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Objective To investigates the applicability of cutting balloon in the pretreatment of superficial coronary artery calcified lesions, so as to decrease the occurrence of serious consequences in the treatment of calcified lesions. Methods The effect of cutting balloon on calcified plaques with different curvatures, thickness, and length was analyzed using the finite element method, with normal balloon as a control. The thickness of calcified plaque was set to 0.3 mm and 0.4 mm, and the length was set to 2 mm and 4 mm. The calcification degree was set to 120°, 180°, 270°and 360° according to the intravenous ultrasound (IVUS) calcification severity grading, with a total of 16 types of calcified plaques. The brittle fracture module was used to simulate calcification fracture of calcified plaques, and virtual stent implantation was carried out based on pretreatment simulation. The effect of pretreatment was evaluated by calcification fracture condition and stent roundness. Results For superficial calcification lesions, in lesions less than 120°, the balloon could not remove the calcification plaque obstruction, and the stent roundness rate was 82.75%. In 180° calcified lesions with thickness of less than 0.3 mm, the calcification was broken by cutting balloon under 1 215.9 kPa expansion pressure, and the post-stent roundness rate was 74.42%; normal balloon could not cause calcification fracture under safe expansion pressure (1 418.55 kPa). In 270°calcified lesions with thickness less than 0.3 mm, the normal balloon produced 3 fractures under 1 013.25 kPa expansion pressure. The cutting balloon produced 2 fractures under 1 013.25 kPa expansion pressure, and the balloon could not fracture the circular calcified lesions with thickness of 0.3 mm. Conclusions Cutting balloon is recommended for 180°calcified lesions with thickness less than 0.3 mm, the normal balloon is recommended for 270°calcified lesions, and balloon pretreatment is not recommended for annular lesions with thickness greater than 0.3 mm.
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BACKGROUND: There is no efficient and unified optimal scheme for treating coronary bifurcation diseases. Simple strategies such as drug-eluting stent implantation in the main branch and drug-coated balloon dilation in the sub-branches are mostly adopted. However, direct drug-coated balloon dilation cannot overcome the problem of elastic retraction of vascular wall, and there is still a risk of branch loss in the long term. OBJECTIVE: To investigate the efficacy and safety of a cutting balloon versus a semi-compliant balloon for predilation of coronary bifurcation lesions. METHODS: From August 2016 to May 2018, 110 patients with coronary bifurcation lesions admitted at Jiaozuo People’s Hospital were selected, including 83 males and 27 females, aged 18-88 years. The patients were randomized into observation and control groups (n=55/group) and received percutaneous coronary intervention. The main branch in the observation group was predilated by a cutting balloon prior to drug-eluting stent implantation, and the sub-branches were predilated by a cutting balloon prior to drug-coated balloon dilation. The main branch in the control group was predilated by a semi-compliant balloon prior to drug-eluting stent implantation, and the sub-branches were predilated by a semi-compliant balloon prior to drug-coated balloon dilation. Immediate postoperative angiography was performed to determine the forward blood flow TIMI grading of main branches and sub-branches and whether vascular dissection occurred. Coronary angiography quantitative analysis was used to detect the reference diameter, minimum inner diameter and stenosis degree of main and sub-branches before, immediately, 6 and 12 months after surgery. Major cardiovascular adverse events within 12 months after surgery were recorded in both groups. The study was approved by the Ethics Committee of Jiaozuo People’s Hospital. RESULTS AND CONCLUSION: (1) Immediate postoperative angiography showed that the TIMI level 3 rate of the main branches and sub-branches in the observation group was higher than that in the control group (P=0.007, 0.015), the incidence of vascular dissection was lower than that in the control group (P=0.023, 0.012), and the emergency target vessel reconstruction rate was lower than that in the control group (P=0.006, 0.026). (2) The success rate of coronary artery maintenance immediately and at 6 and 12 months after surgery in the observation group was higher than that in the control group (all P < 0.001). (3) The minimum inner diameter of main branches and sub-branches in the observation group was larger than that in the control group immediately and at 6 and 12 months after surgery (all P < 0.01). The degree of inner diameter stenosis was smaller than that in the control group (all P < 0.01). (4) The target vessel restenosis rate of main branch and sub-branches in the observation group was lower than that in the control group within 12 months after surgery (P=0.038, 0.043). The incidence of major cardiovascular adverse events was lower than that in the control group (P=0.025). (5) These results indicate that in coronary bifurcation lesions, drug-eluting stent implantation is suitable for main branch lesions and drug coated balloon is suitable for sub-branch lesion. Cutting balloon predilation is safer and more effective than semi-compliant balloon predilation. Cutting balloon predilation can also reduce the rate of target restenosis and the incidence of major cardiovascular adverse events.
