The bridge occlusion balloon for venous angioplasty in superior vena cava occlusion

Abstract The Bridge Occlusion Balloon is a compliant balloon, specifically designed for temporary Superior vena cava occlusion in case of Superior Vena Cava laceration during lead extraction procedures. We here report the first case, using Bridge Occlusion Ballon for a venous angioplasty in a patient with dysfunctional pacemaker leads and symptomatic Superior Vena Cava occlusion. After successful lead extraction, venography was showing a narrow venous canal. Therefore, venous angioplasty using the Bridge balloon was performed. Especially for high-risk lead extraction cases in patients with Superior Vena Cava stenosis, the Bridge Occlusion Ballon might be used as a combination of a safety-net in case of Superior Vena Cava perforation and for Superior Vena Cava angioplasty.

Percutaneous transluminal myocardial revascularisation: current status and future perspectives.

Percutaneous transluminal myocardial revascularisation presently appears to be a potential palliative treatment for coronary artery disease, neither controlled with drugs nor amenable to available coronary revascularisation techniques. Ongoing trials will provide answer to short and long term efficacy. Recent developments using angiogenic growth factors appear very promising, and the role of growth factors as an adjunct to percutaneous transmyocardial revascularisation with laser remains to be seen.

Angioplastia com excimer-laser para o tratamento de reestenose pós implante de stent de Wiktor e Gianturco-Roubin. Uma nova alternativa de tratamento / Excimer-Laser Angioplasty for the Treatment of Restenosis after Wiktor and Gianturco-Roubin stent placement. A New therapeutic Alternative

We report the use of excimer-laser angioplasty for the treatment of Wiktor and Gianturco-Roubin in-stent restenosis of in two patients. Case 1-a 48-year-old man presented unstable angina five months after Wiktor stent was deployed in right coronary artery. Cardiac catheterization revealed stenosis (95) within the stent. Case 2-a 65-year-old man presented stable angina four months after Gianturco-Roubin stent was deployed in left anterior descending artery. Cardiac catheterization revealed stenosis (80) within the stent. Excimer-laser angioplasty within the stent reduced the stenosis to 19and 30, respectively. The patients recovered and currently, six months post-procedure, are free of chest pain, and cardiac catheterization revealed stenosis to 30and 35, respectively, within the stent. Therefore, the procedure was an effective means of treating restenosis after coronary stent placement, and a prospective comparison of excimer-laser angioplasty and other management alternatives to in-stent restenosis is needed.

Transmyocardial laser revascularisation as an adjunct to CABG.

Transmyocardial laser revascularisation (TMLR), a new technique in which the ischaemic myocardium is perfused via laser-created transmural channels, was performed in 116 patients at the Escorts Heart Institute. TMLR was combined with CABG in 104 of these patients. The main indication for the combined procedure was the presence of one or more bypassable vessels along with diffuse disease in the other vessels. The age of the patients ranged from 37 to 73 years. Preoperatively, 53.84 percent of patients had Canadian Cardiovascular Society (CCS) class III angina while 24 percent had class IV angina. The mean LVEF was 46 percent; however, 19 percent of the patients had LVEF < 35 percent. Thirteen patients were operated upon a beating heart without cardiopulmonary bypass. The early mortality was 2.88 percent, 7.69 percent of patients showed elevation in CPK-MB, while 5.76 percent had a rise in Troponin 'T' and 2 percent of patients showed ECG changes. The mean follow-up was 7.6 months. Myocardial perfusion scan showed a step-wise improvement in reversible ischaemia, the perfusion index increasing from 52 percent at 3 months to 91 percent at 12 months. At 12 months, 91.6 percent of patients were angina-free. The Karnofsky score of 46 percent at baseline also increased to 86 percent at 12 months.

