Pub Date : 2004-01-04DOI: 10.3109/9780203490891-67
Michel Henry, Takao Ohki, A. Polydorou, K. Strigaris, D. Kiskinis
{"title":"Carotid stenosis: medical treatment","authors":"Michel Henry, Takao Ohki, A. Polydorou, K. Strigaris, D. Kiskinis","doi":"10.3109/9780203490891-67","DOIUrl":"https://doi.org/10.3109/9780203490891-67","url":null,"abstract":"","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"1 1","pages":"764-773"},"PeriodicalIF":0.0,"publicationDate":"2004-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"69462867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Thury, G. van Langenhove, A. Wardeh, D. Foley, P. Serruys
Although the principle of reducing plaque load in the coronary artery remains very appealing, clinical benefit from debulking devices has not been demonstrated unequivocally. Other approaches to prevent restenosis had been the application of various pharmacological agents. Unfortunately, the majority of clinical studies have not reproduced the promising results observed in the experimental laboratories. New frontiers in improving atherectomy devices and in optimizing concomitant medical treatment are currently being explored. We report on the EUROCARE trial investigating the possible benefit of carvedilol after coronary atherectomy, and the Pullback Atherectomy (PAC) pilot trial using a novel atherectomy device.
{"title":"Further insights into coronary debulking: the EUROCARE trial of directional atherectomy and the PACT trial of pullback atherectomy.","authors":"A. Thury, G. van Langenhove, A. Wardeh, D. Foley, P. Serruys","doi":"10.1053/SIIC.2000.0142","DOIUrl":"https://doi.org/10.1053/SIIC.2000.0142","url":null,"abstract":"Although the principle of reducing plaque load in the coronary artery remains very appealing, clinical benefit from debulking devices has not been demonstrated unequivocally. Other approaches to prevent restenosis had been the application of various pharmacological agents. Unfortunately, the majority of clinical studies have not reproduced the promising results observed in the experimental laboratories. New frontiers in improving atherectomy devices and in optimizing concomitant medical treatment are currently being explored. We report on the EUROCARE trial investigating the possible benefit of carvedilol after coronary atherectomy, and the Pullback Atherectomy (PAC) pilot trial using a novel atherectomy device.","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"5 4 1","pages":"185-92"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58333449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Historical background and lessons learned from early randomized trials.","authors":"D. Holmes","doi":"10.1053/SIIC.2000.0141","DOIUrl":"https://doi.org/10.1053/SIIC.2000.0141","url":null,"abstract":"","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"5 4 1","pages":"163-5"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58333845","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Coronary stents have improved the short and long-term outcomes of selected patients undergoing catheter-based coronary interventions. However, the use of these devices in complex coronary lesions has also created an incessant form of in-stent restenosis that still defies treatment. Plaque burden has been recognized as an important factor that may incite neo-intimal proliferation after stent implantation. Prospective non-randomized experience has shown that plaque removal prior to stent implantation using directional atherectomy is a promising approach to reduce restenosis in selected patients. However, the proof of concept awaits the results of the randomized trials. Ultimately, the clinical utility of this approach will depend upon: (1) further improvements on the current directional atherectomy device; (2) minimizing the incidence of non-Q-wave myocardial infarction with selective use of IIb-IIIa platelet receptor antagonists or distal protection devices; (3) targeting patients at high risk for restenosis in whom efficient debulking is feasible such as non-calcified lesions in vessels >2.75 mm and <3.5 mm in diameter that require long stents, aorto-ostial lesions, bifurcational lesions, and chronic total occlusions.
{"title":"Atherectomy plus stenting: what do we gain?","authors":"I. Moussa, J. Moses, A. Colombo","doi":"10.1053/SIIC.2000.0138","DOIUrl":"https://doi.org/10.1053/SIIC.2000.0138","url":null,"abstract":"Coronary stents have improved the short and long-term outcomes of selected patients undergoing catheter-based coronary interventions. However, the use of these devices in complex coronary lesions has also created an incessant form of in-stent restenosis that still defies treatment. Plaque burden has been recognized as an important factor that may incite neo-intimal proliferation after stent implantation. Prospective non-randomized experience has shown that plaque removal prior to stent implantation using directional atherectomy is a promising approach to reduce restenosis in selected patients. However, the proof of concept awaits the results of the randomized trials. Ultimately, the clinical utility of this approach will depend upon: (1) further improvements on the current directional atherectomy device; (2) minimizing the incidence of non-Q-wave myocardial infarction with selective use of IIb-IIIa platelet receptor antagonists or distal protection devices; (3) targeting patients at high risk for restenosis in whom efficient debulking is feasible such as non-calcified lesions in vessels >2.75 mm and <3.5 mm in diameter that require long stents, aorto-ostial lesions, bifurcational lesions, and chronic total occlusions.","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"5 4 1","pages":"217-25"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58333260","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Directional coronary atherectomy (DCA) has evolved from its early use as a tool for minimal plaque debulking to its current use of more aggressive lumen enlargement. The trend toward improved lumen results and reduced restenosis following DCA compared to percutaneous transluminal coronary angioplasty (PTCA) in the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT) was confirmed as a significant improvement in the subsequent Balloon versus Optimal Atherectomy Trial (BOAT). BOAT showed that acute lumen results and late angiographic restenosis could be significantly improved by DCA over PTCA, without any increase in procedural complications or late cardiac events. The role of DCA in conjunction with coronary stents is currently being defined as studies suggest that residual plaque burden after stenting is predictive of late restenosis. The Atherectomy before Multilink Stent Improves Lumen Gain and Clinical Outcomes Study (AMIGO) will help determine whether plaque debulking prior to stenting can reduce restenosis.
