Fortnightly Review: New methods of making blocked coronary arteries patent again

Abstract

The use of percutaneous transluminal coronary angioplasty is limited by procedural complications and the serious drawback of restenosis, but some new techniques have been developed in an attempt to lower the complication rate for difficult lesions and reduce the rate of restenosis. These include devices to physically remove atheromatous plaque, such as the Simpson Coronary AtheroCath and the transluminal extraction catheter, as well as devices to ablate the plaque in situ, including the Rotablator and the excimer laser catheter. Although each device may have advantages in certain types of lesion, few data on their use have been reported in properly controlled randomised trials. The data available so far do not suggest that these devices will be safer than balloon angioplasty or that they will reduce restenosis. However, using metallic stents to support coronary arteries after balloon angioplasty seems to reduce acute complications and to lower the rate of restenosis, and the use of stents is likely to increase.

Modern surgical devices for treating thromboses: Current status and prospects

“…In the majority of cases balloon dilation proved to be successful: a 50% decrease in the degree of stenosis is angiographically observed in 90% of patients without serious complications [4,40]. However, in spite of continuous upgrade of balloon design, this procedure is poorly controllable.…”

“…This gives rise to acute stenosis in 3-5% patients, whereas re-stenosis within 6 months after surgery is observed in 25-50% cases. These are the most common aftereffects of balloon dilation [40,65].…”

“…Stentering [35,40,41,65,67,68,70] is based on the use of metal sieve tubes (stents) designed to enlarge the blood vessel lumen and to press endothelium fragments against the intima surface. The procedure of stentering (Fig.…”

“…Simpson [4,40,78,79] and TEC (Transluminal Endarterectomy Catheter) [34,40,47,62] catheters are used for mechanical extraction.…”

“…The rotablator [40,48,56,73] is a flexible shaft with a diamond-coated drill (diameter, 1-2.5 mm; rotation rate, 150,000-190,000 rpm, Fig. 3j).…”