Successful multiple segment coronary angioplasty: Effect of completeness of revascularization in single-vessel multilesions and multivessels

A long-term follow-up study was performed to evaluate the long-term value of performing multiple dilatations according to their procedural (single-vessel multilesion or mutltivessel dilatations) and anatomic types (single-vessel disease with multiple dilatations or multivessel disease dilatations with complete and incomplete revascularization). From 1980 until 1988, 248 patients met the following criteria: (1) at least two lesions dilated (range: 2 to 4) and (2) all attempted lesions successfully dilated. The mean length of follow-up was 33 months. The end points analyzed were death, myocardial infarction, redilatation, and bypass surgery. No differences were found for these events between the single-vessel multilesion group (144 patients) and the multivessel group (104 patients). The 4.5-year probability of event-free survival was 68% and 70%, respectively, for the multilesion group and the multivessel group. In the event-free patients, 57% versus 59% were asymptomatic and 45% versus 46% were not taking antianginal drugs. In the anatomic subgroups, there were less event-free patients in the cohort of incompletely revascularized multivessel disease patients (55% of 55 patients) when compared with the cohort of those who were completely revascularized (84% of 79 patients) or when compared with the single-vessel disease multiple dilatation patients (74% of 107 patients). The 4.5-year event-free survival probability for each group was 44%, 78%, and 74%, respectively. This difference was caused by more infarctions (9% versus 2% versus 4%, respectively) and bypass operations in the multivessel disease, incomplete revascularization group (20% versus 5% versus 10%, respectively). In event-free patients, improvement of angina was similar and was documented in over 85% of patients in each group. Furthermore, the number of asymptomatic patients at follow-up was similar in all groups except that within the incomplete revascularization group, less patients were free of antianginal drugs (21% versus 51% versus 48%). Finally, 48% of the entire cohort performed an exercise test 4.6 months (mean) after dilatation and no difference was found in any of the variables in any group. About 10% of the patients experienced angina and approximately 30% had a positive exercise test for ischemia by ST segment criteria. The functional performance in every group was over 90% of the predicted work load. These results suggest that completeness of revascularization in multivessel disease patients is an important prognostic variable. However, the symptomatic improvement after dilatation is very rewarding in all subsets of patients and argues in favor of the continued use of multiple dilatations as a treatment strategy

Left Main Coronary Angioplasty: Assessment of a “Risk Score” to Predict Acute and Long‐Term Outcome

Due to the recent emergence of adjunctive techniques such as cardiopulmonary bypass support, left main angioplasty may become more routinely applied in the near future. In order to choose the best possible therapy, a precise risk assessment will be desirable. Twenty‐two left main angioplasties were thus re

Adjustment method for mechanical Boston scientific corporation 30 MHz intravascular ultrasound catheters connected to a Clearview console. Mechanical 30 MHz IVUS catheter adjustment.

Intracoronary ultrasound (ICUS) is often used in studies evaluating new interventional techniques. It is important that quantitative measurements performed with various ICUS imaging equipment and materials are comparable. During evaluation of quantitative coronary ultrasound (QCU) software, it appeared that Boston Scientific Corporation (BSC) 30 MHz catheters connected to a Clearview ultrasound console showed smaller dimensions of an in vitro phantom model than expected. In cooperation with the manufacturer the cause of this underestimation was determined, which is described in this paper, and the QCU software was extended with an adjustment. Evaluation was performed by performing in vitro measurements on a phantom model consisting of four highly accurate steel rings (perfect reflectors) with diameters of 2, 3, 4 and 5 mm. Relative differences (unadjusted) of the phantom were respectively: 15.92, 13.01, 10.10 and 12.23%. After applying the adjustment: -0.96, -1.84, -1.35 and -1.43%. In vivo measurements were performed on 24 randomly selected ICUS studies. These showed differences for not adjusted vs. adjusted measurements of lumen-, vessel- and plaque volumes of -10.1 +/- 1.5, -6.7 +/- 0.9 and -4.4 +/- 0.6%. An off-line adjustment formula was derived and applied on previous numerical QCU output data showing relative differences for lumen- and vessel volumes of 0.36 +/- 0.51 and 0.13 +/- 0.31%. 30 MHz BSC catheters connected to a Clearview ultrasound console underestimate vessel dimensions. This can retrospectively be adjusted within QCU software as well as retrospectively on numerical QCU data using a mathematical model