{"title":"Directional coronary atherectomy: optimal atherectomy trials and new combined strategies with coronary stents.","authors":"C. Simonton","doi":"10.1053/SIIC.2000.0139","DOIUrl":"https://doi.org/10.1053/SIIC.2000.0139","url":null,"abstract":"Directional coronary atherectomy (DCA) has evolved from its early use as a tool for minimal plaque debulking to its current use of more aggressive lumen enlargement. The trend toward improved lumen results and reduced restenosis following DCA compared to percutaneous transluminal coronary angioplasty (PTCA) in the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT) was confirmed as a significant improvement in the subsequent Balloon versus Optimal Atherectomy Trial (BOAT). BOAT showed that acute lumen results and late angiographic restenosis could be significantly improved by DCA over PTCA, without any increase in procedural complications or late cardiac events. The role of DCA in conjunction with coronary stents is currently being defined as studies suggest that residual plaque burden after stenting is predictive of late restenosis. The Atherectomy before Multilink Stent Improves Lumen Gain and Clinical Outcomes Study (AMIGO) will help determine whether plaque debulking prior to stenting can reduce restenosis.","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"5 4 1","pages":"193-8"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58333625","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The development of atherectomy catheters and their use in clinical practice during percutaneous revascularization procedures permitted the analysis of the pathophysiology of obstructive coronary disease in vivo. The various clinical presentations of coronary disease are related to distinct morphological aspects of the culprit coronary stenosis as assessed by angiography, angioscopy or intravascular ultrasound imaging. Analysis of plaque fragments revealed the underlying histopathology. Restenotic lesions following various mechanical interventions have been studied in detail both in native coronary arteries and in bypass conduits. The biological reaction to implantation of endovascular stents involves inflammation around the stent wires as well as smooth muscle cell proliferation. Specific processes such as nitric oxide production or the activity of intramural proteases can be characterized and contribute to identify targets for future pharmacological therapy.
{"title":"Morphological analysis of atherosclerotic plaque retrieved by coronary atherectomy.","authors":"C. Depré, F. Ribichini, W. Wijns","doi":"10.1053/SIIC.2000.0137","DOIUrl":"https://doi.org/10.1053/SIIC.2000.0137","url":null,"abstract":"The development of atherectomy catheters and their use in clinical practice during percutaneous revascularization procedures permitted the analysis of the pathophysiology of obstructive coronary disease in vivo. The various clinical presentations of coronary disease are related to distinct morphological aspects of the culprit coronary stenosis as assessed by angiography, angioscopy or intravascular ultrasound imaging. Analysis of plaque fragments revealed the underlying histopathology. Restenotic lesions following various mechanical interventions have been studied in detail both in native coronary arteries and in bypass conduits. The biological reaction to implantation of endovascular stents involves inflammation around the stent wires as well as smooth muscle cell proliferation. Specific processes such as nitric oxide production or the activity of intramural proteases can be characterized and contribute to identify targets for future pharmacological therapy.","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"5 4 1","pages":"175-84"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58333171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Coronary atherectomy offers the intuitive advantage of removing tissue mass in order to improve blood flow. A second major benefit of atherectomy is the opportunity to study lesion tissue and make pathophysiological insights. The value of the latter cannot be over emphasized, as current animal models for the study of atherosclerosis and restenosis are fraught with limitations. In this review, we outline some of the key descriptive findings that have emerged from the study of atherectomy specimens. Specifically, we will focus on the role of smooth muscle cell proliferation, thrombus organization and matrix formation in primary atherosclerotic lesions, as well as restenotic lesions after balloon angioplasty and stenting.
