No abstract

The effect of fish oil on restenosis was evaluated in patients undergoing coronary balloon angioplasty. In addition to routine pharmacotherapy, subjects were given 2.8 g of eicosapentanoic acid (EPA) daily. Treatment was started within twenty-four hours after successful percutaneous transluminal coronary angioplasty (PTCA). After six months of therapy, participants were subjected to coronary arteriography, exercise scintigraphy, exercise electrocardiography, or clinical evaluation. Follow-up evaluation involved 97 coronary lesions in 85 patients. Partial or significant restenosis occurred in 36.5% of patients and 33% of vessels. The presence of severe stenosis before PTCA, dissection, thrombus, multilesion PTCA, and template bleeding time values were not correlated with restenosis. Dilation of the left anterior descending (LAD) and a residual stenosis greater than or equal to 35% were associated with restenosis. Approximately 20% of the patients related difficulty in taking the fish oil. Furthermore, these results show no advantage over expected restenosis rates.

Distal embolization of atheroma and thrombus is a major concern when performing balloon angioplasty in coronary saphenous vein grafts (SVGs). The transluminal extraction catheter (TEC) is designed to remove this material and may improve the safety of percutaneous treatment of SVG disease. We assessed the acute results and long-term outcome of 67 patients (mean age 65.6 +/- 8.1 years; range 47-83 years) who underwent 73 separate TEC atherectomy procedures. Eighty-eight SVG lesions were treated (mean age 8.7 +/- 3.8 years from bypass surgery). Procedural success (< 50% final diameter stenosis and absence of major complications) was obtained in 63 patients (86%). Adjunctive balloon angioplasty and/or directional coronary atherectomy was required in 69 of the procedures (95%). Major complications, occurring in 8 patients (11%), were acute closure in 4 (5%), resulting in Q-wave myocardial infarction in 3 and urgent bypass surgery in 1, and distal embolization in 4 (5%; 1 associated with Q-wave myocardial infarction). Angiographic follow-up was available for 50 patients and restenosis was present in 26 (52%). These data suggest TEC atherectomy can be performed in SVGs with an acceptable procedural risk, but restenosis remains a significant limitation which will require other strategies to overcome.

No abstract

No abstract

Thermal laser angioplasty (TLA) experience of 59 hospital cases in 1988 (Group A) was compared with 113 outpatient cases treated from March 1989 to September 1991 (Group B). Angiographic success was higher in Group B (66.4%) as compared with Group A (55.9%). Complications of major dissection, perforation, and local thrombus were similar. Distal emboli (P=0.04), retroperitoneal hematomas (P=0.02), and urokinase administration (P=0.03) were more prevalent in Group A. At follow-up (six to thirty-six months), 57% of Group B patients were symptom free but only 36 of Group A were. Symptomatic improvement, despite recurrence of intermittent claudication (IC), was present in 21% of group A and 6% of Group B subjects. Though unpredictable, the mean ankle/arm indices were found in the following clinical categories: 100% reocclusion by angiography, 0.46; IC same as before TLA, 0.56; IC with mild-marked improvement, 0.70%; asymptomatic, 0.94. Average length of lesion-Group A, 10.5 cm versus Group B, 17 cm. This review does show improved primary success rates with further operator experiences despite tackling of more difficult lesions. The reduction in complications is related to the decreased use of urokinase and the availability of trained support personnel.

A retrograde approach to recanalization of totally occluded superficial femoral arteries proved efficacious in this study. The primary success rate was 83% and overall success rate was improved from 50% to 70%. Hemorrhagic complications were lower than with the antegrade approach.