP and IL\|6 increased at 6 h and reached their maxima at 24 h after angioplasty.The sICAM\|1 level increased at 1 h and reached its peak at 6 h.The levels of sICAM\|1 at 1,6,24,48 hours after cutting balloon angioplasty were lower than that after conventional balloon angioplasty.The CRP and IL\|6 levels at 6,24,48 hours after cutting balloon angioplasty were less than that after conventional balloon angioplasty.The maximum inflation pressure(MIP)of cutting balloon angioplasty was significantly smaller than that of conventional balloon angioplasty.Conclusion:Balloon angioplasty increased CRP,IL\|6 and sICAM\|1 levels.These changes were smaller in the cutting balloon angioplasty group than that in the conventional balloon angioplasty group.This suggests that cutting balloon angioplasty may produce less vessel wall injury,which may account for the lower rate of restenosis.
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We evaluated the effectiveness of Cutting Balloon angioplasty for ostial lesions of the left anterior descending artery compared with conventional balloon angioplasty. Cutting Balloon angioplasty (n = 7) produced larger acute gain (1.70 ± 0.37 vs 0.48 ± 0.25 mm, P < 0.001) and smaller late loss index (0.54 ± 0.55 vs 1.32 ± 0.81, P < 0.05) than conventional balloon angioplasty (n = 7). As a result, late restenosis was seen in only two patients undergoing Cutting Balloon angioplasty, but in all seven patients undergoing conventional balloon angioplasty. Ostial lesions of the left anterior descending artery may be one of the suitable targets of Cutting Balloon angioplasty . (J Interven Cardiol 2000;13:7–14)
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Restenosis after successful balloon angioplasty remains problematic. Early elastic response after angioplasty is significant when considering the possible development of restenosis. The purpose of this study was to compare early elastic recoil within 10 minutes after successful percutaneous transluminal coronary angioplasty and early lumen loss at 24 hours after angioplasty in a cutting balloon group and a conventional balloon group.Extent of early elastic recoil was quantitatively measured as the difference of mean balloon diameter at maximal inflation pressure and minimal luminal diameter after angioplasty in 82 cutting balloon-treated lesions and 51 conventional balloon-treated lesions.Reference diameter and balloon/artery ratio were similar between the cutting balloon and conventional balloon groups (2.89 0.47 mm vs. 2.88 0.60 mm; 1.19 0.11 vs. 1.19 0.13, respectively). Early elastic recoil after angioplasty was significantly smaller in the cutting balloon than the conventional balloon group (0.96 0.40 mm vs. 1.12 0.37 mm, respectively; p = 0.04). Also, the mean amount of lumen loss from 10 minutes after angioplasty to 24 hours after was significantly smaller in the cutting balloon than the conventional balloon group (0.08 0.28 mm vs. 0.20 0.33 mm, respectively; p = 0.02).There is significantly less early elastic recoil in the cutting balloon angioplasty than in the conventional balloon angioplasty group. The efficacy of cutting balloon continues 24 hours after angioplasty.
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Objective To determine if the cutting balloon angioplasty has advantages over conventional balloon percutaneous transluminal coronary angioplasty (PTCA) in treatment of in-stent restenosis (ISR). Methods A total of 266 lesions treated for ISR were divided into two groups according to the treatment strategy: conventional balloon PTCA and cutting balloon angioplasty. Angiogram obtained during the procedure and 6 month after the two interventions, and quantitative angiograpic analysis was performed. Results ①Immediately after intervention, the maxium luminal diameter(MLD) in cutting balloon angioplasty group was similar to the one achieved of conventional balloon angioplasty[(2.51±0.65) vs (2.53±0.65) mm, P0.05]. ②At six-month follow-up, the MLD has no significant change between the conventional balloon PTCA group and the cutting balloon angioplasty group [(1.75±0.83) vs (1.96±0.74) mm, P0.05]. ③The cutting balloon angioplasty group has a lower late lumen loss(P0.05). Conclusion We conclude that cutting balloon angioplasty did not increase the MLD immediately after intervention and at 6-month follow-up as compared with conventional balloon angioplasty in the treatment of in-stent restenosis, but with a less late lumen loss.
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