BACKGROUND AND OBJECTIVES: A cutting balloon (CB) is a balloon catheter with 3 or 4 metal blades on its surface used for making controlled endovascular surgical incisions and promising minimal intimal injury. Some reports suggest advantages of the use of CB in the treatment of in-stent restenosis (ISR). The purpose of this study was to report the clinical experience of the use of CB for ISR. SUBJECTS AND METHODS: 28 patients were enrolled in this study. Angiographic success (defined by 40% residual stenosis), in-hospital, 30 days and 6 months clinical outcomes were evaluated. RESULTS: Angiographic success was 92.9% (26/28). The number of inflations and maximal inflation pressure were 2.8+/-0.9 and 10.1+/-1.3 ATM, respectively. The balloon/artery (B/A) ratio was 1.1+/-0.2. There was a case of stent insertion for treating type D dissection and a case of rotational atherectomy for suboptimal result after CB angioplasty. 25 cases underwent analysis through 6 months of clinical follow-up. During the 6-month clinical follow-up, 4 cases of re-PTCA were documented, while MACE during in-hospital time and the subsequent 30 days was 0%. CONCLUSION: Our experience demonstrated that CB can be performed safely and effectively in coronary ISR. Further clinical and angiographic effectiveness are warranted in a large-scale clinical trial.
Angioplasty ; Angioplasty, Balloon* ; Atherectomy, Coronary ; Catheters ; Coronary Restenosis ; Follow-Up Studies ; Humans ; Inflation, Economic ; Stents*

BACKGROUND: Restenosis is a major limitation of balloon angioplasty. Recently, new angioplasty devices have been used in an attempt to reduce the restenosis compared with coronary balloon angioplasty. Directional coronary atherectomy effectively dilated the lesion by removal of the atherosclerotic plaque. Therefore, we tried to evaluate immediate and late clinical outcomes after directional coronary atherectomy in the 57 patients with coronary artery disease. METHODS: From October 1991 to March 1997, fifty seven consecutive patients with 69 lesions were treated with directional coronary atherectomy. The patients underwent coronary angiography at pre-intervention, immediately after intervention and at 6 months post-intervention. Restenosis was assessed clinically and by computer-assissted quantitative measurements of luminal dimensions. Patients were requested to undergo coronary angiography at 6 months after directional coronary atherectomy. Angiographic restenosis was defined as more than 50% diameter stenosis by quantitative coronary angiographic analysis. RESULTS: Successful results were achieved in 61 of the 69 lesions(88%) and mean stenosis was reduced from 78.0+/-13.0% to 10.0+/-5.0%. Atherectomy resulted in an increase in minimal lumen diameter from 0.8+/-0.3mm to 3.0+/-0.6mm. Six months follow-up angiogram was obtained in 68% of 50 eligible lesions. The overall angiographic restenosis rate was 32%. Six month clinical follow-up was obtained in 94% of the eligible lesions. The clinical recurrence occured in 38% of the patients. The target lesion revascularization rate was 17%. CONCLUSIONS: Removal of coronary artery plaque with directional atherectomy led to large luminal diameter and six months follow-up angiography shows an overall restenosis rate of 32% However, further clinical study is warranted to evaluate the efficacy of atherectomy with larger numbers of patients.
Angiography ; Angioplasty ; Angioplasty, Balloon ; Angioplasty, Balloon, Coronary ; Atherectomy ; Atherectomy, Coronary* ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels ; Follow-Up Studies ; Humans ; Phenobarbital ; Plaque, Atherosclerotic ; Recurrence

BACKGROUND: Despite improved operator technique and advanced equipment designs, acute closure and restenosis remain as serious limitations to both the short and long-term success of balloon angioplasty. Atherectomy is a new transluminal interventional technique for the treatment of coronary artery obstructive disease. We evaluate preliminary experience of directonal coronary atherectomy (DCA) for complex coronary artery lesions. METHODS: We tried DCA in the 16 lesions of 15 nonrandomized sequential patients(mean age 66 years, M/F : 12/3) with coronary artery lesions that were ostial lesion in 4, ulcerated and/or eccentric in 13, restenosis after PTCA in 2 and after stent implantation in 2. The target vessel was right coronary artery in 7 and left anterior descending artery in 9. RESULTS: Primary success was achieved in 14 of 16 lesions (88%) by atherectomy and in 5(36%) by additional use of balloon angioplasty. Atherectomy retrieved tissue in 15 out of 15 attempts(100%). One patients suffered acute closure due to large dissection during the DCA which was solved successfully after stent implantation. CONCLUSIONS: Atherectomy can predictably treat selected patients with eccentric, ostial bulky coronary lesions with overall safety comparable to that of conventional balloon angioplasty, although the procedure as currently performed does not appear to prevent restenosis.
Angioplasty, Balloon ; Arteries ; Atherectomy ; Atherectomy, Coronary* ; Coronary Vessels ; Equipment Design ; Humans ; Stents ; Ulcer

