New balloon catheter for prolonged percutaneous transluminal coronary angioplasty and bypass flow in occluded vessels

Abstract

A new balloon catheter was developed for continuous perfusion of coronary arteries during angioplasty (CPC catheter). Steerable Grüntzig balloon catheters (3.7 mm) with two lumina were formed. The first lumen was used for balloon inflation. Side holes to the second lumen proximally and distally to the balloon were created for coronary perfusion even during inflation phase. At a perfusion pressure of 120 mmHg, a flow rate of 63 +/- 3 ml/min with 0.9% saline and 43 +/- 1 ml/min with plasma expander were measured. In experiments on five dogs, dilation time until appearance of signs of ischemia could be prolonged in three of five dogs from 30 to 40 s, 120 to 203 s, and 180 to 420 s comparing conventional and CPC balloon catheters. In 11 patients with proximal lesions, dilation time could be increased from 39.5 +/- 23.9 s to 81.1 +/- 36.3 s (p less than 0.01) until appearance of angina pectoris. ST segment changes were observed in 10/11 patients using conventional catheters. Using CPC catheters, no ST segment changes were observed in four patients; time until appearance of ST segment changes was delayed in the other seven patients. The CPC catheter seems to be an alternative catheter in proximal lesions of the left and right coronary artery, allowing the possibility of prolonged dilation and increased safety to the patient. In case of dissection or perforation, the CPC catheter can be used for perfusion of the distal part of the coronary vessel until emergency bypass surgery.

Preservation of distal coronary perfusion during prolonged balloon inflation with an autoperfusion angioplasty catheter.

“…Several such perfusion systems have been used experimentally and clinically and have proved to be effective in reducing acute myocardial ischemia.8-" However, such perfusion systems are complex and cumbersome. Erbel et al 20 have reported results in five dogs and 11 patients with an autoperfusion-type catheter; prolongation of time from onset of dilatation to appearance of ischemia was noted in three of the dogs and eight of the patients. Their catheter had a larger profile and fewer sideholes, which may account for some of the difference in results.…”

New concept in coronary angioplasty: Dilatation with a helical balloon that allows simultaneous autoperfusion

“…7). Clearly, myocardial perfusion and reduction of ischemia, both of which have been amply demonstrated to occur with the Erbel-type catheter [2][3][4], are preferable to the absence of antegrade coronary flow that occurs during standard balloon inflations. However, the requirement for a large lumen and the retraction and replacement of the guidewire during procedures performed with conventional perfusion devices are limitations that may, in part, explain why these catheters are not used in favor of nonperfusion devices.…”

“…Autoperfusion catheters are available and have been clearly shown to limit myocardial ischemia during bal-loon inflation [2][3][4]. The limitation of ischemia can reduce the risk of complex angioplasty.…”

High-Resolution Intravascular Magnetic Resonance Imaging

“…Possible solutions include shortening of imaging times with the use of ultrafast echoplanar data acquisition strategies 24 or the use of tunneled balloon designs. 25 With such a continuous perfusion catheter, dilation times for PTCA could be significantly increased. 25 MRI of vascular walls can also be accomplished with external surface coils.…”

“…25 With such a continuous perfusion catheter, dilation times for PTCA could be significantly increased. 25 MRI of vascular walls can also be accomplished with external surface coils. 26 The relatively poor results obtained in this study primarily reflect differences in the animal model: Whereas Skinner et al 26 used a deendotheliazation model resulting in well-developed atherosclerotic plaque, this study included rabbits with very early-stage disease.…”