Angioplastia coronária em oclusäo crônica de nove anos e meio: utilizaçäo do laser com um novo cateter para recanalizaçäo / Coronary angioplasty in chronic occlusion of nine and half years: use of laser with a new catheter for recanalization

A chronic total occlusion lasting 9.5 years, was successfully treated with a Prima (TN) Laser catheter, of Spectranectics. The authors report a case of a fifty seven year old male that suffered an inferior myocardial infarction 9.5 years ago. Although the morphological characteristics of the lesion seemed easy to pass through the obstruction with the guide wire, the balloon dilatation was not possible because of the hardness of a chronic lesion lasting that long. The intervention was concluded successfully in another opportunity using the laser catheter with certain facility. This case, reported as the first one in Latin America, rises new possibilities and increases the success rate of coronary angioplasty of total chronic occlusions. We hope that in the following cases we will be able to reach the same result, widening the indications of coronary angioplasty

Angioplastia coronária com o uso do laser: análise crítica dos primeiros pacientes / Laser Facilited Coronary Angioplasty. A Critical Analysis of the Initial Cases

PURPOSE--To evaluate the success rate and complications, as well as the technical difficulties involved catheter laser coronary angioplasty, making evident the unsuccessful cases. METHODS--Twenty eight patients were treated with laser from August to November, 1993. The treatment was complemented with balloon angioplasty. Lesions were complex: 10 (36 per cent) were type B and 18 (64 per cent), type C. Concerning the obstruction grade, 18 (64 per cent) were > or = 95 per cent. Laser generator CVX 300(TM) Spectranectics as well as Extreme(TM) and Vitesse(TM) catheters with 1.4, 1.7 and 2.0mm in diameter, concentric and excentric, were used. Laser procedure success was defined as a reduction > 20 per cent in the obstruction grade. The procedure success was attended when the residual stenosis was < 50 per cent after a 15-minute observation, after balloon complementation. RESULTS--The unsuccess rate with laser catheter (Lc) was 34 per cent (10 lesions) of which 3 cases were solved by other methods, 5 were not successful because of anatomic difficulties in surpassing the lesion and, in the two others the success criterium in the reduction of the obstruction grade of the coronary artery was not achieved, although the lesion surpassing was possible with the use of balloon catheter. The final success reached 89 per cent (21 lesions). The procedure complications were a case of thrombosis, a perforation accompanied by a myocardial infarction and another myocardial infarction (non-Q wave), all with good outcome. CONCLUSION--The use of laser in the treatment of coronary artery obstructive lesions is a viable method. Nonetheless, more experience is necessary to demonstrate its actual value, optimizate the results and may be reduce restenosis rate

Laser assisted balloon angioplasty in lower extremity occlusive disease.

Percutaneous transluminal laser angioplasty was used as an adjunct to balloon angioplasty in 36 occluded lower extremity artery segments in 32 patients. Indications for intervention were severe claudication in 25 (78.1%) and rest pain or gangrene in 7 (21.9%) patients. Neodymium-yttrium-aluminium-garnet laser heated probe was used to recanalize the iliac artery in 19, femoral artery in 9, both iliac and femoral arteries in 2, and popliteal and tibial arteries in 2 patients. Patients with successful laser recanalization underwent balloon angioplasty to further widen the lumen. Initial angiographic success was achieved in 28 (87.5%) patients with recanalization of 32 (88.9%) of 36 occlusions. Three patients had extra-axial catheter/guide wire passage and 1 patient had acute thrombosis of the recanalized artery which was successfully reperfused by thrombolytic therapy. At discharge the Doppler ankle-arm pressure index had increased from 0.46 +/- 0.15 to 0.84 +/- 0.12 (p < 0.001) in 29 patients with recanalized arteries. There was marked clinical improvement in these patients. On 6-47 (mean = 23.4 +/- 7.5) months follow up of 28 successfully treated patients 26 (92.9%) showed sustained clinical improvement. Thus laser assisted balloon angioplasty appears to be a safe and useful adjunct in recanalization of lower extremity occlusive disease.