Detection of restenosis after percutaneous transluminal coronary angioplasty using the exercise treadmill test and technetium 99m-sestamibi scintigraphy.

BACKGROUND: The detection of myocardial ischemia after percutaneous transluminal coronary angioplasty (PTCA) is important because 30-50 per cent of the patients will develop restenosis within 6 months. Symptoms of chest pain and exercise stress test (EST) have shown to be less sensitive for detection of ischemia than exercise Technetium-99m Sestamibi (Tc-99m MIBI). The purpose of this study was to compare the sensitivity and specificity of chest pain, EST and Tc-99m MIBI with coronary angiography (CAG). METHOD: Tc-99m MIBI with SPECT imaging was performed at months 1, 3 and 6 and CAG was repeated 6 months after successful PTCA. Earlier Tc-99m MIBI and CAG were performed in patients with recurrent angina pectoris or suspected restenosis. RESULTS: Forty six patients (M 29, F 17) who had undergone successful angioplasty were prospectively enrolled. Their mean age was 61 +/- 19 yrs. Eighty eight lesions (LAD63%, LCX34%, RCA19%) were performed. Lesion characteristics were type A in 9 per cent, type in B 30 per cent and type C in 61 per cent. Fifty four per cent of PTCA were performed for single vessel disease and 46 per cent for multivessel disease. The mean duration of time between PTCA and follow-up CAG was 6.1 +/- 2.7 months. We detected restenosis from CAG in 58 per cent of the cases. The Tc-99m MIBI had higher sensitivity to detect restenosis than anginal pain (85.0% vs 39.4% p < 0.005) or EST (85.0% vs 63.6% p < 0.05) when compared with CAG. The overall accuracy of Tc-99m MIBI for the detection of restenosis was 80 per cent. CONCLUSION: Tc-99m MIBI with SPECT imaging constitutes a better means than symptoms or exercise test to detect restenosis after successful coronary angioplasty.

Safety and acceptable initial outcomes of reused balloon catheters for percutaneous transluminal coronary angioplasty.

OBJECTIVES: This study was conducted to compare the safety and initial outcomes applying reused balloon (RB) catheters with those of attained new balloon (NB) catheters when performing percutaneous transluminal coronary angioplasty. BACKGROUND: Recently, PTCA procedures have been used increasingly for the treatment of patients with coronary heart disease. In the era of national economic constraint, reused balloon catheters will reduce the cost of expensive, imported coronary angioplasty devices. Hence, data concerning the safety and success rate of RB catheters compared with NB catheters are urgently required. METHODS: Prospective comparative study between reused and new balloon catheters for coronary angioplasty. Data forms were completed after each procedure and before the patient was discharged after an 18-month period. RESULTS: From July 1996 to December 1997, 221 cases (121-RB, 100-NB) were enrolled. Mean age, ejection fraction, diseased vessel and lesion characteristics were similar in both groups. The number of lesions was much higher performed in the RB than in the NB group (1.7 +/- 0.9 vs 1.4 +/- 0.8, p = 0.02). The RB group had more cases of acute myocardial infarction than the NB group (7.4% vs 1%, p = 0.003), however, the angiographic and case success rate were the same (99.5% vs 97.9% and 98.3% vs 97% respectively). Major adverse cardiac events in RB amounted to 1.7 per cent and for NB to 1.0 per cent (p = ns). The total amount of balloons used in RB was much higher than in the NB group (1.5 +/- 0.6 vs 1.1 +/- 0.3, p = <0.0001). There were neither infection nor positive blood cultures in either group. CONCLUSIONS: Reused balloon catheters can be safely used for percutaneous transluminal coronary angioplasty with a high success rate. The total cost of angioplasty can be reduced without a decline in efficacy.

Percutaneous transluminal coronary angioplasty in King Chulalongkorn Memorial Hospital: a four-year experience.

From January 1993 to December 1996, 461 cases (743 lesions) of percutaneous transluminal coronary angioplasty (PTCA) were performed at King Chulalongkorn Memorial Hospital. Seventy eight per cent of the patients were male. Mean age was 61.1 +/- 9.6 yrs and mean ejection fraction was 0.59 +/- 0.18. The indications for PTCA were chronic stable angina (53%), post myocardial infarction (MI) angina (26.6%), unstable angina (17.4%) and acute MI (3%). Emergency PTCA was performed on 15 cases with 5 patients in cardiogenic shock. Fifty four per cent of the cases were performed in single vessel disease, 33 per cent in double vessel disease and 13 per cent in tripple vessel disease. The vessels dilated were the left anterior descending artery (44.2%), right coronary artery (27.8%), left circumflex artery (26.7%), left main (0.9%) and saphenous vein graft (0.4%). Mean balloon size was 2.48 mm. The overall success rate of PTCA, defined as residual diameter stenosis less than 50 per cent, was 91.5 per cent. In addition to PTCA, 123 stent implantations with mean stent size 2.98 mm and 15 rotational athrectomy were done in 114 cases. Complications of PTCA occurred in 32 cases (6.9%). Ten patients (2.2%) had abrupt closure, 1 of these needed emergency coronary bypass graft surgery (CABG). One patient (0.2%) had cerebral embolism with minor residual neurological deficit. One patient (0.2%) had toe gangrene which eventually needed amputation. One patient (0.2%) who presented with acute extensive anterior wall MI and failure of thrombolytic therapy died 8 hours after successful PTCA due to refractory cardiogenic shock. In the patients who also had stent implantation, there were 6 stent misplacements: 3 in the right femoral artery without any complication, 2 were misplacements in the coronary system and 1 dislodged in LM necessitating emergency CABG. CONCLUSION: PTCA is the coronary interventional procedure that can be performed with a high success rate and minimal complications.

The first 100 cases of intracoronary stent implantation in cardiac center, King Chulalongkorn Memorial Hospital.

At King Chulalongkorn Memorial Hospital from July 1994 to December 1996, 123 stents were implanted in 75 males and 25 females. Average age of the patients was 61.3 +/- 9.6 years. Fifty-five per cent of the cases were performed in stable angina, 26 per cent in post myocardial infarction angina. 17 per cent in unstable angina and 2 per cent in acute myocardial infarction. Seventy stents were implanted in the left anterior descending artery, 25 in the left circumflex artery, 27 in the right coronary artery and one stent in the left main. The indications for stent implantation were abrupt closure in thirteen sites, mild dissection in 58, suboptimal dilatation in 19, restenosis in 23 and de novo in 10. Mean size of the stents was 2.99 +/- 0.49 mm and mean inflation pressure was 11.9 atmosphere. Palmaz-Schatz stent was the most commonly used (53.6%) followed by AVE Microstent II (42.3%). There were 3 stents loss in the right femoral artery without any complications. Two stents were misplaced, one stent dislodged in the left main and needed emergency coronary bypass graft surgery. Two patients developed acute stent thrombosis and were successfully reopened with intracoronary urokinase. No patient had major bleeding complication, subacute thrombosis, acute myocardial infarction or death. CONCLUSION: Stent implantation can be performed rather safely with a high success rate and minimal complications.