Percutaneous transluminal coronary angioplasty with an over-the-wire system.

Abstract

The original Gruentzig coaxial catheter system for percutaneous transluminal coronary angioplasty (PTCA) utilized a blunt, closed-end, inner balloon catheter with a short guide wire attached to its tip. Options for safely crossing severe stenoses with this large, nonmaneuverable catheter were limited. More recently, over-the-wire systems have been developed in which the lesion initially is crossed with a small-caliber floppy or steerable guide wire, then by the balloon catheter advanced over the wire. Technical success was achieved in 78 of our first 100 PTCAs with this system. Significant cardiac complications occurred in ten patients, seven of whom required emergency coronary bypass surgery. A recently published survey of all PTCA techniques reported a technical success rate of 62%. Our higher success rate may be attributed to certain advantages of the over-the-wire system, which are discussed in detail. A learning curve is associated with this procedure: our success rate was 65% in the first 20 cases but 81% thereafter. These results can be considered typical of those expected at hospitals now beginning PTCA programs with advanced over-the-wire technology.

Overview of Technological Development, Complications, and Grossing Techniques in Percutaneous Coronary Intervention

“…The fixed wire era is reported as the 1977–1982 period in a five-year study comprising 631 patients where successful angioplasty was reported for 59% of stenosed arteries and where 65 of 91 patients (83%) with a one-year follow-up reported overall improved condition; on the other hand, emergency coronary artery bypass was required in six percent of cases, myocardial infarction occurred in four percent, and in-hospital death occurred in one percent (4). The over-the-wire era saw increased success rates associated with an improved catheter design in which the arterial lesion was crossed first by a small-caliber floppy steerable guide wire, then by the balloon catheter that was advanced over the guide wire; because of the improved outcomes, the 1985–1986 Percutaneous Transluminal Coronary Angioplast Registry was re-opened in order to track outcomes (5, 6). The so-called stent era saw success rates improve to 97% with overall improved immediate and one-year outcomes, despite the fact that PCI use had also expanded to include more patients with severe comorbidities, acute coronary syndromes, and complex multi-vessel disease (7).…”