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Results of coronary angioplasty using the transluminal extraction catheter
J J Popma1, M B Leon, G S Mintz
1Department of Internal Medicine (Cardiology Division), Washington Hospital Center, Washington, D.C. 20010.
Insights
Transluminal extraction catheter (TEC) angioplasty shows promise for complex coronary lesions. While effective in reducing stenosis, complications like distal embolization can occur, especially with thrombus-containing grafts.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Complex coronary lesion anatomy presents challenges for traditional angioplasty.
- The transluminal extraction catheter (TEC) was developed to address these complexities.
- Assessing TEC's efficacy and safety in this patient group is crucial.
Purpose of the Study:
- To evaluate the procedural outcomes of coronary angioplasty using the TEC in patients with complex coronary lesion anatomy.
- To identify factors associated with procedural success and complications.
- To assess the impact of TEC on lesion stenosis and patient outcomes.
Main Methods:
- Retrospective review of 51 patients undergoing TEC angioplasty for complex coronary lesions.
- Analysis of procedural success rates, major complications, and adverse lesion features.
- Intracoronary ultrasound imaging to assess lesion morphology post-TEC.
- Follow-up evaluation for recurrent symptoms and need for reintervention.
Main Results:
- Procedural success was achieved in 82% of patients; major complications occurred in 7 patients.
- TEC significantly reduced diameter stenosis (76% to 50%, p < 0.001).
- Adjunct balloon angioplasty further reduced stenosis to 32% (p < 0.001).
- Distal embolization occurred in 5 patients with thrombus-containing saphenous vein grafts.
- Lesion thrombus was the only factor correlating with unsuccessful outcomes.
- Plaque fissuring and dissection were noted on intracoronary ultrasound.
- 40% of patients experienced recurrent symptoms during follow-up.
Conclusions:
- Coronary angioplasty with TEC is a viable option for complex coronary anatomy.
- TEC effectively reduces stenosis, but adjunctive balloon angioplasty may be necessary.
- Distal embolization remains a concern, particularly in saphenous vein graft lesions with thrombus.
- Further research is needed to optimize TEC use and minimize complications.
Abstract:
To assess the procedural results after coronary angioplasty using the transluminal extraction catheter (TEC) in patients with complex lesion anatomy, experience with 51 patients undergoing this procedure was reviewed. One or more adverse lesion morphologic features were present in 45 patients (88%) and > or = 2 adverse features were present in 38 (74%). Procedural success (< 50% final diameter stenosis and the absence of major complications) was obtained in 42 patients (82%); major complications occurred in 7 patients (death, 3; Q-wave myocardial infarction, 4; emergency bypass operation, 2). Distal embolization was noted in 5 patients with thrombus-containing saphenous vein graft stenoses. Only lesion thrombus correlated with an unsuccessful outcome. After TEC use, diameter stenosis was reduced from 76 +/- 13 to 50 +/- 22% (p < 0.001). Adjunct balloon angioplasty was used in 44 procedures (86%), further reducing the diameter stenosis to 32 +/- 22% (p < 0.001 compared with post-TEC). High-frequency intracoronary ultrasound was performed in 11 patients after TEC use. Plaque fissuring was present in all lesions and intraluminal dissection was noted in 4 (36%). Residual plaque after TEC use was found in virtually all lesions. During the 5.2 +/- 2.8-month follow-up period, 17 patients (40%) developed recurrent symptoms. Coronary bypass surgery was performed in 4 patients and repeat coronary angioplasty was required in 3. In addition, 3 patients died from cardiac causes. It is concluded that coronary angioplasty using the TEC may be a useful alternative to balloon angioplasty in patients with complex coronary anatomy, although distal embolization may still occur in thrombus-containing saphenous vein graft lesions.