Frequency of success and complications of coronary angioplasty of a stenosis at the ostium of a branch vessel

Mathias, David W.; Mooney, Jodi Fishman; Lange, Hans; Goldenberg, Irvin F.; Gobel, Fredarick L.; Mooney, M.

doi:10.1016/0002-9149(91)90009-a

Cited by 112 publications

(69 citation statements)

References 11 publications

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“…The vertebral origin shares anatomic features of other arterial ostia, such as in the coronary circulation, where a dispropor- tionately high in-stent restenosis rate has been observed. 43 This has been attributed to the unique mural architecture, namely robust smooth muscle and elastin at such branching points that confer a tendency toward elastic recoil. The length of the atherosclerotic lesion also appears to have an influence on recurrence of luminal compromise.…”

Section: Efficacymentioning

confidence: 99%

“…El origen de la arteria vertebral comparte ciertas característi-cas anatómicas con el ostium de origen de otras arterias, como las de la circulación coronaria, en las que se ha observado una tasa desproporcionadamente elevada de reestenosis en el stent 43 . Esto se ha atribuido a la arquitectura peculiar de la pared, es decir, un músculo liso más robusto y la presencia de elastina en esos puntos de ramificación que provoca una tendencia a la retracción elástica.…”

Section: Eficaciaunclassified

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A Systematic Review of Stenting and Angioplasty of Symptomatic Extracranial Vertebral Artery Stenosis

Stayman

Nogueira²,

Gupta³

2011

Stroke

135

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Background and Purpose-Extracranial vertebral artery stenosis (ECVAS) is common among patients with ischemic stroke. Despite the limited knowledge of the natural history of patients with symptomatic vertebral disease, endovascular revascularization techniques are now utilized in clinical practice. We sought to determine the risk of endovascular treatment for ECVAS with a systematic review of the literature. Methods-A search strategy was used using the terms "stenting," "vertebral," "ostium," "origin," and "extracranial" through Medline. All articles were reviewed along with their references to determine the risk and durability of endovascular treatment. Results-A total of 27 articles were identified that met inclusion criterion, with a total of 980 of 993 patients treated with stents. The majority of patients (56%) were noted to have contralateral vertebral artery stenosis or occlusion and 92% were symptomatic at the time of treatment. A total of 11 patients (1.1%) experienced a stroke and 8 (0.8%) experienced a transient ischemic attack within 30 days of the procedure. Drug-eluting stents were associated with lower restenosis rates (11%) compared to bare metal stents (30%) at a mean of 24 months of follow-up. Conclusions-Stenting and angioplasty of ECVAS appear to have a low rate of periprocedural stroke or transient ischemic attack and restenosis rates that may not be as high as suspected. Given the frequency of ECVAS as an etiology for ischemic stroke, future studies aimed at determining efficacy of this treatment modality relative to medical therapy would be of benefit to clinicians caring for these patients. (Stroke. 2011;42:2212-2216.)

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Section: Efficacymentioning

confidence: 99%

Section: Eficaciaunclassified

A Systematic Review of Stenting and Angioplasty of Symptomatic Extracranial Vertebral Artery Stenosis

Stayman

Nogueira²,

Gupta³

2011

Stroke

135

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“…3,4 The "kissing balloon technique" resulted in improved, though suboptimal, lumen restoration. 3 Several other approaches such as rotative or directional atherectomy were also attempted, but these techniques did not translate into significantly better results.…”

Section: Clinical Outcome Datamentioning

confidence: 99%

Present Status of Coronary Bifurcation Stenting

Sukhija

Mehta

Sachdeva

2007

Clinical Cardiology

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SummaryPercutaneous coronary intervention (PCI) for bifurcation lesions is technically limited by the risk of side branch occlusion. In comparison with nonbifurcation interventions, bifurcation interventions have a lower rate of procedural success, higher procedural costs and a higher rate of clinical and angiographic restenosis. The recent introduction of drug-eluting stents (DES) has resulted in reduced incidence of main vessel restenosis compared with historical controls. However, sidebranch ostial residual stenosis and long-term restenosis still remain problematic. In the era of DES, techniques employing two stents have emerged that allow stenting of the large side branch in addition to the main artery. Stenting of the main vessel with provisional side branch stenting seems to be the prevailing approach. This paper reviews outcome data with different treatment modalities for this complex lesion with particular emphasis on the use of DES as well as potential new therapeutic approaches.

