Incidence, predictors, and management of acute coronary occlusion after coronary angioplasty

Feyter, Pim J. de; Jaegere, Peter P.T. de; Serruys, Patrick W.

doi:10.1016/0002-8703(94)90675-0

Cited by 104 publications

(41 citation statements)

References 45 publications

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“…However, this technique was plagued by multiple problems, including the risk of acute vessel closure secondary to occlusive coronary dissection, sometimes necessitating emergency coronary artery bypass surgery. [1][2][3] Although late luminal enlargement and vascular remodeling could take place, more often restenosis 4 -8 would occur instead. The restenosis would essentially be caused by constrictive remodeling 9 -13 and, to a lesser extent, by elastic recoil 14 or the neointimal hyperplastic healing response.…”

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confidence: 99%

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Onuma¹,

Serruys²

2011

Circulation

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389

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T he invention of balloon angioplasty as a percutaneous treatment for obstructive coronary disease by Andreas Gruntzig in 1977 was a huge leap forward in cardiovascular medicine and undoubtedly will always be remembered as a revolution in the field of revascularization. However, this technique was plagued by multiple problems, including the risk of acute vessel closure secondary to occlusive coronary dissection, sometimes necessitating emergency coronary artery bypass surgery. 1-3 Although late luminal enlargement and vascular remodeling could take place, more often restenosis 4 -8 would occur instead. The restenosis would essentially be caused by constrictive remodeling 9 -13 and, to a lesser extent, by elastic recoil 14 or the neointimal hyperplastic healing response. [15][16][17] The advent of bare metal stenting (BMS) and the landmark Belgian-Netherlands Stent Study (BENESTENT) and Stent Restenosis Study (STRESS) trials have established BMS as the second revolution in interventional cardiology. 18,19 This technology provided a solution to acute vessel occlusion by sealing the dissection flaps and preventing recoil. The rate of subacute occlusion was reduced to 1.5%, making emergency bypass surgery a rare occurrence. Restenosis rates were further reduced from 32% to 22% at 7 months, but this rate was still high, and neointimal hyperplasia inside the stent was even more prominent than with angioplasty, necessitating repeat treatment in numerous patients. 18 Because the vessel was now caged with metal, late luminal enlargement and advantageous vascular remodeling could no longer occur. Another problem, namely late stent thrombosis (ST), was also first described. 20 To solve the problem of in-stent restenosis, after the historic failure of brachytherapy to resolve this problem, 21,22 drug-eluting stents (DES) were introduced. The first 45 patients implanted with the sirolimuseluting Bx velocity stent (Cordis, Johnson & Johnson, Warren, NJ) were found to have negligible neointimal hyperplasia at follow-up. 23,24 This was confirmed in the randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization (RAVEL) study. 25,26 The introduction of DES was thus dubbed the third revolution in interventional cardiology. Both large-scale randomized trials and all-comer registries showed excellent results in terms of the need for repeat revascularization. However, the early enthusiasm has been tempered in recent years after widespread concerns about the increased risk of late and very late ST. [27][28][29][30][31] Registries of all comers treated with DES showed late ST rates of 0.53%/y, with a continued increase to 3% over 4 years. 32,33 In the Arterial Revascularization Therapies Study II (ARTS II) trial, which enrolled patients with complex multivessel disease, the rate of combined definite, probable, and possible ST was as high as 9.4% at 5 years, accounting for 32% of major adverse cardiovascular events (MACEs). 34 In addition, postmortem pathological specimens of DES revealed sig...

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confidence: 99%

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Onuma¹,

Serruys²

2011

Circulation

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389

151

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“…The high number of bail-out stent implantations reflects the fact that, in the more severe atherosclerotic changes which are usually present in multivessel disease, interventional techniques often cause flow-limiting dissections [20, 21]. In accordance with other investigations, the need for an emergency bypass operation was completely eliminated, and the rate of procedure-related myocardial infarctions was reduced compared to former results, which can be attributed to the use of stents and glycoprotein IIb/IIIa receptor blockers [5, 22, 23].…”

Section: Discussionmentioning

confidence: 99%

Angiographic Outcome in Multivessel Disease (GABI II Study) Using New Coronary Device Interventions and Comparison with GABI I Trial Results

Dietz¹,

Baldus

Rupprecht

et al. 2004

Cardiology

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Percutaneous coronary interventions using stents were investigated in patients with multivessel disease. Acute and long-term results were compared with those of the German Angioplasty Bypass Surgery Investigation trial in a prospective multicenter study. The study included 134 patients in whom 277 lesions were treated. Angiographic success and procedural success were achieved in 268 of 277 lesions (97%) and 118 of 134 patients (88%), respectively. Control angiography performed in 90 of 118 eligible patients (76%) exhibited restenosis in 43 of 182 lesions (24%). Multivariate regression analysis found that a diffuse lesion, the lesion and stent length, and the final luminal diameter were predictive for restenosis. Thus, immediate and long-term results of multivessel coronary intervention utilizing stents were improved compared to percutaneous transluminal coronary angioplasty of multivessel lesions. However, there is still need for improvement of long-term results, especially in particular lesion subgroups.

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“…ECG evidence of ischemia identifies those with significant risk for acute vessel closure (6,118,119,(778)(779)(780). When angina pectoris or ischemic ECG changes occur after PCI, the decision to proceed with further interventional procedures, CABG surgery, or medical therapy should be individualized on the basis of factors such as hemodynamic stability, amount of myocardium at risk, and the likelihood that the treatment will be successful.…”

Section: Postprocedures Evaluation Of Ischemiamentioning

confidence: 99%

“…Factors that correlate with a poor outcome after acute coronary closure include age greater than 70 years, large ischemic burden, presentation with acute coronary syndromes, and LV ejection fraction less than 30% (778)(779)(780).…”

Section: Postprocedures Evaluation Of Ischemiamentioning

confidence: 99%