Double‐wire angioplasty of the right coronary artery bifurcational stenosis

For percutaneous transluminal coronary angioplasty (PTCA) of oversized arteries, often-times a satisfactory dilatation cannot be achieved with conventional balloon systems due to the unavailability of adequately sized balloons. This fact has contributed to a higher restenosis rate for this group of patients. We were able to obtain a satisfactory dilatation result in an oversized right coronary artery with a shepherd's crook configuration and eccentric anatomy at the origin using two balloon-on-a-wire systems and an Amplatz type guiding catheter. Although such favorable dilatation of an oversized artery using this "hugging balloon technique" can be expected, issues do exist such as difficult maneuverability and estimation of the balloon size obtained through simultaneous dual balloon inflation wherein size does not simply equal the sum of the two balloon catheters. It is hoped that there will be further improvements of the technique and development of new systems. At this time, however, it is felt that this is the most effective and reasonable strategy to achieve a high chance of success in oversized vessel lesions.

Section: Discussionmentioning

confidence: 96%

Multivessel ptca using the hugging balloon technique based on single guide catheter and dual balloon‐on‐a‐wire systems

Yoshida

Yabe

Nakano

et al. 1991

“…Imaginative applications of this hardware to clinical and morphologic problems resulted in the "kissing balloon" technique using single or double guiding catheters for bifurcation stenoses in the coronary and peripheral arterial systems [1][2][3][4][5][6][7][8][9][10][11][12][13]. Recently, two dilatation catheters were used simultaneously to achieve a favorable balloodvessel ratio in saphenous vein grafts of greater diameter than even the largest coronary balloon catheters currently available.…”

Section: Introductionmentioning

confidence: 99%

Angioplasty of unusually large coronary arteries using the hugging balloon technique via a single guiding catheter

Mayo

Myler

Stertzer

et al. 1989

Unusually large native coronary arteries, in particular those supplying expansive regions of myocardium, may not be adequately dilated using currently available coronary angioplasty catheters. The "hugging balloon" technique, in which two dilatation catheter balloons are simultaneously inflated side-by-side, has been previously described for lesions in large saphenous vein grafts using the double guiding catheter (and dual entry site) technique. With the development of large lumen guiding catheters and lower profile dilatation catheters, we report the initial use of the hugging balloon technique via a single guiding catheter in oversized native coronary arteries.

“…This technique was first Most coronary bifurcation lesions involve the left anterior descending and the diagonal branches. Fewer involve the left circumflex (91 and the right coronary [6,12] arteries. A classification scheme of coronary bifurcation morphology was proposed by George et al in 1986 [ 5 ] .…”

mentioning

confidence: 99%

Bifurcation lesions and the kissing‐device technique

Myler

1995

Juxtaposed "Kissing" stents as a technique to preserve both limbs of a renal artery bifurcation lesion is reported by Drs. Avula and Dorros in this issue of Carheferizarion and Cardiovascular Diagnosis.The technique to treat bifurcation lesions in peripheral arteries was introduced 16 years ago by Andreas Gruentzig for externalinternal iliac stenoses using two dilatation catheters in a procedure he termed "kissing-balloon" angioplasty. This technique was first Most coronary bifurcation lesions involve the left anterior descending and the diagonal branches. Fewer involve the left circumflex (91 and the right coronary [6,12] arteries. A classification scheme of coronary bifurcation morphology was proposed by George et al. in 1986 [ 5 ] .In the 1986 textbook "Angioplasty" [ 131, we presented several cases of bifurcation stenoses using the kissing balloon technique in the coronary and peripheral circulation; one case involved a renal bifurcation stenosis (Figure 1 ). This patient with renovascular hypertension and an abnormal renal scan had successful kissing balloon angioplasty via two renal guiding catheters introduced percutaneously via right and left femoral arterial sites. Through these guiding catheters, two coronary balloon catheters were advanced over coronary guidewires. Successful angioplasty was achieved and resulted in normalization of the renal scan and a normotensive status without antihypertensive treatment at 6 months followup.In 1993