Frequency in nonangioplasty patients of morphologic findings reported in coronary arteries treated with transluminal angioplasty

Isner, Jeffrey M.; Fortin, Roberta V.

doi:10.1016/s0002-9149(83)80116-7

Cited by 34 publications

(2 citation statements)

References 13 publications

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“…Accordingly, these breaks were attributed to handling and processing, rather than to acoustic trauma. 5 The variability of the elastic fibers in the internal elastic lamina, which is associated with the existence of arteriosclerotic changes, was in similar proportions in both groups. Otherwise, no change in the architecture of the arterial wall was observed (Figure 2).…”

Section: Resultsmentioning

confidence: 80%

Shock-wave thrombus ablation, a new method for noninvasive mechanical thrombolysis

Rosenschein

Yakubov

Guberinich

et al. 1992

The American Journal of Cardiology

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Successful experimental and clinical experience with thrombus ablation has been attained with high-power acoustic energy delivered in a catheter. The goal of this study was to investigate the feasibility of noninvasive thrombus ablation by focused high-power acoustic energy. The source for high-power acoustic energy was a shock-wave generator in a water tank equipped with an acoustic lens with a fixed focal point at 22.5 cm. Thrombus was prepared in vitro, weighed (0.24 +/- 0.08 g), and inserted in excised human femoral artery segments. The arterial segments wer ligated, positioned at the focal point and then randomized into either test (n = 8) or control (n = 7). An x-ray system verified the 3-dimensional positioning of the arterial segment at the focal point. A 5 MHz ultrasound imaging system continuously visualized the arterial segment at the focal point before, during and after each experiment. The test segments were exposed to shock waves (1,000 shocks/24 kv). The arterial segment content was then flushed and the residual thrombus weighed. The arterial segment and thrombus were fixed and submitted to histologic examination. The test group achieved a significant ablation of thrombus mass (0.25 +/- 0.15 vs 0.07 +/- 0.003 g; p = 0.0001) after application of shock waves. Arterial segments showed no gross or microscopic damage. Ultrasound imaging revealed a localized (1.9 +/- 0.5 cm2), transient (744 +/- 733 ms), cavitation field at the focal point at the time of application of focused shock waves. Thus, focused high-power acoustic energy can effect noninvasive thrombus ablation without apparent damage to the arterial wall.(ABSTRACT TRUNCATED AT 250 WORDS)

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Section: Resultsmentioning

confidence: 80%

Shock-wave thrombus ablation, a new method for noninvasive mechanical thrombolysis

Rosenschein

Yakubov

Guberinich

et al. 1992

The American Journal of Cardiology

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“…Does this observation carry the same risk of restenosis as an "extraluminal extravasation of contrast material"? Furthermore, h e r and Fortin [47] noted dissection clefts and plaque fractures in patients in whom angioplasty had not been performed. They concluded that "improved vessel patency may be seen in the absence as well as presence of such lesions (and) precludes from assurance that such lesions are the sole basis for successful angioplasty.…”

Section: Discussion Of Recurrence Datamentioning

confidence: 99%

Recurrence after coronary angioplasty

Myler

Shaw

Stertzer

et al. 1987

Cathet. Cardiovasc. Diagn.

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Recurrence (restenosis) after coronary angioplasty has undermined the initial success of the procedure and has compromised, to some extent, the attractiveness of the technique in the treatment of ischemic heart disease. Assessment of recurrence predictors has been problematic due to lack of coordination of angioplasty recurrence research and includes: incomplete angiographic documentation, variations in definitions of restenosis anatomically and the results of restenosis physiologically (ie, myocardial ischemia), the dirth of morphologic specifications of subsets under investigation and late outcome pathology, limitations in statistical analyses used, and minimal efforts to classify the available data on recurrence. A review of the literature suggests that all findings regarding recurrence after angioplasty can be organized in four categories: clinical, morphologic, technical (or procedural), and pharmacologic. The reported findings with high concordance as risk factors for recurrence after angioplasty include the clinical factors of diabetes mellitus, hyperlipidemia, and angina of short duration or unstable presentation. Morphologic factors which have been corroborated vis-à-vis recurrence include stenoses with diameter reduction of greater than 90% before and greater than 30% after angioplasty, residual trans-stenotic pressure gradients of greater than 20 mmHg after angioplasty, and lesions that are diffuse, long, eccentric, or calcified. Technical factors associated with recurrence include lower balloon/vessel (or graft) ratios and the absence of (uncomplicated) "intimal dissection." The category most deficient in research regarding recurrence after angioplasty is pharmacologic. Since there are statistically documented and reproducible factors predictive of restenosis, to ignore or minimize these findings or resist further evaluation (because of the ease and safety of performing repeat angioplasty) is to deny the opportunity to understand the mechanisms and favorably affect the incidence of recurrence. This review concludes with two major implications of the restenosis research: certain clinical, technical, and pharmacologic factors, if addressed, may predictably decrease the rate of restenosis and certain clinical and morphologic factors may increase the risk of restenosis; these factors may be less readily modified (eg, diabetes, lesion calcification) and thus must be considered in the decision for angioplasty.(ABSTRACT TRUNCATED AT 400 WORDS)

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Prolonged application of pressure in transluminal coronary angioplasty

Kaltenbach

Beyer

Walter

et al. 1984

Cathet. Cardiovasc. Diagn.

103

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We investigated the morphologic structure and fluid content of atherosclerotic specimens of fresh human postmortem artery segments before and after application of a pressure of 5 atmospheres simulated by a weight of 5 kg per 1 cm2. After applying pressure in nonorganized atheromata, we noticed a marked reduction in thickness while in fibrotic atheromata we observed only smaller differences in thickness. Reduction in fluid content was significantly more pronounced in nonorganized atheromatous tissue. Reduction in thickness was closely related to reduction in weight (i e, fluid content). The time of pressure application necessary to achieve the optimal result averaged 60 sec. The conclusions drawn from these experiments were incorporated into clinical application of coronary angioplasty. Prolonged balloon inflation was applied to the last 400 out of a total of 600 coronary angioplasty procedures, performed between October 1977 and October 1983. Stenoses not sufficiently responsive to balloon inflation periods of 5-10 sec were exposed to periods of 60 sec (30-120 sec). The number of "non dilatable" stenoses was 15% with the standard short pressure procedure, but only 5% with the prolonged pressure application. No serious complications related to prolonged pressure application were observed. Thus, from experimental data and clinical experience the application of longer pressure periods appears justified and beneficial.

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Frequency in nonangioplasty patients of morphologic findings reported in coronary arteries treated with transluminal angioplasty

Cited by 34 publications

References 13 publications

Shock-wave thrombus ablation, a new method for noninvasive mechanical thrombolysis

Shock-wave thrombus ablation, a new method for noninvasive mechanical thrombolysis

Recurrence after coronary angioplasty

Prolonged application of pressure in transluminal coronary angioplasty

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