Clinical and Angiographic Outcome after Cutting Balloon Angioplasty

Abstract

The cutting balloon is a new device for coronary angioplasty, that, by the combination of incision and dilatation of the plaque, is believed to be promising for treatment of in-stent restenosis. The purpose of the study was to evaluate the safety and efficacy of CBA. We reviewed the immediate and 6-month follow-up angiographic and clinical outcome of 147 patients (109 men and 38 women) with a mean age of 67.3 +/- 10 undergoing this procedure at eight interventional centers in Austria. The target lesions treated with CBA were in-stent restenosis in 61% of patients, stenosis after balloon angioplasty in 8% of patients, and native lesions in 33% of patients. Sixty-five percent of the patients included had multivessel disease. Lesion type was A in 18% of patients, B1 in 31% of patients, B2 in 39% of patients, and C in 12% of patients. The degree of stenosis was 87% +/- 9%, the length of the target lesion treated with CBA was 8.8 +/- 5.1 mm. Target vessel was left circumflex artery in 22 cases, right coronary artery in 36 cases, and left anterior descending artery in 89 cases. The overall procedural success rate was 90.5%. "Stand-alone" CBA was performed in 63% of patients, the procedure was combined with coronary stenting in 16% of patients, and with balloon angioplasty in 21% of patients. Coronary complications occurred in eight cases (5.4%) with coronary dissection in seven (total dissection rate of 4.7%) and urgent bypass surgery in one case (0.7%). No further complications such as death, occlusion, or perforation of coronary arteries, embolization, or thrombosis were observed. Six-month clinical follow-up revealed q-wave myocardial infarction in 2.7% of patients, aortocoronary bypass surgery in 8.5% of patients, and repeated percutaneous coronary intervention in 17% of patients (11.5% with stenting). Six-month angiographic follow-up of patients with recurrent angina showed target lesion restenosis (> 50% diameter stenosis) in 14% of patients, late lumen loss with < or = 50% diameter stenosis in 6% of patients and progression of "other than target" lesions with > 50% diameter stenosis in 14% of patients. This series demonstrates the safety and feasibility of cutting balloon angioplasty in patients with complex coronary artery disease and in-stent restenosis.

Cutting Balloon Angioplasty for Carotid Artery In-stent Stenosis Supported by Three-dimensional Rotational Angiography With Automated Vessel Analysis Software -Technical Note-

“…1) In-stent stenosis of more than 75% vessel diameter loss in the coronary artery generally indicates treatment, and such high-grade restenosis occurs in 20-80% of all percutaneous transluminal coronary angioplasty. 3) Cutting balloon angioplasty yields larger initial gain and lower recurrence of stenosis for coronary artery. 3) We propose that precise measurement of the stent diameter as a reference for intervention and choice of the appropriate size of the cutting balloon catheter are the keys to success for cutting balloon angioplasty.…”

“…3) Cutting balloon angioplasty yields larger initial gain and lower recurrence of stenosis for coronary artery. 3) We propose that precise measurement of the stent diameter as a reference for intervention and choice of the appropriate size of the cutting balloon catheter are the keys to success for cutting balloon angioplasty. Although cutting balloon angioplasty carries the risk of vessel injury by the microblades, the implanted stent acts as a barrier to protect the vessel from the microblades in cases of in-stent stenosis.…”

“…Accumulated experience in interventional cardiology suggests that angioplasty with a cutting balloon provides a better initial result and lower recurrence of stenosis than conventional balloon angioplasty for coronary artery in-stent stenosis. 3) The catheter is not a widely used device for neuroendovascular intervention, and there are only a few reports of cutting balloon angioplasty for the treatment of carotid artery in-stent stenosis. 4,10,12) Furthermore, the technical details essential to achieve successful treatment were not described.…”

Treating Intractable Venous Stenosis: Present and Future Therapy

“…Early studies describe the use of cutting balloons for the treatment of stenoses not amenable to standard and high‐pressure balloon catheters in the coronary arteries (17–19). These balloon catheters have tiny, longitudinally mounted atheromes (microsurgical blades) embedded within the balloon material which, when inflated, “score” the intima to create controlled trauma to the vessel wall.…”

Intrakoronare Brachytherapie - Ein Update

“…Die Zahl der durchgefu È hrten Koronarangioplastien ist seit ihrer Einfu È hrung weltweit deutlich angestiegen (17,28,37). Die Problematik der Restenose nach perkutanen Koronarinterventionen, insbesondere nach koronarer Stentimplantation, stellt eine wesentliche Herausforderung der klinischen Kardiologie dar (15,16,21 (2,3,4,6,17,20,22,23,26,27,29,30,34,36,41…”