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Background@#Coronary calcification is a major determinant of stent underexpansion and subsequent adverse events. This study aimed to evaluate the acute- and long-term outcomes of rotational atherectomy (RA) followed by cutting balloon (CB) versus plain balloon before drug-eluting stent implantation for calcified coronary lesions.@*Methods@#From June April 2013 to March 2016, a total of 127 patients with moderately or severely calcified coronary lesions were treated with RA. Patients were divided into two groups according to the balloon type after RA: RA+CB group (n = 75) and RA+plain balloon group (n = 52). Minimal lumen diameter and acute lumen gain were analyzed by quantitative coronary angiography. In-hospital and long-term (>1 year) outcomes were recorded. Multivariate Cox regression analysis was performed to determine the independent predictors of in-stent restenosis.@*Results@#The mean age of the patients was 65.5 years, and 76.4% were men. Total lesion length and minimal lumen diameter at baseline were similar in the two groups. After RA and balloon dilation, the lumen diameter was significantly larger in the RA+CB group than in the RA+plain balloon group (1.57 ± 0.46 mm vs. 1.10 ± 0.40 mm, t = 4.123, P 1 year) in-stent restenosis (hazard ratio: 0.136, 95% confidence interval: 0.020-0.936, P = 0.043).@*Conclusions@#In patients with moderately or severely calcified lesions, a strategy of RA followed by CB before stent implantation can increase lumen diameter and acute lumen gain. This strategy is safe with lower risk of long-term in-stent restenosis.
Subject(s)
Aged , Female , Humans , Male , Angioplasty, Balloon, Coronary , Atherectomy, Coronary , Coronary Angiography , Coronary Artery Disease , Diagnostic Imaging , Therapeutics , Drug-Eluting Stents , Percutaneous Coronary Intervention , Stents , Treatment Outcome摘要
Objective To explore the effectiveness and safety of branch protection technique with provisional stenting strategy in coronary bifurcation lesions by utilizing jailed balloon protection technique after pre-dilation in branch with cutting balloon. Methods 32 patients undergone jailed balloon protection technique after pre-dilation in branch with cutting balloon during January, 2015 to May, 2016 in Peking University of People's Hospital were enrolled consecutively in our study. 32 patients were involved including a total of 32 bifurcation lesions which were medina type 1,1,1 (n = 25, 78. 1% ), Medine type 0,1,1 (n =5,15. 6% ) and Medine type 1,0,1 (n = 2, 6. 3% ). For side branch diameter ≥2. 5 mm, the diameter ratio of cutting balloon to side branch was 1: 1. The angiography success rate after using branch protection during main branch stent implantation, perioperative complications and major adverse cardiac events were observed. Results ( 1 ) The angiography success rate of branch protection was 100% . ( 2 ) No perioperative complications and major adverse cardiac events were observed. Conclusions Side branches were effectively protected in provisional stenting strategy by applying jailed balloon protection technique after pre-dilation using branch cutting balloon.
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Objective To evaluate the safety and efficacy of drug-coated balloon in small branch ostial lesions of coronary arteries (Medina type 0,0,1 lesion).Methods A total of 48 patients were enrolled in the study and they were randomly divided into the Drug-Coated Balloon (DCB) angioplasty group (22 cases) and the Cutting Balloon (CB) angioplasty group (26 cases).They underwent percutaneous coronary intervention (PCI) with either DCB or with CB in small branch ostial lesions of coronary arteries respectively,The immediate outcomes and long-term efficacy were investigated.Results There were no statistical differences between the two groups in baseline clinical date before PCI.There were no coronary perforation,pericardial tamponade,acute thrombotic events in the two groups.There was no significant difference in minimal lumen diameter (MLD) immediately after PCI between the two groups.During followup angiography,the MLD in the DCB group was significantly larger than in the CB group [(1.8 ± 0.2) mm vs.(1.5 ± 0.3) mm,P =0.006].There were no death,nonfatal myocardial infarction or revascularization recorded in the groups during 6 months of follow-up.Conclusion The immediate outcomes between DCB and CB were similar in small branch ostial lesions for coronary arteries angioplasty.The long-term efficacy of DCB angioplasty is better than CB angioplasty.
