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2006, Number 4

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Arch Cardiol Mex 2006; 76 (4)

Binary restenosis post-cutting balloon PTCA before stenting

Flores FJ, Palomo VJA, Bernal RE, Santiago HJ, Montoya SA, Astudillo SR, Estrada GJ, Abundes VA, Farell CJ

Language: Spanish
References: 24
Page: 408-414
PDF size: 102.00 Kb.


ABSTRACT

The goal of the study is to describe our experience in percutaneous transluminal coronary angioplasty with cutting balloon, evaluating the immediate and mid-term outcomes. The cutting balloon is a device used as a strategy to promote plaque rupture and to allow for its distribution. Methods: This is a descriptive study to evaluate the clinical and angiographic restenosis rate (Binary restenosis). Patients with incomplete clinical data were excluded. From January 2003 to June 2004, 1,300 PTCA with stent were made; we selected a group of 39 patients in whom the cutting balloon was used (3.3%). Average age was 60.4 ± 9.2 years. There were 32 men (80%) and 8 women (20%). Diabetes Mellitus in 10 (25%), dyslipidemia in 18 (45%), systemic hypertension in 22 (55%), smoking in 22 (55%). The indication for coronary angiography was stable angina in 21 (52.5%), unstable angina in 15 (37.5%), acute myocardial infarction without ST segment elevation in 3 (7.5%). Results: We treated 45 lesions: 4 (8.8%) main left, 24 (53.3%) anterior descending, 7 (15.5%) circumflex obtuse, 2 (4.4%) marginal, 8 (17.7%) right coronary. The average lesion severity before treatment was 88.8% ± 11. Lesions encountered corresponded to type B1 in 1 (2.2%), B2 in 22 (48.8%), and C in 22 (48.8%). The average lesion length was 19 mm ± 5.8 mm. The average vessel diameter was 3.6 mm ± 0.46 mm. We achieved a clinical follow-up of 100%. We performed angiographic control in 32 patients (71.1%) to evaluate instent restenosis, with an average follow-up of 7.6 ± 3 months. Clinical and angiographic restenosis corresponded to 25 and 31.25% respectively. Complications: Two (6.2%) patients presented complications; one died because of coronary perforation of the right coronary artery with pericardial effusion and tamponade. Conclusions: The cutting balloon is a useful device for the management of complex lesions (B2 and C) but the restenosis rate with this device is similar to the one obtained with PTCA and stenting. So we do not recommend it for rutine use.


REFERENCES

  1. Seong P, Cheol L, Myeong-Ki H, Jae-Joong K, Nae-Hee L, Seung-Jung P: Role of cutting balloon angioplasty before coronary stent implantation. Am Heart J 2000; 139: 1-4.

  2. Barath P, Fishelenings V, Forrester S: Cutting balloon: a novel approach to percutaneous coronary intervention. Am J Cardiol 1991; 68: 1249-1252.

  3. Elazi S, Kastratit T, Neumann P: Vessel size and long term outcome after coronary stent placement. Circulation 1998; 98: 1875-1880.

  4. Umeda H, Iwase M, Kanda H, Izawa H, Nagata K, Ishiki R, et al: Promising efficacy of primary gradual and prolonged balloon angioplasty in small coronary arteries: a randomized comparison with cutting balloon angioplasty and conventional balloon angioplasty. Am J Cardiol 2004; 147: 145-152.

  5. Albiero R, Silber S, Di Mario C, Cernigliaro C, Battaglia S, Reimers B, et al: Cutting balloon versus conventional angioplasty for the treatment of instent restenosis. Results of the restenosis cutting balloon evaluation trial (RESCUT). J Am Coll Cardiol 2004; 43: 943-49.

  6. Adamian M, Colombo A, Briguori C, Nishida T, Marsico F, Di Mario C: Cutting balloon angioplasty for treatment of instent restenosis a matched comparison with rotational atherectomy additional stent implantation and balloon angioplasty. J Am Coll Cardiol 2001; 38: 672-679.

  7. Okura H, Shimodozomo S, Hayade M, Bonneau H, Yock P, Fitzgerald P: Impact of deep vessel wall injury and vessel stretching on subsequent arterial remodeling after balloon angioplasty a serial intravascular ultrasound study. Am Heart J 2002; 144: 323-328.

