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.

Intervenção coronária percutânea em octogenários: houve mudanças no perfil dos casos tratados nos últimos cinco anos? / Percutaneous coronary intervention in eighty-year-old individuals: have there been changes in the profile of cases treated in the last five years?

Com o aumento da longevidade da população, as intervenções coronárias percutâneas (ICP) em octogenários têm sido realizadas com frequência crescente. No entanto, como os pacientes vivem mais, possivelmente apresentar-se-ão ao cardiologista com doença mais avançada, tanto em relação às comorbidades como à propria coronariopatia, fato que, se confirmado, poderia influenciar os resultados almejados...

ntroduction: As population longevity increases, percutaneous coronary interventions (PCI) in eighty-year-old individuals have been increasingly more performed. However, as patients live longer, they are likely to be referred to the cardiologist with a more advanced disease, both in terms of comorbidities and coronary disease, which might influence the desired results...

Chronic effects of percutaneous transmyocardial laser revascularization in patients with refractory angina / 中华心血管病杂志

<p><b>OBJECTIVE</b>Conflicting results exist on the therapeutic effects of percutaneous myocardial laser revascularization (PMR) in patients with refractory angina pectoris. This study assessed the effects of PMR on myocardial innervation and perfusion in patients with refractory angina pectoris.</p><p><b>METHODS</b>Patients with refractory angina unsuitable for standard revascularization treatment (PTI and CABG) were randomly divided into medication plus PMR (PMR, n = 17) and medication group (M, n = 13). Coronary sinus noradrenaline (NE) and epinephrine (E) levels, heart rate variability (HRV), total ischemic burden (TIB), and ischemic ST segmental events (STI), myocardial perfusion were evaluated at pre-, immediately post and 12 months post treatment (mean followed up time = 11.6 +/- 4.9 months).</p><p><b>RESULTS</b>In PMR group, one patient developed non-persistent ventricular tachycardia, 2 developed pericardial tamponade and another one patient developed heart failure at 24 h after operation. Coronary sinus NE and E were significantly lower 60 min post PMR compared to pre-PMR and HRV was significantly increased 24 h post PMR. One year post treatments, angina grade was significantly decreased in PMR (1.7 +/- 0.3) than that in M group (0.4 +/- 0.2, P < 0.05) while other parameters were similar between the groups.</p><p><b>CONCLUSIONS</b>PMR induced an early transient denervation and decreased angina grade one year post treatment in patients with refractory angina.</p>

A new technique for transmyocardial laser revascularization / 中华外科杂志

<p><b>OBJECTIVE</b>To investigate the effects of traditional transmyocardial laser revascularization (T-TMLR) and non-transmural myocardial laser revascularization (N-TMLR) on myocardial ischemic and necrotic areas and angiogenesis.</p><p><b>METHODS</b>In 30 rabbit models, Evans blue -TTC staining and HE staining were used for measuring ischemic and necrotic areas and observing angiogenesis.</p><p><b>RESULTS</b>The ischemic areas in the MI + T-TMLR (30.6 +/- 1.0)% and the MI + N-TMLR group (30.2 +/- 0.4)% were significantly decreased compared with the MI group (37.2 +/- 0.2)% (F = 21.04, P < 0.01). The necrotic areas in the MI + T-TMLR (17.0 +/- 0.7)% and the MI + N-TMLR group (16.9 +/- 0.6)% was not different from that in the MI group (17.9 +/- 0.5)% (F = 1.73, P > 0.05). The angiogenesis in the MI + T-TMLR (1.8) and the MI + N-TMLR (1.6) was significantly increased compared with that in the MI group (0.6) (F = 15.32, P < 0.01).</p><p><b>CONCLUSIONS</b>MI + N-TMLR can achieve the same effects of MI + T-TMLR. Inducing angiogenesis via laser channels and decreasing ischemic area may be one of the predominant mechanisms of TMLR, whereas whether laser channels themselves are patent is not relation to the effects of TMLR.</p>

Percutaneous laser for lumbar disc decompression

There are several advantages of percutaneous laser. Candidates for this technique are patients who have CT or MRI imaging findings showed that the spinal disc(s) were displaced but remained to be intact, with correlative pain symptoms and received conservative treatment for at least three months without success. The patients have only to suffered regional anesthesia, have not to hospitalize, free from scar, have not any spinal problem, time of immobilization and activity limitation was shorter

Primarily results of percutaneous laser disc decompression in Center for Biomedical Physics in Ho Chi Minh

The disc herniation occurs in 1/3 population in the world but 3% of this population had clinical symptoms that need a treatment. 87 patients received the method of percutaneous laser disc decompression has show that the successful rate was 80%. There had no major complications. There was only case suffering from the small abscess at the back of spine

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.

Acute and follow-up results of laser angioplasty: single center experience.

Excimer laser angioplasty was used to treat total occluded coronary arteries and instent restenosis lesions with high success rate. To assess immediate and long-term results of patients treated with excimer laser, we analyzed demographic information and the immediate results of 44 patients who underwent ELCA. The patients were followed up and assessed for clinical restenosis. The initial success rate of ELCA was 86.4 per cent which is comparable to plain balloon angioplasty performed during the same period. Clinical restenosis was 29 per cent. In conclusion, ELCA for patients with coronary artery disease can be performed with initial high success rate and reasonable long-term restenosis.