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Objective To investigate the early outcome of cutting balloon (PCB) in the management of hepatoenterostomy stricture.Methods The clinical data of 12 cases of supposed benign anastomotic strictures after hepatoenterostomy were retrospectively studied.Hepatic duct jejunal anastomotic stricture was confirmed by MRI or PTC,and patients underwent anastomosis plastic repair by CB.Biliary drains tube were removed when free flow of the contrast material through the anastomosis was observed by cholangiography at least 2 weeks postoperative.The follow-up period was 1 year.Results Cutting balloon procedures were successful in all the 12 cases.The symptoms of jaundice and infection were abated.3 cases suffered from postoperative transient complications.On follow up,1 patient died of tumor recurrence,2 patients reported biliary calculi associated with actue cholangitis which were relieved after corresponding treatment.Conclusions Cutting balloon repair of the biliary-enteric anastomotic strictures is a safe,reliable and minitraumatic procedure.
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BACKGROUND: Cutting Balloon angioplasty (CBA) may be a useful treatment modality for in-stent restenosis (ISR) as it maintains a stable position during dilatation and results in potentially less injury than plain old balloon angioplasty (POBA). The purpose of this study was to compare CBA and POBA with intracoronary radiation therapy (IRT) for in-stent restenosis (ISR). METHODS: We selected 157 consecutive patients from the WRIST (Washington Radiation for In-stent restenosis Trial) series of gamma radiation trials using both gamma and beta emitters for ISR of native coronaries or saphenous vein grafts, who were treated with CBA or POBA as the only treatment strategy before intracoronary radiation therapy. Patients in the CBA (N=64) and POBA (N=93) groups were matched for baseline demographic and procedural characteristics. Radiation was delivered successfully in all cases. RESULTS: At angiographic follow up, acute gain was higher in the CBA group than the POBA group (1.7+/-.7 mm vs. 1.4+/-.9 mm, p=0.03). The angiographic restenosis rate (17.1% vs. 23.5%, p=NS) and edge restenosis rate (6.3% vs. 12.2%, p=NS) were not significantly lower in the cutting balloon cohort. At a 6 month clinical follow up, the CBA group showed a statistically decreased rate of clinically driven target vessel revascularization compared to the POBA group (5.7% vs.18.3%, p=0.038). CONCLUSION: Cutting balloon angioplasty is a reasonable treatment strategy for in-stent restenosis prior to intracoronary radiation therapy.
Subject(s)
Humans , Angioplasty, Balloon , Brachytherapy , Cohort Studies , Coronary Restenosis , Dilatation , Follow-Up Studies , Gamma Rays , Saphenous Vein , Stents , Transplants , Wrist摘要
Percutaneous transluminal angioplasty (PTA) is an effective method in treating arteriovenous fistula (AVF) stenosis in hemodialysis patients. But, some stenoses are resistant to these procedures. Recently, cutting balloon angiopasty has been introduced as an alternative method for resistant AVF stenosis. We here report two cases of resistant AVF stenosis successfully treated by cutting balloon angioplasty in hemodialysis patients.
Subject(s)
Humans , Angioplasty , Angioplasty, Balloon , Arteriovenous Fistula , Constriction, Pathologic , Renal Dialysis摘要
BACKGROUND AND OBJECTIVES: A cutting balloon angioplasty for the treatment of diffuse in-stent restenosis has been reported to be superior to conventional percutaneous transluminal coronary angioplasty. Intracoronary radiation therapy is also a novel technique for preventing a recurrence of in-stent restenosis following percutaneous coronary intervention. Holmium (166Ho) is a high-energy beta-emitter, which is available in liquid form. We performed a cutting balloon angioplasty, with subsequent intracoronary 166Ho brachytherapy, for the treatment of in-stent restenosis. SUBJECTS AND METHODS: Fifty two patients, with in-stent restenosis, were treated with cutting balloon angioplasy and intracoronary 166Ho brachytherapy. For the irradiation, a balloon approximately 10 mm longer than the stent was used. Radiation doses of 18 Gy at a depth of 1 mm from balloon-artery interface were used. A quantitative coronary angiography was performed during the procedure and at the 6-month follow-up. The patients were followed clinically for an average of 16.8+/-9.8 months. RESULTS: The procedures were successful in all patients. The minimal luminal diameter of in-stent restenosis lesions, initially and after treatment, and the lesion length were 0.58+/-0.30 and 2.55+/-0.29 mm, and 20.7+/-7.1 mm, respectively. Thirty four (65.4%) patients completed the angiographic follow-up at 6 months. The minimal luminal diameter of lesion and late loss were 2.03+/-0.83 and 0.57+/-0.79 mm, respectively. The target lesion restenosis rate was 14.7%. No patients presented with MACE, such as MI, death or stent thrombosis. CONCLUSION: The combination of cutting balloon angioplasty and intracoronary 166Ho brachytherapy was feasible, safe and effective for the treatment of diffuse in-stent restenosis.