Stent migration from the delivery balloon catheter is a rare but serious complication during percutaneous coronary intervention, particularly when a part of the stent stretches into the aorta. We report an unusual case of stent migration treated with a combination of a gooseneck snare and rotablation. A part of the stent was overstretched and unrolled into the aorta and the rest of the stent remained implanted in the coronary artery. The stent was captured with a gooseneck snare but could not be retrieved because it was connected to a stent remnant implanted in the coronary artery. The stent strut was cut with rotablation, and the stent was successfully removed through the femoral sheath.
Angioplasty, Balloon, Coronary ; Aorta ; Atherectomy, Coronary ; Catheters ; Coronary Vessels ; Percutaneous Coronary Intervention ; SNARE Proteins ; Stents

BACKGROUND AND OBJECTIVES: Since 1987, coronary stents have changed the pattern of practice of interventional cardiology, by reducing the complications and improving the clinical outcomes. However, coronary stent restenosis still remains a significant clinical problem in the field of interventional cardiology. The aim of this trial was to compare the clinical efficacy of a rotational atherectomy (ROTA), with that of a plain old balloon angioplasty (POBA), in patients with coronary stent restenosis. SUBJECTS AND METHODS: One hundred and three patients (men 80, 58.4+/-10.3 years of age), diagnosed with coronary stent restenosis, at Chonnam National University Hospital, between January 1999 and December 2000, were analyzed. The clinical end-points were the occurrence of major adverse cardiac events (MACE): death, myocardial infarction and target lesion revascularization (TLR) during the one-year clinical follow-up. RESULTS: The baseline clinical and angiographic characteristics were similar between the two groups. Before the percutaneous coronary intervention (PCI), the diameter of stenosis of the POBA and ROTA groups were 81.9+/-14.0 and 82.9+/-10.0%, respectively, which decreased to 25.5+/-15 and 22.7+/-12% after treatment. At the one-year clinical follow-up, the TLR rates were 7.0 and 6.3% in the POBA and ROTA groups, respectively. The MACE results were not different between the two groups (7.0 and 9.4% in the POBA and ROTA groups, respectively). CONCLUSION: There was no significant long-term clinical benefit of a rotational atherectomy prior to a POBA, compared with a POBA alone, for the treatment of coronary stent restenosis.
Angioplasty ; Angioplasty, Balloon* ; Atherectomy, Coronary* ; Cardiology ; Constriction, Pathologic ; Follow-Up Studies* ; Humans ; Jeollanam-do ; Myocardial Infarction ; Percutaneous Coronary Intervention ; Stents*

The disc herniation occurs in 1/3 population in the world but 3% of this population had clinical symptoms that need a treatment. 87 patients received the method of percutaneous laser disc decompression has show that the successful rate was 80%. There had no major complications. There was only case suffering from the small abscess at the back of spine
Angioplasty, Balloon, Laser-Assisted ; Abscess

BACKGROUND: Balloon PTCA for the distal, long, eccentric coronary artery stenosis will be at high risk for severe dissection or acute occlusion during or after procedure. METHODS AND RESULTS: High Speed Rotational Atherectomy followd by low pressure balloon angioplasty due to distal, long, eccentric coronary artery stenosis. Rotational coronary atherectomy debulked the lesion quickly without difficulty. Rotational Coronary Atherectomy with adjuctive low pressure balloon inflation was successful without event. CONCLUSIONS: This case illustrates the point that complementary deployment of devices may not only improve success of percutaneous coronary intervention, but also may extend its scope.
Angioplasty, Balloon ; Atherectomy, Coronary* ; Coronary Stenosis ; Inflation, Economic ; Percutaneous Coronary Intervention

No abstract available.
Angioplasty, Balloon, Coronary*

Angioplasty, Balloon, Coronary ; Humans

Angioplasty, Balloon, Coronary ; Humans