Guidelines for percutaneous transluminal coronary angioplasty

Ryan, Thomas J.; Bauman, William B.; Kennedy, J. Ward; Kereiakes, Dean J.; King, Spencer B.; McCallister, Ben D.; Smith, Sidney C.; Ullyot, Daniel J.

doi:10.1016/0735-1097(93)90794-2

Cited by 234 publications

(36 citation statements)

References 146 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Considering the preliminary results of pioneering groups,9 10 it may be anticipated that MIDCAB surgery for LAD culprit lesions can be as effective as conventional coronary artery bypass grafting using the internal mammary artery, which has been shown to be more effective than interventional treatment with respect to event free survival and relief of ischaemic symptoms 2021 In addition, interventional treatment of coronary lesions of the circumflex system or the right coronary artery appears to be less frequently associated with subsequent restenosis than treatment of LAD lesions 1722-25 The still significant rate of LAD restenosis of around 20% within the first year, even in the era of stenting,26 could be avoided provided MIDCAB grafting proves to result in superior long term effects.…”

Section: Discussionmentioning

confidence: 99%

“…In addition to patients with multivessel disease and extensive comorbidity, such hybrid approaches may also be reasonable in patients with two vessel disease presenting with LAD type C lesions, which are considered to represent suboptimal indications for interventional treatment 17. Expecting further progression of coronary artery disease in these patients, primary MIDCAB grafting as the surgical part of a hybrid procedure may prevent complications associated with reoperation through a mid sternotomy occurring later on.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, some authors tend to perform PTCA first, with the option that in case of any interventional complication surgery will effectively treat the underlying coronary disease as well as the interventional complication in one procedure 1228 Additionally, certain PTCA complications such as intimal disruption, thrombus formation or embolisation, and even stenting could require extensive anticoagulation,17with increased risk of bleeding complications if performed after MIDCAB surgery. On the other hand, failure of PTCA with need for emergency bypass surgery is rare with decreasing incidence,29 30and primary PTCA with complications requiring pharmacotherapy such as aspirin, ticlopidine, or glycoprotein IIb/IIIa inhibitors31 32 might delay the following MIDCAB procedure unnecessarily.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Myocardial "hybrid" revascularisation with minimally invasive direct coronary artery bypass grafting combined with coronary angioplasty: preliminary results of a multicentre study

Wittwer

2000

Heart

View full text Add to dashboard Cite

Objective-To expand the benefits of the minimally invasive direct coronary artery bypass (MIDCAB) concept to patients with multivessel disease, a hybrid procedure combining surgical revascularisation of the left anterior descending artery with interventional procedures for additional coronary lesions has recently been introduced. Preliminary results in patients undergoing this hybrid procedure are presented. Design and patients-Since December 1996, 35 patients (29 male, 6 female, mean (SD) age 56.7 (17) years) underwent a hybrid revascularisation performed as a primary MIDCAB procedure for grafting of the left anterior descending artery with the left internal mammary artery, followed by staged angioplasty and stenting of additional coronary lesions. Results-After MIDCAB grafting the postoperative course was uneventful in all patients. Coronary reangiography after a median of seven days revealed patent and functioning left internal mammary artery grafts in all patients. Applying subsequent percutaneous transluminal coronary angioplasty and occasional stenting (n = 14), a total of 47 lesions were treated successfully. Procedure related complications did not occur. All patients remained free from angina and no stress ECG changes were recorded. Conclusions-The preliminary results of this hybrid approach to myocardial revascularisation suggest that this is a safe and eVective procedure for complete revascularisation in selected patients with multivessel disease. Elderly and reoperative patients with significant comorbidity may benefit especially from such hybrid procedures by avoiding cardiopulmonary bypass and mid sternotomy. (Heart 2000;83:58-63) Keywords: hybrid revascularisation; minimally invasive cardiac surgery; interventional treatment; multivessel revascularisation Revascularisation of multivessel coronary artery disease with the left internal mammary artery (LIMA) and additional vein grafts using cardiopulmonary bypass and cardioplegic arrest currently represents the standard technique in coronary surgery.1 2 Despite continuing improvements in equipment and surgical technique, deleterious eVects of cardiopulmonary bypass, such as systemic inflammatory reactions, postoperative organ dysfunction, and coagulatory disorders, still pose problems. 3-5Aiming for less invasive cardiac surgery, several groups have reported encouraging results of coronary artery bypass grafting without cardiopulmonary bypass through conventional sternotomy or through diVerent minimised incisions. [6][7][8] In two larger series, a left anterolateral minithoracotomy was used to harvest the LIMA with subsequent coronary artery grafting of anterior vessels on a beating heart without cardiopulmonary bypass.9 10 Because of limited access through this incision, this approach cannot be applied for multivessel revascularisation without additional incisions or use of cardiopulmonary bypass.To expand the benefits of minimally invasive direct coronary artery bypass (MIDCAB) approaches to patients with multivessel disease, a "hybrid" p...

