Coronary Artery Incision and Dilation

Lary, Banning G.

doi:10.1001/archsurg.1980.01380120046011

Cited by 10 publications

(6 citation statements)

References 5 publications

(1 reference statement)

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“…1 The hypothesis is that the unavoidable vascular injury is controlled and localized to the area of incisions and that interincisional segments are spared. [1][2][3] In animal experiments, with the sharp surgical incision, medial smooth muscle cells were less stretched, and the vascular injury was localized to the incision sites. 2 In addition, platelet-derived growth factor A mRNA expression and DNA synthesis were localized to the incisional segments after Cutting Balloon dilatation but were observed circumferentially after conventional balloon dilatation.…”

Section: Our Findings Support the Theory Of Cutting Balloon Angioplastymentioning

confidence: 99%

“…[1][2][3] In animal experiments, with the sharp surgical incision, medial smooth muscle cells were less stretched, and the vascular injury was localized to the incision sites. 2 In addition, platelet-derived growth factor A mRNA expression and DNA synthesis were localized to the incisional segments after Cutting Balloon dilatation but were observed circumferentially after conventional balloon dilatation. 3 These experiments indicate that Cutting Balloon can minimize the traumatic vessel wall injury that is associated with balloon dilatation and that probably triggers a series of cellular and subcellular events leading to myointimal proliferation and consequently to restenosis.…”

Section: Our Findings Support the Theory Of Cutting Balloon Angioplastymentioning

confidence: 99%

“…As a result, the elastic recoil may be reduced. [1][2][3] In addition, intravascular ultrasound study demonstrated that the longitudinal incisions of plaque and vessel wall reduce true dissection rates as well as nominal vessel area decrease. 4 Thus, Cutting Balloon angioplasty may limit the degree of traumatic vessel wall injury, typically encountered in conventional balloon angioplasty.…”

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confidence: 99%

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Lower Expression of Neutrophil Adhesion Molecule Indicates Less Vessel Wall Injury and Might Explain Lower Restenosis Rate After Cutting Balloon Angioplasty

et al. 1998

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Background-The Cutting Balloon is a novel dilatation catheter for coronary angioplasty (InterVentional Technologies Inc). It produces longitudinal, microsurgical incisions in the vessel wall before the actual dilatation. It is assumed that these controlled surgical incisions relieve hoop stress and reduce vessel wall injury and eventually restenosis. However, no clinical indicator to support the theory of reduced injury has been described. Certain clusters of differentiation (eg, CD11, CD18 on the leukocytes) are implicated in leukocyte adhesion, increased permeability, and opsonization. Therefore, they might serve as clinical indicators of the injury level of the vessels after angioplasty. Methods and Results-We randomly selected 64 patients with isolated left anterior descending coronary artery disease for either Cutting Balloon angioplasty or conventional balloon angioplasty. The expression of CD18 and CD11b on the surface of neutrophils was determined by flow cytometric analysis. Serum levels of soluble intercellular adhesion molecule-1 (sICAM-1) were also measured. The expression of both the CD18 and CD11b in the coronary sinus blood gradually increased and reached its maximum at 48 hours after angioplasty. The sICAM-1 levels in the coronary sinus serum also increased after angioplasty. Percentage increases of CD18 and CD11b expression and the increase of the sICAM-1 levels at 48 hours after angioplasty (as ratios to baseline values before angioplasty) were less in the Cutting Balloon angioplasty group than in the conventional balloon angioplasty group (CD18, 1.10Ϯ0.05 versus 1.31Ϯ0.05, PϽ0.05; CD11b, 1.23Ϯ0.06 versus 1.72Ϯ0.10, PϽ0.001; sICAM-1, 1.12Ϯ0.05 versus 1.25Ϯ0.02, PϽ0.05). In all patients, the late lumen loss at follow-up angiogram positively correlated with the increased levels of CD11b (Rϭ0.59, PϽ0.001) and sICAM-1 (Rϭ0.38, PϽ0.05) at 48 hours after angioplasty. Conclusions-Balloon angioplasty upregulated Mac-1 (CD11b/CD18) on the surface of the neutrophils and increased sICAM-1 levels in association with late loss increase. These changes were significantly smaller in the Cutting Balloon angioplasty group than in the conventional balloon angioplasty group. This suggests that Cutting Balloon angioplasty may produce less vessel wall injury and, consequently, less neutrophil activation, which may account for the lower rate of restenosis.