{"title":"Pathophysiological insights from studies of retrieved coronary atherectomy tissue.","authors":"C. Glover, E. O’Brien","doi":"10.1053/SIIC.2000.0136","DOIUrl":"https://doi.org/10.1053/SIIC.2000.0136","url":null,"abstract":"Coronary atherectomy offers the intuitive advantage of removing tissue mass in order to improve blood flow. A second major benefit of atherectomy is the opportunity to study lesion tissue and make pathophysiological insights. The value of the latter cannot be over emphasized, as current animal models for the study of atherosclerosis and restenosis are fraught with limitations. In this review, we outline some of the key descriptive findings that have emerged from the study of atherectomy specimens. Specifically, we will focus on the role of smooth muscle cell proliferation, thrombus organization and matrix formation in primary atherosclerotic lesions, as well as restenotic lesions after balloon angioplasty and stenting.","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"5 4 1","pages":"167-73"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58333150","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The beneficial short and long-term results of coronary stenting have resulted in a dramatic increase in stent utilization, accounting for greater than 80% of coronary interventions [1--9]. However, the long-term beneficial effect of coronary stenting is limited by the occurrence of a 14 to 61% restenosis rate [10--13]. The optimal percutaneous revascularization strategy for the treatment of in-stent restenosis remains undetermined. Although balloon angioplasty has been performed with high initial procedural success, the long-term results are disappointing due to significant recurrence [14--18]. In this article we describe the feasibility, safety, immediate and long-term outcome of directional coronary atherectomy (DCA) as a treatment modality in a cohort of patients undergoing percutaneous intervention for the treatment of in-stent restenosis at the Massachusetts General Hospital.
{"title":"The place of directional coronary atherectomy for the treatment of in-stent restenosis.","authors":"I. Palacios, P. Sánchez, N. A. Mahdi","doi":"10.1053/SIIC.2000.0143","DOIUrl":"https://doi.org/10.1053/SIIC.2000.0143","url":null,"abstract":"The beneficial short and long-term results of coronary stenting have resulted in a dramatic increase in stent utilization, accounting for greater than 80% of coronary interventions [1--9]. However, the long-term beneficial effect of coronary stenting is limited by the occurrence of a 14 to 61% restenosis rate [10--13]. The optimal percutaneous revascularization strategy for the treatment of in-stent restenosis remains undetermined. Although balloon angioplasty has been performed with high initial procedural success, the long-term results are disappointing due to significant recurrence [14--18]. In this article we describe the feasibility, safety, immediate and long-term outcome of directional coronary atherectomy (DCA) as a treatment modality in a cohort of patients undergoing percutaneous intervention for the treatment of in-stent restenosis at the Massachusetts General Hospital.","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"5 4 1","pages":"209-16"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58333557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
S. Reith, P. Radke, O. Volk, J. vom Dahl, H. Klues
In-stent restenosis (ISR) is still a growing problem in interventional cardiology due to the increasing number of stent implantations. Various treatment modalities are available at present. As a non ablative strategy balloon angioplasty is the strategy of choice for focal ISR, while ablative techniques such as directional coronary atherectomy, Excimer laser coronary angioplasty and rotational atherectomy are used preferentially in diffuse restenosis processes. These debulking techniques are optimized by peri-interventional use of intravascular ultrasound and adjunctive balloon angioplasty. Study data comparing different interventional approaches, usually with adjunct balloon angioplasty, have not proven an optimal treatment modality for ISR yet.
{"title":"The place of rotablator for treatment of in-stent restenosis.","authors":"S. Reith, P. Radke, O. Volk, J. vom Dahl, H. Klues","doi":"10.1053/SIIC.2000.0140","DOIUrl":"https://doi.org/10.1053/SIIC.2000.0140","url":null,"abstract":"In-stent restenosis (ISR) is still a growing problem in interventional cardiology due to the increasing number of stent implantations. Various treatment modalities are available at present. As a non ablative strategy balloon angioplasty is the strategy of choice for focal ISR, while ablative techniques such as directional coronary atherectomy, Excimer laser coronary angioplasty and rotational atherectomy are used preferentially in diffuse restenosis processes. These debulking techniques are optimized by peri-interventional use of intravascular ultrasound and adjunctive balloon angioplasty. Study data comparing different interventional approaches, usually with adjunct balloon angioplasty, have not proven an optimal treatment modality for ISR yet.","PeriodicalId":79534,"journal":{"name":"Seminars in interventional cardiology : SIIC","volume":"5 4 1","pages":"199-208"},"PeriodicalIF":0.0,"publicationDate":"2000-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"58333773","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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