Evolution of coronary atherosclerosis in patients with mild coronary artery disease studied by serial quantitative coronary angiography at 2 and 4 years follow up

AIMS: Angiographic studies on the natural course of both focal and diffuse coronary atherosclerosis have not been performed before, but can both be assessed by quantitative coronary angiography. The objective of this study was to describe the natural course of focal and diffuse coronary atherosclerosis over time. METHODS AND RESULTS: In 129 patients with mild coronary artery disease, but not on lipid-lowering medication, three coronary angiograms were made each 2 years apart. Nine hundred and sixty five angiographically diseased and non-diseased segments were analysed by quantitative coronary angiography. Mean lumen diameter and minimal lumen diameter were used as measures of diffuse and focal coronary atherosclerosis. Mean lumen diameter and minimum lumen diameter decreased by 0.02 and 0.03 mm per year. The rate of progression was similar in the angiographically non-diseased, as in the mildly and moderately diseased segments. Progression of diffuse coronary atherosclerosis was largest in severely stenosed lesions (percentage diameter stenosis > or = 50%) and in the right coronary artery with a loss of 0.19 mm and 0.16 mm in mean lumen diameter. Progression of focal disease was most prominent in new and mild lesions and the right coronary artery, with a decrease in minimum lumen diameter of 0.34 mm and 0.22 mm. In most subgroups, progression occurred gradually over time. On a per segment level, progression and the occurrence of new lesions occurred in 4.4% and 4.2%. Regression and disappearance of a lesions was found in 2.3% and 1.9%. On a per patient level, 36% were progressors, 12% had a mixed response, 36% were stable, and 16% were regressors. CONCLUSION: Diffuse and focal coronary atherosclerosis progressed at the same rate in the first and second 2 years in stenosed and non-stenosed segments. The rate of coronary atherosclerosis progression was small, but was higher for focal than for diffuse disease. A minority of lesions progressed and spontaneous regression was rare

Directional atherectomy: combining basic research and intervention

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Percutaneous transluminal coronary angioplasty for angina pectoris after a non-Q-wave acute myocardial infarction

Despite initially favorable prognosis in patients with non-Q-wave acute myocardial infarction (AMI), long-term mortality in this subset of patients appears to be similar to or even greater than that in patients with Q-wave AMI. The relatively poor late prognosis is primarily due to a high incidence of unstable angina and recurrent AMI. Between January 1982 and January 1987, 114 patients with suitable coronary narrowing underwent percutaneous transluminal coronary angioplasty (PTCA) for angina pectoris (present either at rest or during mild exertion, and despite optimal pharmacologic therapy), a median of 31 (range 2 to 362) days after a non-Q-wave AMI. Success was achieved in dilating the obstructed artery in 98 patients (113 of the 129 dilated arteries). Emergency bypass surgery was performed in 7 patients. Mean clinical follow-up of 20 (range 3 to 59) months was obtained in all patients and revealed no deaths. Of the 98 patients with successful PTCAs, 6 (6%) developed a nonfatal recurrent AMI and 62 (63%) were asymptomatic. However, recurrent angina affected 31 patients (32%) and was treated by repeat PTCA (n = 18), coronary bypass surgery (n = 5) or pharmacologic therapy (n = 8). At follow-up, 74% of the patients (73 of 98) were asymptomatic after a successful PTCA and, if necessary, a repeat PTCA, without incidence of recurrent AMI, coronary bypass surgery or death. The high initial success rate, low incidence of subsequent death and late recurrent AMI and sustained symptomatic benefit suggest that PTCA is an effective initial treatment strategy in these selected patients