New devices in the transluminal treatment of the coronaries obstruction

pp 185-195

Abstract

Usual limitations of coronary angioplasty are: acute coronary occlusion, chronic total obstructions, diffuse coronary atherosclerosis and restenosis. New devices have been developed as a consequence of these limitations. The aim of this work is to describe our experience with these devices. We tested: directional coronary atherectomy catheter (Simpson). transluminal extraction catheter (TEC), Palmaz-Schatz stent (stent) and thromboaspiration techniques (T A). The were 45 patients treated with these new devices (Simpson: 14; TEC: 9; stent: 15, and TA: 7). The age (mean ± SD) was 58.5 ± 9.3 years (36-72). Thirty-five were males. Simpson (14 cases): 8 proximal eccentric obstructions of the left anterior descending coronary artery (LAD) (one was a restenosis), one restenosis of the right coronary artery (RCA) and 5 RCA eccentric lesions in its middle portion. Eight cases were prediated with a standard PTCA technique and in one case standard PTCA completed the atherectomy. The intervention was successful in 93 % (13/14) of the patients. The follow up range was 1 to 5 months. One patient had an acute myocardial infarction (AMI) in the territory of the treated coronary artery, another patient had restenosis at 40 month, the rest of the patients are asymptomatic (4 with negative ergometric stress test). TEC (9 cases): 3 LAD, 4 RCA, 1 first diagonal and 1 saphenous vein by-pass graft (SVBG) to the LAD. The indication was: in 5 cases restenosis, in one obstruction in a by-pass and in 3 diffuse obstruction. In every case a standard PTCA completed the intervention. There was a primary success in 100 % (9/9). After 120 days of follow-up all the patients are asymptomatic. Stent (15 cases): 6 RCA, 5 LAD, 1 in the left circumflex coronary artery and 3 by-pass. The indication was: in 6 cases a restenosis, in 2 proximal obstruction in a SVBG, in 5 acute coronary occlusion during PTCA and 2 coronary stenosis plus aneurysm The primary success was 100 % (10/10) in the elective cases and 40 % (2/5) in the emergency cases. After 280 days (15/570) of follow-up 7 of 10 elective patients are asymptomatic (1 had an AMI, another restenosis 13 month later and 1 had a non related death. TA (7 cases): 3 LAD, 2 RCA and 2 SVBG. The indication was acute coronary thrombosis in 3 patients and distal embolization in 4. The primary success was 71 % (5/7). Conclusion: The non conventional transluminal coronary angioplasty with new devices can be considered as an alternative of standard transluminal coronary angioplasty because it can be indicated with good primary success rate and good evolution in the follow-up.