Subject(s)
Humans , Angioplasty, Balloon , Angioplasty, Balloon, Coronary , Brachytherapy , Coronary Angiography , Follow-Up Studies , Holmium , Percutaneous Coronary Intervention , Phenobarbital , Recurrence , Stents , Thrombosis摘要
BACKGROUND AND OBJECTIVES: A cutting balloon (CB) is a balloon catheter with 3 or 4 metal blades on its surface used for making controlled endovascular surgical incisions and promising minimal intimal injury. Some reports suggest advantages of the use of CB in the treatment of in-stent restenosis (ISR). The purpose of this study was to report the clinical experience of the use of CB for ISR. SUBJECTS AND METHODS: 28 patients were enrolled in this study. Angiographic success (defined by 40% residual stenosis), in-hospital, 30 days and 6 months clinical outcomes were evaluated. RESULTS: Angiographic success was 92.9% (26/28). The number of inflations and maximal inflation pressure were 2.8+/-0.9 and 10.1+/-1.3 ATM, respectively. The balloon/artery (B/A) ratio was 1.1+/-0.2. There was a case of stent insertion for treating type D dissection and a case of rotational atherectomy for suboptimal result after CB angioplasty. 25 cases underwent analysis through 6 months of clinical follow-up. During the 6-month clinical follow-up, 4 cases of re-PTCA were documented, while MACE during in-hospital time and the subsequent 30 days was 0%. CONCLUSION: Our experience demonstrated that CB can be performed safely and effectively in coronary ISR. Further clinical and angiographic effectiveness are warranted in a large-scale clinical trial.
Subject(s)
Humans , Angioplasty , Angioplasty, Balloon , Atherectomy, Coronary , Catheters , Coronary Restenosis , Follow-Up Studies , Inflation, Economic , Stents摘要
Objective To study the platelet activity changes in patients before and after percutaneous coronary cutting balloon angioplasty (CBA) and plain old balloon angioplasty (POBA) as well as its clinical significance.Methods Blood was obtained from the coronary sinus. Bioassay method used for assessment of PDGF. The plasma 6-keto-PGF 1a level was determined using ELISA.Results The amount of PDGF and 6-keto-PGF 1a were significantly different after PTCA between CBA group and POBA group (P
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Objective To evaluate the safety,efficiency and short-term results of cutting balloon coronary angioplasty.Method This procedure was performed on 63 lesions in 52 patients (male 94%,age 57?9 years).Results The overall procedural success rate for the cutting balloon angioplasty without predilation were 92.1%.Seven out of 9 cases of total occluded lesions had satisfactory results.Two cases of in-stent restenosis were also treated with CB successfully.Forty-three lesions were treated with cutting balloon followed by stents insertion.In 20 lesions treated with the cutting balloon alone,there was a marked reduction in the luminal stenosis from 78.8?11.6% to 7.2?5.6%.One patient developed pericardial tamponade 3 hours after cutting balloon angioplasty,which was resolved with pericardiocentesis.No severe dissection,no abrupt coronary closure,no emergency bypass surgery and acute myocardial infarction occurred.During 6 to 2 months' follow-up,only one patient treated by cutting balloon alone experienced angina pectoris and coronary angiography showed a restenosis, there were no further cardiac event.Conclusion Cutting balloon coronary angioplasty is a safe and effective interventional therapy with a high success rate and satisactory short-term results.
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0.05); the levels of LL, LI, RRS in CBA group and CBA+IBT group were significantly lower than those in control group(P
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Objective To study the results from Cutting balloon for stiff and uncompliant coronary lesion. Methods Thirty-three patients with coronary artery disease underwent conventional coronaryangioplasty with high pressure balloon. Cutting balloon was used for those lesions after they failed in high pressure balloon angioplasty. Results The total success rate for cutting balloon for stiff and uncompliant lesion was 87.9%. We got remarkable results from cutting balloon (MLD 2.47?0.54 mm; DS 16%?15%) with less dilation pressure and dilation time (8.93?1.23 atm; 1.65?0.44 min). Conclusion Our results show that cutting balloon can be used in the stiff lesion and some calcified lesion which was once considered to be contraindiction it could be a high procedural successful rate and very safe with less complications compared with other kinds of new technology.
