Multilesion coronary angioplasty: Clinical and angiographic follow-up

Vandormael, Michel; Deligönül, Ubeydullah; Kern, Morton J.; Harper, Michael S.; Presant, Stephen; Gibson, Paul; Galan, Kathy; Chaitman, Bernard R.

doi:10.1016/s0735-1097(87)80003-7

Cited by 186 publications

(26 citation statements)

References 19 publications

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“…Diabetes has been a "minefield" for percutaneous coronary interventions (PCI), presenting an exceptionally high risk of restenosis up to 71% after plain balloon angioplasty 8 and up to 38% after bare-metal stents (BMS). 9 In addition, diabetic patients carry a higher risk of total vessel occlusion after stenting, 9 leading to myocardial infarction, reduced ventricular function, and congestive heart failure.…”

Section: Article See P 121 and 130mentioning

confidence: 99%

More Deserved Focus on Diabetic Patients

Ndrepepa

King

Kastrati

2011

Circ: Cardiovascular Interventions

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W orldwide diabetes mellitus has reached epidemic proportions, and its prevalence is rising. Estimates predict an increase in the prevalence of diabetes from 2.8% (171 million) in 2000 to 4.4% (366 million) in 2030. 1 The prevalence of coronary heart disease is as high as 55% among adult patients with diabetes. 2 Patients with diabetes have a 2-to 4-fold increase in the risk of coronary artery disease, which accounts for three-quarters of diabetes-related deaths and is by far the most common cause of mortality in these patients. 3 Patients with diabetes have accelerated and more diffuse coronary artery disease with longer lesions often associated with negative coronary remodeling, smaller diameter vessels on angiography, 4 and reduced collateral development. 5 The diffuse and rapidly progressing atherosclerosis increases the need for revascularization therapy in diabetic patients. 6 Thus, in the United States, one-quarter to one-third of all revascularization procedures are performed in diabetic patients. 6,7 Of note, compared with nondiabetic patients, patients with diabetes have worse outcomes after surgical or catheter-based revascularization procedures. Article see p 121 and 130Diabetes has been a "minefield" for percutaneous coronary interventions (PCI), presenting an exceptionally high risk of restenosis up to 71% after plain balloon angioplasty 8 and up to 38% after bare-metal stents (BMS). 9 In addition, diabetic patients carry a higher risk of total vessel occlusion after stenting, 9 leading to myocardial infarction, reduced ventricular function, and congestive heart failure. 9,10 These factors along with the accelerated progression of atherosclerosis reduce long-term survival of patients with diabetes. 11 The limitations of balloon angioplasty and BMS have contributed to the superiority of coronary artery bypass graft surgery over PCI shown in previous trials comparing these 2 treatment strategies in diabetic patients. 12 With the development and clinical use of drug-eluting stents (DES), restenosis was markedly reduced among patients with and without diabetes. 13 Despite further recent developments in stent technology, improved periprocedural care, and current antithrombotic drugs, revascularization therapy is still suboptimal in diabetic patients. Apart from restenosis, which still remains higher in diabetic patients, several other areas of uncertainty in the field of revascularization therapy for patients with diabetes still remain. First, the most complex diabetic patients, that is, those with multivessel or diffuse coronary artery disease, have been excluded from recruitment in the DES trials. Thus, the efficacy of DES in these patients most in need of revascularization procedures is largely unknown. Second, current knowledge of the efficacy of PCI in diabetic patients is largely derived from subgroup analyses, which are markedly underpowered to detect the outcomes of interest with statistical fidelity. Third, the possibility of increased risk of stent thrombosis in patients with diabetes has been...

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Section: Article See P 121 and 130mentioning

confidence: 99%

More Deserved Focus on Diabetic Patients

Ndrepepa

King

Kastrati

2011

Circ: Cardiovascular Interventions

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“…Among the clinical variables, diabetes mellitus and unstable angina are reported most frequently. The anatomical variables such as; proximal stenosis, saphenous-vein graft involvement of the left anterior descending artery, chronically occluded artery, stenosis more 5 to 10 mm in length, severe pre PTCA stenosis [42,43,44], and procedural variable such as residual stenosis, small residual lumen, and used undersized balloon [45] may increase incidences of restenosis after PTCA.…”

Section: Risk Factors For Restenosismentioning

confidence: 99%

Short Term and Long Term Complications after Percutaneous Transluminal Coronary Angioplasty (PTCA)

Sharma¹

2017

IJCH

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Background: The nonsurgical treatment of arteries narrowed by atherosclerosis was introduced in 1964, when Dotter and Judkin performed transluminal angioplasty of femoral artery stenoses [1]. In 1970, Gruntzig modified the dilation catheter to allow its use in coronary arteries dilation [2]. Subsequently, In 1977 he performed the first Percutaneous Transluminal Coronary Angioplasty (PTCA) in a patient. Since onward, PTCA has been used in many patients with stable angina, unstable angina or acute myocardial infarction. Its use was initially limited to the treatment of discrete stenoses in proximal segment of a coronary artery, but improvements in equipments and techniques have lead its use in patients with stenoses, that are more complex or located in distal arterial segments and in patients relatively at high risk for complications [3]. Despite the wider application of PTCA, the success rate remained high. Over the past decade, the number of procedure performed has steadily increased, with over 300,000 performed in united state in 1990 [4].