  8. Nakamura M, Yock P, Kataoka T, Heidi B, Suzuki T, Yamaguchi T, et al: Impact of deep vessel wall injury on acute response and remodeling of coronary artery segments after cutting balloon angioplasty. Am J Cardiol 2002; 91: 6-11.

  9. Hara H, Nakamura M, Asahara T, Nishida T, Yamaguchi T: Intravascular ultrasonic comparisons of mechanisms of vasodilatation of cutting balloon angioplasty vs conventional balloon angioplasty. Am J Cardiol 2002; 89: 1253-1256.

  10. Bittl J, Chew D, Toplo E, Kong D, Califf R: Meta-analysis of randomized trials of percutaneous transluminal coronary angioplasty versus atherectomy, cutting balloon atherectomy or laser angioplasty. J Am Coll Cardiol 2004; 43: 936-42.

  11. Mauri I, Bonan R, Weiner B, Legrand V, Bassand J, Pompa J: Cutting balloon angioplasty for the prevention of restenosis. Results of the cutting balloon global randomized trial. Am J Cardiol 2002: 1079-1083.

  12. Ergene O, Seyithanoglu B, Tastan A: Comparison of angiographic and clinical outcome after cutting balloon and conventional balloon angioplasty in vessels smaller than 3 mm in diameter: a randomized trial. J Invasive Cardiol 1998; 10: 70-76.

  13. Ledesma M, Farell J, Astudillo R, Abundes A, Escudero J, Montoya A: Stents coronarios: Experiencia en el Hospital de Cardiología del Centro Médico Siglo XXI. Arch Cardiol Mex 1997; 67: 101-105.

  14. Palomo J, Solorio S, Farell J, Abundes A, Ledesma M: Resultados inmediatos postimplante de stents coronarios en pacientes octogenarios. Arch Cardiol Mex 1998; 68: 18-26.

  15. Martínez Ríos M, Elid G, Luna J, Villavicencio R, Ban E, Gaspar J, et al: Beneficio del stent coronario en la reducción de complicaciones cardíacas mayores en síndromes coronarios agudos. Arch Cardiol Mex 1999; 69: 121-126.

  16. Palomo J, Reyes F, Montoya A, Farell J, Abundes A, Ledesma M: Resultados inmediatos y a mediano plazo postimplante de stents coronarios en pacientes diabéticos. Arch Cardiol Mex 2002; 72: 36-44.

  17. Palomo J, Padilla F, Reyes F, Montoya A, Astudillo R, Flores J, Farell J, et al: Resultados de implantación de stent coronario en angioplastía primaria en el infarto agudo del miocardio. Rev Mex Cardiol 2004; 15(2): 66-74.

  18. Ryan T, Bauman W, Kennedy J, Kereiakes D, King III S, McCallister B, et al: Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association task force on assessment of diagnostic and therapeutic cardiovascular procedures (Committee on percutaneous transluminal coronary angioplasty). J Am Col Cardiol 1993; 22: 2033-2054.

  19. Feed M, O´Neill V, Safian R: Dissection and acute closure. En: The manual of Interventional Cardiology. Birmingham, Michigan. Physician´s Press 2000: 387-405.

  20. Unterberg C, Buchwald A, Barath P, Schimidt T, Kreuzer H, Weigand V: Cutting Balloon coronary angioplasty: Initial clinical experience. Clin Cardiol 1993; 16: 669-664.

  21. Kondo T, Kawagychi K, Awaji Y, Mochizuki M: Immediate and chronic results of cutting balloon angioplasty: a matched comparison with conventional angioplasty. Clin Cardiol 1997; 20: 459-463.

  22. Izumi M, Tschikane E, Funamoto M, Kobayashi T, Sumitzuki S, Sakurai M, et al: Final results of the CAPAS trial. Am Heart J 2001; 142: 782-789.

  23. Tamaki K, Nosaki E, Sugie T: Cutting balloon angioplasty for small size arteries. J Am Coll Cardiol 1999; 33: 1098-1099.

  24. Ergene O, Seyithanoglu B, Tastan A: Comparison of angiographic and clinical outcome after cutting balloon and conventional balloon angioplasty in vessels smaller than 3 mm in diameter: a randomized trial. J Invasive Cardiol 1998; 10: 70-78.




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