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Bailout techniques for failed coronary angioplasty using 6 French guiding catheters
1Amsterdam Department of Interventional Cardiology-OLVG, The Netherlands.
Insights
Percutaneous coronary angioplasty (PTCA) using 6 French guiding catheters can lead to dissections. New low-profile devices and Palmaz Schatz stents effectively treated suboptimal results in patients undergoing PTCA.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
Background:
- Percutaneous coronary angioplasty (PTCA) via 6 French (F) guiding catheters is a common procedure.
- Complications such as acute or threatened closure due to coronary artery dissections can occur, necessitating effective management strategies.
Purpose of the Study:
- To evaluate the use of a new low-profile autoperfusion catheter (ACS, Flowtrack40) and Palmaz Schatz stents for treating suboptimal outcomes after PTCA.
- To assess the feasibility and efficacy of these devices in managing dissections and abrupt closures.
Main Methods:
- Retrospective analysis of 13 patients with suboptimal results from a population of 144 patients who underwent PTCA with 6F guiding catheters.
- Treatment involved a Flowtrack40 autoperfusion catheter or Palmaz Schatz stents, delivered via radial or femoral artery access.
- Palmaz Schatz stent implantation was attempted as a primary technique in nine patients.
Main Results:
- Suboptimal results occurred in 13 patients (9%) following PTCA with 6F guiding catheters.
- A Flow-track40 perfusion catheter was successful in 3 out of 4 patients.
- Palmaz Schatz stents were successfully deployed in most cases, though challenges were encountered in tortuous anatomy or with specific delivery systems.
Conclusions:
- The Flowtrack40 autoperfusion catheter and Palmaz Schatz stents are valuable tools for managing suboptimal results and dissections after PTCA with 6F guiding catheters.
- Careful patient selection and appropriate device selection are crucial for successful outcomes in complex cases.
Abstract:
Coronary angioplasty (PTCA) through 6 French (F) guiding catheters is feasible, although acute or threatened closure following coronary artery dissections may occur. This report describes our experience with the treatment of suboptimal results in 13 patients from a population of 144 patients who had PTCA through 6F guiding catheters. Patients were treated with a new low profile autoperfusion catheter (ACS, Flowtrack40) or with Palmaz Schatz stents, advanced through 6F guiding catheters. PTCA was performed via the radial artery in 11 pts (85%) or via the femoral artery in two patients (15%). In two patients, (15%) PTCA was complicated by an dissection associated with complete loss of flow (TIMI 0) and a dissection was considered to lead to abrupt closure in the remaining 11 patients (85%), despite the presence of normal flow. A Flow-track40 perfusion catheter was successfully applied in three of four patients. In one patient a persisting dissection after restoration of flow by a perfusion catheter was treated with three Palmaz Schatz stents. Implantation of Palmaz Schatz stents was attempted as primary technique in nine patients. In one patient the stent could not cross a dissection in the proximal LAD via the radial artery. With an 8F system via the femoral artery, two stents could successfully be deployed with the stent delivery system. In another patient the stent could not be advanced across a subtotal residual stenosis in a tortuous left anterior descending coronary artery. Despite normal antegrade flow and emergency bypass surgery, this patient developed a non-Q-myocardial infarction. In the remaining patients, the clinical course was uncomplicated.(ABSTRACT TRUNCATED AT 250 WORDS)