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“…1 Diabetic patients appeared to have a higher incidence of myocardial infarction and a greater need for repeated revascularization after coronary angioplasty. 20,21 In fact, the restenosis rate of diabetic patients who underwent coronary angioplasty has been reported to be high, [22][23][24][25][26][27][28] mainly because of the small and diffuse narrowing of diseased coronary arteries that is frequently seen in diabetic patients, which makes it difficult to achieve the optimal large lumen size and is followed by high rate of residual stenosis and restenosis. 29,30 Therefore, coronary angioplasty in diabetic patients has fewer advantages compared with non-diabetic patients.…”

Section: Diabetes Mellitus and Long-term Prognosismentioning

confidence: 99%

Balloon Coronary Angioplasty and Long-Term Survival of Non-Diabetic Patients With Isolated Severe Left Anterior Descending Coronary Artery Disease.

Tomita

Miyazaki

Morii

et al. 2002

Circ J

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ecently, the BARI study reported that the beneficial effect of bypass surgery on long-term survival was more prominent than that of coronary angioplasty in diabetic patients with multivessel coronary artery disease, 1 related, at least in part, to the disadvantage of coronary angioplasty in such patients; that is, the coronary narrowing in diabetic patients is usually diffuse and small, which results in a small minimal lumen diameter after the intervention and a high restenosis rate. 2,3 Another possible explanation is the general disadvantage of coronary angioplasty in achieving complete revascularization compared with bypass surgery in patients with multivessel disease. In fact, multivessel angioplasties were attempted in 70% of the patients in the BARI study and immediate success was achieved in 78%. 1 Thus, incomplete revascularization may contribute to the difference of survival in the 2 groups. To avoid this problem in the interpretation of the study results from patients with multivessel coronary disease, we investigated the long-term prognosis in diabetic and non-diabetic patients with isolated proximal left anterior descending coronary artery (LAD) disease, because LAD disease has Circulation Journal Vol. 66, June 2002 been reported to have significant survival importance. 4 From 1985From to 1994 consecutive patients who underwent their first elective coronary angiography were identified from the computer database at the National Cardiovascular Center and of these, 681 had isolated proximal LAD disease with more than 90% stenosis. Fourteen patients treated with bypass surgery were excluded and the remaining 667 were enrolled in the present study. They were divided into 2 groups according to their diabetic status: diabetes mellitus (DM) or abnormal glucose tolerance (n=225) and non-diabetic (n=442). They were further subdivided into 2 groups according to the initial therapeutic choice: medical therapy (MED group) or percutaneous transluminal balloon coronary angioplasty (PTCA group). Our definitions of coronary risk factors were: hypertension was defined as more than 140 mmHg systolic blood pressure and/or 90 mmHg diastolic blood pressure; hyperlipidemia was defined as more than 220 mg/dl of total serum cholesterol; DM was diagnosed according to WHO criteria. 5 Methods Patients Coronary Angiography and AngioplastyDiagnostic coronary angiography and left ventriculography were performed using a non-ionic contrast medium (Iopamiron 370, Schering Inc or Iomeron, Eisai Inc). The cine-angiography equipment had a bi-plane system (Toshiba Although long-term survival of diabetic patients with multivessel coronary disease has been reported to be better in those treated with bypass surgery than with coronary angioplasty, it is unclear if diabetic patients who undergo coronary angioplasty show better long-term survival than those treated medically. Between 1985 and 1994, 667 consecutive patients with isolated severe (≥90% diameter stenosis) proximal left anterior descending (LAD) coronary artery disease were...

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Multilesion coronary angioplasty: Clinical and angiographic follow-up

Cited by 186 publications

References 19 publications

More Deserved Focus on Diabetic Patients

More Deserved Focus on Diabetic Patients

Short Term and Long Term Complications after Percutaneous Transluminal Coronary Angioplasty (PTCA)

Balloon Coronary Angioplasty and Long-Term Survival of Non-Diabetic Patients With Isolated Severe Left Anterior Descending Coronary Artery Disease.

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