Reestenose de stents coronarianos: resultados imediatos e tardios do tratamento com excimer laser / In-stent restenosis: acute and long-term outcomes after excimer laser coronary angioplasty

Objective - With the increased use of intracoronary stents, in-stent restenosis has become a clinically significant drawback in invasive cardiology. We retrospectively assessed the short-and long-term outcomes after excimer laser coronary angioplasty of in-stent restenosis. Methods - Twenty-five patients with 33 incidents of in-stent restenosis treated with excimer laser coronary angioplasty (ELCA) were analyzed. Sixty-six percent were males, mean age of 73+ 11 years, and 83 per cent were functional class III-IV (NYHA). ELCA was performed using 23 concentric and 10 eccentric catheters with a diameter of 1.6-2.2 mm, followed by balloon angioplasty (PTCA) and untrasound monitoring. The procedure was performed in the following vessels: left anterior descending artery, 10; left circunflex artery, 8; right coronary artery, 6; left main coronary artery; 2 and venous bypass graft, 7. Results - The ELCA was successful in 71 per cent of the cases, and PTCA was 100 per cent successful. The diameter of the treated vessels was 3.44+0.5 mm; the minimal luminal diameter (MLD) increased from 0.30mm pre-ELCA to 1,97mm post-ELCA, and to 2.94mm post-PTA (p<0.001). The percent stenosis was reduced from 91.4+9.5 per cent before ELCA to 42.3+14.9 per cent after ELCA and to 14.6+9.3 per cent after PTCA (P<0.001). Seventeen (68 per cent) patients were asymptomatic at 6 months and 15 (60 per cent) at 1 year. New restenosis rates were 8/33 (24.2 per cent) at 6 months and 9/33 (27.3 per cent) at 12 months. Conclusion - ELCA is safe effective for the treatment of in-stent restenosis. In the present sample, a slight increase in new restenotic lesions between 6 and 12 months was found.

Análisis de los nuevos tratamientos usados en los síndromes coronarios agudos / Analyzis of new treatments used on acute coronary artery syndromes

Se revisa la literatura concerniente al tratamiento de los síndromes coronarios agudos (Infarto agudo del miocardio, Infarto sin onda Q y Angor inestable). Se concluye que el tratamiento ideal para el Infarto Agudo del miocardio es la angioplastía primaria, aplicada en las primeras 6 horas. Según las distintas estadísticas no produce hemorragia; tiene éxito en más del 90 por ciento y una mortalidad inferior al 2 por ciento. Desgraciadamente necesita de la presencia de un equipo de angioplastistas experimentados durante las 24 horas del día y además de un equipo quirúrgico stand by. La trombolisis junto con la aspirina es un excelente tratamiento. Si el trombolítico es la streptokinasa, que es el único que se usa en Chile, no necesita el agregado de heparina, ya que esto no mejora la mortalidad que es de alrededor del 7 por ciento pero aumenta los riesgos de hemorragia, especialmente cerebral. Los bloqueadores de la ECA dan una modesta disminución de la mortalidad (se salvan 5,4 vidas en 1.000 pacientes).Serían especialmente útil en los pacientes con insuficiencia cardíaca y en los reinfartados.El magnesio no sólo no sirve, sino que parece ser dañino. Por último, en cuanto a los nitratos,que tanto se usan en los síndromes coronarios agudos, se ha demostrado, que si bien producen alivio sintomático de la angina, no prolongan la vida. El infarto sin onda Q y el angor inestable, pese a su patogenia consistente en la formación de un trombo en el sitio en que ha habido un accidente de placa, no se benefician con los trombolíticos. El tratamiento ideal de estos síndrome coronarios agudos es la angioplastía que alcanza un éxito de 95 por ciento en los infarto sin onda Q y de 97 por ciento en el angor inestable, con mortalidades inferiores al 2 por ciento

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.

Excimer laser no tratamento da doença coronária obstrutiva: experiência inicial / Excimer laser in treatment of coronary artery disease: initial experience

Quatro pacientes do sexo masculino, com idades entre 47 e 77 (52 + ou - 45) anos, com angina do peito e características angiográficas enquadrando-se nas indicaçöes atuais do método utilizado, realizaram a desobstruçäo coronária com o excimer laser. Os vasos abordados foram a artéria coronária descendente anterior em três pacientes e a artéria coronária direita em um. Em todos, o procedimento com laser foi complementado com angioplastia coronária convencional. Resultado satisfatório após a realizaçäo do procedimento (laser e angioplastia) foi considerado como obtençäo de reduçäo de obstruçäo a valores menores ou igual a 50 por cento na ausência de complicaçöes. O sucesso inicial do procedimento (laser e angioplastia) foi observado em todos os pacientes. O grau de obstruçäo dos vasos abordados reduziu-se de 75-100 por cento (80 + ou - 8,5 por cento) para 0-50 por cento (20 + ou - 6 por cento) após ambos os procedimentos. Näo houve complicaçöes durante a fase hospitalar. Assim, a aplicaçäo do excimer laser, em situaçöes específicas, parece ser procedimento eficaz e seguro com alto índice de sucesos, resultados esses que necessitaräo de estudos posteriores

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