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Myocardial "hybrid" revascularisation with minimally invasive direct coronary artery bypass grafting combined with coronary angioplasty: preliminary results of a multicentre study

Wittwer

2000

Heart

View full text Add to dashboard Cite

show abstract

“…Coronary intervention was performed according to the guidelines of the American Heart Association/American College of Cardiology. 8 The study was carried out according to the principles of the Declaration of Helsinki. Written informed consent according to local practice for the intervention as described above and for a follow up angiography six months after the procedure was obtained for every patient.…”

Section: Patient Selectionmentioning

confidence: 99%

Clinical and angiographic outcome after conventional angioplasty with optional stent implantation compared with direct stenting without predilatation

Miketic

Carlsson²,

Tebbe³

2002

Heart

View full text Add to dashboard Cite

Objective: To compare in a randomised trial the procedural and clinical outcome and long term patency of conventional angioplasty with optional stent implantation versus direct stenting without predilatation. Methods: Patients undergoing coronary intervention for symptomatic coronary artery disease were randomly assigned to conventional angioplasty with optional stenting or to direct stent implantation without predilatation. The post-stent treatment consisted of antiplatelets. Follow up angiography was performed six months after the initial procedure. Results: Between December 1998 and August 1999, 181 of 190 eligible patients were randomly assigned to either optional stenting (n = 92) or direct stenting (n = 89). The procedural success was similar in both groups (87 (97.8%) in the optional v 87 (94.6%) in direct stenting group, p = 0.88). There were five cases of crossover from the direct stenting to the optional stenting group. Six patients experienced a Q wave myocardial infarction without further complications (4 in the optional v 2 in the direct stenting group, p = 0.36). One patient in whom coronary angioplasty failed underwent elective bypass surgery. No patients required urgent bypass surgery and no patients died. The reduction in late luminal loss (mean (SD) 1.19 (0.87) mm in the optional v 0.62 (0.69) mm in the direct stenting group, p = 0.004) led to a significant improvement in minimal luminal diameter at follow up (1.87 (0.93) mm in the optional v 2.56 (0.86) mm in the direct stenting group, p = 0.002), resulting in a significant reduction in restenosis rate, defined as > 50% diameter stenosis at follow up 6.5 (2.1) months after the initial procedure (28 (30.4%) in the optional v 14 (15.7%) in the direct stenting group, p = 0.019). Direct stenting significantly reduced the overall procedure and fluoroscopy times, the amount of contrast medium used, and the number of angioplasty catheters needed. The incidence of clinical events during the six month follow up did not differ significantly between the groups. No patient died during follow up. Conclusions: Direct stent implantation without predilatation significantly reduced late luminal loss, giving a better improvement in minimal luminal diameter and restenosis rate than with optional stenting. There were five patients in whom direct stenting failed who needed predilatation followed by stent implantation. However, in most patients direct stent implantation without predilatation is a feasible treatment option with a favourable long term outcome and a low incidence of complication. The procedure may help to reduce the cost of coronary interventions by reducing overall procedure and fluoroscopy times, the amount of contrast medium used, and the number of angiography catheters needed.

show abstract

“…Sufficient patient and procedural data must be recorded to allow some form of risk stratification to be included in the audit process, and both centres and individual operators must take account of these factors when deciding the type of patients to accept for intervention. Risk may be related to patient specific factors, such as the presence of comorbid conditions (renal failure, diabetes) and clinical presentation (for example, stable angina, unstable angina, evolving myocardial infarction, etc), or lesion specific characteristics such as those suggested by the American College of Cardiology/American Heart Association task force15 which classified stenoses into A, B1, B2, and C lesions. Anticipated outcome must take account of these factors.…”

Section: Case Selectionmentioning

confidence: 99%

Coronary angioplasty: guidelines for good practice and training

Society¹

2000

Heart

View full text Add to dashboard Cite

Guidelines for percutaneous transluminal coronary angioplasty

Cited by 234 publications

References 146 publications

Myocardial "hybrid" revascularisation with minimally invasive direct coronary artery bypass grafting combined with coronary angioplasty: preliminary results of a multicentre study

Myocardial "hybrid" revascularisation with minimally invasive direct coronary artery bypass grafting combined with coronary angioplasty: preliminary results of a multicentre study

Clinical and angiographic outcome after conventional angioplasty with optional stent implantation compared with direct stenting without predilatation

Coronary angioplasty: guidelines for good practice and training

Contact Info

Product

Resources

About