Atherectomy, Coronary ; methods ; Drug-Eluting Stents ; Humans

Aged ; Aged, 80 and over ; Atherectomy, Coronary ; instrumentation ; methods ; Female ; Humans ; Male ; Treatment Outcome

Objective: To explore the safety and efficacy of excimer laser coronary angioplasty (ELCA) for the treatment of degenerated great saphenous vein graft (SVG). Methods: This is a single-center, prospective, single-arm study. Patients, who were admitted to the Geriatric Cardiovascular Center of Beijing Anzhen Hospital from January 2022 to June 2022, were consecutively enrolled. Inclusion criteria were recurrent chest pain after coronary artery bypass surgery (CABG), and coronary angiography confirmed that the SVG stenosis was more than 70% but not completely occluded, and interventional treatment for SVG lesions was planned. Before balloon dilation and stent placement, ELCA was used to pretreat the lesions. Optical coherence tomography (OCT) examination was performed and postoperative index of microcirculation resistance (IMR) were assessed after stent implantation. The technique success rate and operation success rate were calculated. The technique success was defined as the successful passage of the ELCA system through the lesion. Operation success was defined as the successful placement of a stent at the lesion. The primary evaluation index of the study was IMR immediately after PCI. Secondary evaluation indexes included thrombolysis in myocardial infarction (TIMI) flow grade, corrected TIMI frame count (cTFC), minimal stent area and stent expansion measured by OCT after PCI, and procedural complications (Ⅳa myocardial infarction, no reflow, perforation). Results: A total of 19 patients aged (66.0±5.6) years were enrolled, including 18 males (94.7%). The age of SVG was 8 (6, 11) years. The length of the lesions was greater than 20 mm, and they were all SVG body lesions. The median stenosis degree was 95% (80%, 99%), and the length of the implanted stent was (41.7±16.3)mm. The operation time was 119 (101, 166) minutes, and the cumulative dose was 2 089 (1 378, 3 011)mGy. The diameter of the laser catheter was 1.4 mm, the maximum energy was 60 mJ, and the maximum frequency was 40 Hz. The technique success and the operation success rate were both 100% (19/19). The IMR after stent implantation was 29.22±5.95. The TIMI flow grade of patients after ELCA and stent implantation was significantly improved (all P>0.05), and the TIMI flow grade of all patients after stent implantation was Grade Ⅲ. The cTFC decreased significantly after ELCA (33.2±7.8) and after stent placement (22.8±7.1) than preoperative level (49.7±13.0) (both P<0.001). The minimum stent area was (5.53±1.36)mm², and the stent expansion rate was (90.0±4.3)%. Perforation, no reflow, type Ⅳa myocardial infarction and other complications were not observed. However, postoperative high-sensitivity troponin level was significantly increased ((67.937±33.839)ng/L vs. (5.316±3.105)ng/L, P<0.001). Conclusion: ELCA is safe and effective in the treatment of SVG lesions and could improve microcirculation and ensure full expansion of stent.
Male ; Humans ; Aged ; Prospective Studies ; Percutaneous Coronary Intervention ; Lasers, Excimer/therapeutic use* ; Saphenous Vein/transplantation* ; Constriction, Pathologic ; Atherectomy, Coronary/methods* ; Myocardial Infarction ; Coronary Angiography ; Stents ; Treatment Outcome

OBJECTIVETo review and summarize the early outcomes and clinical experience of coronary endarterectomy (CE) and bypass grafting without cardiopulmonary bypass for patients with diffused coronary artery disease.

METHODSFrom May 2003 to May 2005, 53 patients with diffused coronary artery disease underwent CE and bypass grafting without cardiopulmonary bypass. There were 41 males and 12 females aged from 55 to 79 (mean 64 +/- 7) years old. 72% patients (38/53) were in Canadian Cardiac Society (CCS) angina class III and IV. 49% (26/53) had history of myocardial infarction. Coronary angiogram revealed that 3 cases had double vessels disease and, other 50 cases had triple vessels disease with 9 left main stem disease. The left ventricular ejection fraction (LVEF) ranged from 0.26 to 0.65 (0.52 +/- 0.17). Seventy endarterectomies were performed in 53 patients totally which included 38 in left anterior descending artery (LAD), 8 in circumflex artery and 24 in right coronary artery. Five cases received on-lay venous patch after CE in LAD and then grafted by internal mammary artery (IMA) on the patch. There were 53 left IMAs, 2 radial arteries, others were great saphenous veins, the mean number of grafts was 3.8 +/- 1.1 with index of completeness of revascularization (ICR) 1.03 +/- 0.07.

RESULTSIntra-operative graft flow-meter was used to check the flow in the grafts before chest closure. There is no death in the group. Sixty-three (90%) out of 70 grafts after CE showed a satisfactory grafts flow intra-operatively. Two patients had peri-operative myocardial infarctions but neither had hemodynamic changes. All patients discharged uneventfully with mean hospital stay 9 days postoperatively. Forty-four patients had 6 to 29 months follow-up with no angina re-occurrence. Six patients had coronary angiogram 3 to 27 months postoperatively with all patent grafts to the CE coronaries.

CONCLUSIONCE and bypass grafting without cardiopulmonary bypass is technically feasible and can be performed safely in patients with diffused coronary artery disease with increased completeness of myocardial revascularization.

Aged ; Aged, 80 and over ; Atherectomy, Coronary ; methods ; Cardiopulmonary Bypass ; Coronary Artery Bypass, Off-Pump ; Coronary Artery Disease ; surgery ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Retrospective Studies ; Treatment Outcome