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Objective To evaluate the safety, efficacy and short term results of cutting balloon (CB) coronary angioplasty Methods CB angioplasty was performed on 116 lesions in 102 patients (male 90%, age 57 5?11 2 years) Results The overall success rates of the primary cutting balloon angioplasty without predilatation were 94% Combined with small conventional balloon predilatation improves the procedural success rate to 97% 16 cases of in stent restenosis were also treated with CB successfully 72 lesions were treated with CB followed by stents insertion In 44 lesions treated with the CB alone, there was a marked reduction in the luminal stenosis from (80 9?11 6)% to (11 6?5 9)% One patient developed cardial tamponade 3 hours after CB angioplasty, which was resolved with pericardiocentesis One case developed severe dissection after CB angioplasty No abrupt coronary closure, emergency bypass surgery and acute myocardial infarction occurred 10 (9 8 %)patients experienced angina pectoris during 1 to 20 months (average 11 2 months) follow up, there were no further cardiac events in other patients 3 cases of angiographic restenosis were confirmed in 12 patients who underwent follow up angiography Conclusion CB angioplasty is a safe and efficient technique with a high success rate and satisfactory short term results
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Objective By Comparing the early and late coronary angiograms results between cutting balloon angioplasty (CBA) and plain old balloon angioplasty (POBA), to evaluate the efficacy of CBA on coronary in stent restenosis Methods 166 patients with in stent restenosis after PTCA were randomized into two groups: CBA group (98 cases) and POBA group (68 cases) according to the balloon used Its instant and late mimimal lumen diameters (MLD) diameter stenoses (DS) and restenosis rates after PTCA in above two groups were compared Results Although no significant difference in mimimal lumen diameters (MLD) ([2 6?0 6]mm vs [2 7?0 4]mm), diameter stenosis (DS) (% vs %) was observed instantly after the procedure between the two groups, the required balloon inflation pressure was significantly lower with CBA ([8 3?0 9]atm vs [14 7?4 6]atm, P
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10 mm) treated by CBA or BA were retrospectively analyzed. CBA was used in 74 patients and BA in 43 patients. Results Initial success (residual restenosis ≤30% with no major complications) was achieved in 99% of cases in CBA group and 100% in cases of BA group. Follow-up angiography was performed in all patients at (5.8?1.6) months. The diameter stenosis percent after CBA was lower and the instant gain after CBA was larger than that after BA (11.81%?9.17% versus 26.33%?10.04% and 1.96?0.51 mm versus 1.51? 0.54 mm, respectively; P
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Objective To evaluate the effect of cutting balloon angioplasty and stent implantation on serum TNF ?, IL 6 and IL 8, and investigate the relationship between the concentrations of serum TNF ?, IL 6 and IL 8 after operation and the incidences of late cardiac events after intervention Methods Eighty patients underwent PTCA with normal balloon or cutting balloon Values of serum TNF ?, IL 6 and IL 8 before and after intervention were measured using enzyme linked immuno sorbent assay Results The concentrations of serum TNF ?, IL 6 and IL 8 were increased significantly in the restenosis group, especially in the POBA group There was no obvious difference in no restenosis group Conclusion The lower restenosis rate in cutting balloon group was related to its lower injury and inflammation of blood vessels The concentrations of serum TNF ?, IL 6 and IL 8 6 hours after intervention may be the predictable sign of restenosis after intervention
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Objective To determine the effect and feasibility of kissing dilating with cutting balloon and conventional balloon for bifurcated lesions Methods We divided 34 patients with true bifurcated stenosis into cutting ballon group (13 patients) and stenting group (21 patients) Intravascular ultrasound (IVUS) was performed before and immediately after the interventional procedure Several indexes including minimal lumen diameter, external vessel crossectional area, lumen crossectional area, plaque crossectional area, vessel/lumen diameter and %diameter stenosis were calculated, respectively Results In cutting balloon group, more common lesions were found in left anterior descending artery and first diagonal (43 5% vs 28 9%, P
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70%) were involved in this study. Patients were assigned as intracoronary ?-radiation (Beta Cath 30 mm or 40 mm system, Novoste) with CBA group (n=112) and control group (n=183). Pullback radiation was performed for long ISR lesions. In the control group, the patients received intracoronary ?-radiation or CBA alone. In both groups, quantitative coronary angiography was performed, and target vessel revascularization (TVR) and major adverse cardiovascular events (MACE) were documented. Results Clinical follow-up (6.3?1.6 months) was conducted in 106 patients (95%) in the intracoronary ?-radiation with CBA group and 172 patients (94%) in the control group. In the follow-up, in the intracoronary ?-radiation with CBA group, MLD was larger and DS was lower than that in the comparison group. Both TVR and MACE occurred significantly less in the intracoronary ?-radiation with CBA group than in the control group (5% vs 16% for TVR, and 10% vs 25% for MACE; P