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[Coronary atherectomy using the transluminal endarterectomy extraction catheter. Initial experience]
J R Büchler1, E Armelin, W A Pimentel Filho
1Hospital Beneficência Portuguesa, São Paulo.
Insights
Coronary atherectomy using the transluminal endarterectomy-extraction catheter is a safe and feasible new technique for treating coronary artery disease, showing satisfactory immediate results in patients.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Device Technology
Background:
- Coronary artery disease (CAD) necessitates innovative treatment modalities.
- Minimally invasive techniques are crucial for improving patient outcomes and recovery times.
Observation:
- A novel coronary atherectomy technique utilizing the transluminal endarterectomy-extraction catheter was applied to four patients (ages 46-65) with significant coronary artery stenosis.
- Patients presented with varied clinical conditions including stable angina, recent angina, post-myocardial infarction residual stenosis, and syncope with ECG alterations.
- The treated arteries included the left anterior descending and left circumflex arteries, with both concentric and eccentric lesions.
Findings:
- Pre-procedure stenosis averaged 90%, reduced to a mean of 32.5% post-atherectomy.
- Three out of four patients were discharged within 48 hours.
- The procedure demonstrated a high safety profile with no reported chest pain during the procedure, dissection, or perforation in most cases. One instance of post-procedure occlusion was successfully managed with balloon angioplasty.
Implications:
- The transluminal endarterectomy-extraction catheter represents a promising alternative for CAD treatment.
- This technique offers potential for reduced hospital stays and favorable immediate procedural outcomes.
- Further research and larger trials are warranted to fully establish the long-term efficacy and safety of this novel atherectomy device.
Purpose:
To describe a new alternative technique for treating coronary artery disease: the coronary atherectomy with the transluminal endarterectomy-extraction catheter.
Methods:
Four patients, 1 female and 3 males age 46 to 65 years (mean 53 +/- 8.5 years), were submitted to coronary atherectomy with the transluminal endarterectomy-extraction catheter. One patient presenting stable angina, one presenting recent angina, one with residual stenosis after acute myocardial infarction treated with intravenous streptokinase and one with two episodes of syncope and ECG alterations. The treated arteries were: left anterior descending in 3 patients and left circumflex in one. Two lesion were concentric and two were segmentary and eccentric.
Results:
The coronary artery stenosis ranged from 80 to 95% (mean of 90 +/- 7.1%) before the atherectomy and from 20-50% (mean of 32.5 +/- 12.6%) after the atherectomy. Except the first patient, the other 3 were discharged in less than 48 hours after the atherectomy. None presented chest pain during the procedure and in three of them were no recordings of dissection or coronary artery perforation. In one patient the treated artery presented total occlusion (thrombus) 15 minutes after the procedure, but was immediate and successfully reopened with balloon angioplasty.
Conclusion:
Coronary atherectomy with the "transluminal endarterectomy-extraction catheter" has shown to be a safe and feasible procedure and to bring satisfactory immediate results.