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Section: Our Findings Support the Theory Of Cutting Balloon Angioplastymentioning

confidence: 99%

Section: Our Findings Support the Theory Of Cutting Balloon Angioplastymentioning

confidence: 99%

mentioning

confidence: 99%

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Lower Expression of Neutrophil Adhesion Molecule Indicates Less Vessel Wall Injury and Might Explain Lower Restenosis Rate After Cutting Balloon Angioplasty

et al. 1998

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“…b Photograph of the CB in deflated state shows the microsurgical blades (black arrows) covered by balloon folds (white arrows) localised to the area of incisions and sparing the interincisional segments. It has been shown in animal experiments that this type of microsurgical incision causes less stretching of the smooth muscle cells [18]. In addition, platelet-derived factor A, mRNA expression and DNA synthesis are localised to the incisional segments, in contrast to circumferential vessel wall involvement after conventional PTA [9].…”

Section: Biological Response To Cutting Balloon Angioplastymentioning

confidence: 99%

Cutting balloons for the treatment of vascular stenoses

Tsetis

Morgan²,

Belli³

2006

Eur Radiol

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The aim of this article is to review the mechanism, technical characteristics, biological response and clinical applications of cutting balloon angioplasty in peripheral vessels. The cutting balloon is a non-compliant, balloon catheter equipped with three-to-four microtome-sharp atherotomes. When used appropriately, it is safe and easy to use, with a high immediate success rate and few complications, provided oversizing is avoided. There is some evidence that pre-dilation with a standard or high-pressure balloon may also predispose to vascular rupture. The cutting balloon has proved to be beneficial in treating difficult complex lesions in the coronary arteries. Early experience in non-coronary vessels shows that cutting balloon angioplasty can be used to treat peripheral bypass anastomotic and haemodialysis fistula stenoses that are resistant to conventional high-inflation pressures. Its application in de novo peripheral arterial lesions and non-coronary in-stent restenosis is still under discussion. Theoretically, this device induces a smaller degree of vessel wall injury localised to the area of incisions and sparing the interincisional segments; however, this postulated reduction in restenosis rates has not been confirmed in clinical practice.

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“…Animal Studies The concept of a longitudinal cut to the inner coronary artery surface of dogs by a sharp microblade, in order to facilitate further balloon dilatation, was described 20 years ago 3 . The idea at the time was that if the wall were completely cut, a new conduit would develop from the resulting hematoma and adjacent epicardial tissue.…”

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confidence: 99%

The Cutting Balloon for In‐Stent Restenosis:

Bejarano

2004

J Interven Cardiology

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Extraordinary advances have been made in the prevention, medical treatment, and the surgical and percutaneous intervention of coronary artery disease. However, despite the vast contribution of coronary artery stenting, coronary artery disease remains a major health problem. The massive treatment of symptomatic coronary artery disease with non-drug-eluting stents in the past, accounts for a large incidence of in-stent restenosis (ISR). We know today that in the following days after coronary artery angioplasty, new layers of intimal cells, called neo-intima, scaffold the endothelium forming a rubbery membrane. Numerous attempts have been made, and are still ongoing, to prevent the formation or to remove the neo-intima with suboptimal results and cost-effectiveness. Drug-eluting stents seem to be the most promising approach to date, however, the high cost of these devices may limit their use. In the mean time, new cases of ISR present to our cardiology practices. Because of its lower cost and identical technique to a regular balloon, the cutting balloon has emerged in numerous observational studies, and in a few randomized studies as a practical alternative to treat ISR. Although a few randomized studies have compared angioplasty with the cutting balloon versus angioplasty with a regular balloon, there are no randomized or economic studies comparing this device to excimer laser or intracoronary radiation in the treatment of this complication of coronary stenting. We reviewed the most prominent studies to date, on the performance of the cutting balloon in the treatment of ISR.

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Coronary Artery Incision and Dilation

Cited by 10 publications

References 5 publications

Lower Expression of Neutrophil Adhesion Molecule Indicates Less Vessel Wall Injury and Might Explain Lower Restenosis Rate After Cutting Balloon Angioplasty

Lower Expression of Neutrophil Adhesion Molecule Indicates Less Vessel Wall Injury and Might Explain Lower Restenosis Rate After Cutting Balloon Angioplasty

Cutting balloons for the treatment of vascular stenoses

The Cutting Balloon for In‐Stent Restenosis:

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