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“…181,[184][185][186] Treatment of bifurcations with directional atherectomy (without stenting) has been shown to improve the immediate procedural outcome compared with balloon dilatation alone, but the incidence of restenosis remains high. 187 The use of coronary stents has improved the treatment of bifurcation lesions, but it is technically challenging and there is still a high incidence of compromising the branch vessel.…”

Section: Yamashita Colombo and Tobismentioning

confidence: 99%

Limitations of coronary angiography compared with intravascular ultrasound: Implications for coronary interventions☆

Yamashita

Colombo

Tobis

1999

Progress in Cardiovascular Diseases

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The use of intravascular ultrasound catheters to produce images of lumen and plaque cross-sectional areas has had a profound effect on the practice of interventional cardiology. This imaging modality provides, for the first time, a low-power microscopic view of vascular anatomy within a living patient. This article will review some of the advantages of intravascular ultrasound imaging compared with angiography when used for diagnostic or interventional therapeutic procedures.Copyright 1999 by W.B. Saunders Company C oronary angiography is the primary mode of imaging coronary artery disease and guiding interventional procedures. Although coronary angiography was essential for the development of catheter-based coronary interventions, as the complexity of interventional cases increased, several limitations of angiography surfaced. Problems associated with coronary intervention, such as acute closure and restenosis, are related in part to properties of the lesion. Angiographic studies have reported inconsistent predictors of such adverse events. 1,2 One of the main reasons for this inconsistency is the limited power of angiography to delineate the complex anatomy of coronary atherosclerotic lesions. Intravascular ultrasound (IVUS) is a technique that provides two-dimensional, tomographic views of the coronary lumen and wall morphology in vivo, which has several advantages compared with angiography. 3 This article reviews the limitations of angiography and describes the information that IVUS imaging provides to complement angiography during diagnostic and interventional procedures. The ability of IVUS to evaluate lesion characteristics and dimensions alters therapeutic decisions and permits the operator to optimize each intervention. Lesion EvaluationEvaluation of coronary atherosclerotic lesions by angiography has been described by the joint American College of Cardiology/American Heart Association (ACC/AHA) committee. 4 This system delineates lesions by the degree of eccentricity and complexity. However, this analysis is limited by the ability of angiography to visualize only the lumen and not the atherosclerotic plaque itself. 91IVUS provides new insights for lesion evaluation because it produces a tomographic view of the artery and it is the only technique that permits visualization of the diseased artery wall in vivo. This capability is especially useful for diagnosing disease when vessels overlap or if there is a short stenosis. In addition, IVUS images are at a higher magnification than angiography, and its internal scale has been shown to be more accurate than angiographic assessment of plaque dimensions. Moreover, the ability of angiography to provide information on tissue characterization is limited. The following discussion will attempt to describe these differences between angiography and IVUS. Tomographic ImagingAn angiogram shows a longitudinal, two-dimensional view of the lumen of the vessel and does not directly show us the pathology, that is, the atherosclerotic plaque. If the plaque impinges on...

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Frequency of success and complications of coronary angioplasty of a stenosis at the ostium of a branch vessel

Cited by 112 publications

References 11 publications

A Systematic Review of Stenting and Angioplasty of Symptomatic Extracranial Vertebral Artery Stenosis

A Systematic Review of Stenting and Angioplasty of Symptomatic Extracranial Vertebral Artery Stenosis

Present Status of Coronary Bifurcation Stenting

Limitations of coronary angiography compared with intravascular ultrasound: Implications for coronary interventions☆

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