Treatment of unstable angina pectoris with percutaneous transluminal coronary angioplasty (ptca)

Meyer, Jürgen; Schmitz, H. J.; Erbel, Raimund; T, Kiesslich; Böcker‐Josephs, B.; Krebs, W.; Braun, Peter; Bardos, P; Minale, C; Messmer, Bruno J.; Effert, S

doi:10.1002/ccd.1810070408

Cited by 49 publications

(5 citation statements)

References 18 publications

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“…Unstable Angina PTCA has been introduced by Andreas Grª [94] in order to treat patients with stable angina and extended to treat patients with unstable angina, too [156]. Already early on, the results of PTCA revealed a higher complication rate including acute myocardial infarction and need for coronary bypass surgery and mortality in patients with unstable than with stable angina [65,192].…”

Section: Mkroembofization Durÿ Coronary Interventionsmentioning

confidence: 99%

Koronate Mikroembolisierung — Bedeutung bei akuten koronaren Syndromen und bei interventionellen Eingriffen

Erbel¹,

Heusch²

1999

Herz

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The diagnosis coronary artery disease is classically based on patient's symptoms and morphology, as analyzed by angiography. The importance of risk factors for the development of coronary atherosclerosis and disturbance of coronary vasomotion is clearly established. However, microembolization of the coronary circulation has also to be taken into account. Microembolization may occur as a single or as multiple, repetitive events, and it may induce inflammatory responses. Spontaneous microembolization may occur, when the fibrous cap of an atheroma or fibroatheroma (Stary i.v. and Va) ruptures and the lipid pool with or without additional thrombus formation is washed out of the atheroma into the microcirculation. Such events with progressive thrombus formation are known as cyclic flow variations. Plaque rupture occurs more frequently than previously assumed, i.e. in 9% of patients without known heart disease suffering a traffic accident and in 22% of patients with hypertension and diabetes. Also, in patients dying from sudden death microembolization is frequently found. Patients with stable and unstable angina show not only signs of coronary plaque rupture and thrombus formation, but also microemboli and microinfarcts, the only difference between those with stable and unstable angina being the number of events. Appreciation of microembolization may help to better understand the pathogenesis of ischemic cardiomyopathy, diabetic cardiomyopathy and acute coronary syndromes, in particular in patients with normal coronary angiograms, but plaque rupture detected by intravascular ultrasound. Also, the benefit from glycoprotein IIb/IIIa receptor antagonist is better understood, when not only the prevention of thrombus formation in the epicardial atherosclerotic plaque, but also that of microemboli is taken into account. Microembolization also occurs during PTCA, inducing elevations of troponin T and I and elevations of the ST segment in the EKG. Elevated baseline coronary blood flow velocity, as a potential consequence of reactive hyperemia in myocardium surrounding areas of microembolization, is more frequent in patients with high frequency rotablation than in patients with stenting and in patients with PTCA. The hypothesis of iafrogenic microembolization during coronary interventions is now supported by the use of aspiration and filtration devices, where particles with a size of up to 700 microns have been retrieved. In the experiment, microembolization is characterized by perfusion-contraction mismatch, as the proportionate reduction of flow and function seen with an epicardial stenosis is lost and replaced by contractile dysfunction in the absence of reduced flow. The analysis of the coronary microcirculation, in addition to that of the morphology and function of epicardial coronary arteries, and in particular appreciation of the concept of microembolization will further improve the understanding of the pathophysiology and clinical symptoms of coronary artery disease.

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Section: Mkroembofization Durÿ Coronary Interventionsmentioning

confidence: 99%

Koronate Mikroembolisierung — Bedeutung bei akuten koronaren Syndromen und bei interventionellen Eingriffen

Erbel¹,

Heusch²

1999

Herz

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“…Nach diagnostischer Herzkatheteruntersuchung wurde bei zehn Patienten die Indikation zur Dilatation gestellt. Die Vorbereitung der Patienten erfolgte wie bei normaler Ballondilatation (26,27,29…”

Section: Patienten Und Methodeunclassified

“…Die perkutane transluminale koronare Angioplastie hat sich als wichtige Therapie bei Patienten mit stabiler (12,19) und instabiler Angina pectoris (26,27) erwiesen. Die Erfolgsrate liegt heute bei Stenosen über 90% (29,35), bei chronischen Gefäßverschlüssen allerdings nur bei 45-71% (10,16,22,31).…”

Section: High Frequency Rotational Atherectomy In Coronary Heart Diseaseunclassified

Hochfrequenz-Rotationsatherektomie bei koronarer Herzkrankheit

Erbel¹,

O’Neill²,

Auth³

et al. 2008

Dtsch med Wochenschr

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Percutaneous high frequency coronary rotational ablation (PTCR) was used in 10 patients with significant coronary artery disease. PTCR removes arteriosclerotic material from the vessel wall. A diamond-coated (60-80 micron) brass burr-drill, fastened to a flexible drive shaft rotating and tracking along a central coaxial guide wire, was used. The turbine rotates the drive shaft in excess of 150,000-190,000 revolutions per minute. PTCR was successful in all patients, but in three additional percutaneous transluminal coronary angioplasty (PTCA) was then successfully performed. Coronary dissection occurred only once, requiring surgery which was successful. No vessel perforation was observed. All vessels were open on the coronary angiograms performed after 24 hours. The main indication for PTCR seems to be a rigid and longer lesion which can not be dilated with the balloon catheter.

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“…Schon früh hatte Jürgen Meyer in seinen Analysen der perkutane transluminale Koronarangioplastie (PTCA) bei instabiler Angina pectoris erkannt, dass sich die Ergebnisse erheblich von denen bei stabiler Angina pectoris unterschieden, die Komplikationsrate größer und die Restenose höher waren [39,40]. Als Ursache wurde eine unterschiedliche Plaquekomposition vermutet.…”

Section: Plaqueruptur/plaqueerosionunclassified

Neue Erkenntnisse zur Pathogenese und Ätiologie der koronaren Herzerkrankung

Erbel

Görge

2014

Dtsch med Wochenschr

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In clinical practice the non-invasive diagnosis of "coronary heart disease" is based on the clinical findings, the detection of ischemia at rest or during exercise, and elevations of cardiac enzymes. However, due to the compensatory enlargement of the vessel diameter at the beginning of plaque growth, the so-called Glagov effect, early stages of plaque development are missed by the angiography. By means of coronary angiography, changes of the coronary arteries become visible only in patients with angiographically recognizable lumen narrowing compared to the reference vessel segment. Thus, early or diffuse stages of atherosclerosis cannot be detected by ECG, stress-tests or coronary angiography. This limitation explains discrepancies, like positive troponin-test and even transmural ischemia, without angiographic visible coronary lumen narrowing. Diagnostic procedures such as intravascular ultrasound, optical coherence tomography, measurements of vasomotion and computed tomography can, in contrast, detect earlier stages of coronary artery disease and thus contribute to clarification in these patients. In addition, plaque rupture and plaque-erosion lead to acute or recurrent microembolism to distal myocardium with subsequent myocardial necrosis. In patients with formerly unexplained cardiovascular events, intravascular ultrasound, optical coherence tomography, and measurements of vasomotion help to understand the underlying pathophysiology. In the report after cardiac catheterization, the term "ruled out coronary heart disease" should be replaced by "No signs of obstructive coronary heart disease" and additional testing should be performed as necessary.

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Treatment of unstable angina pectoris with percutaneous transluminal coronary angioplasty (ptca)

Cited by 49 publications

References 18 publications

Koronate Mikroembolisierung — Bedeutung bei akuten koronaren Syndromen und bei interventionellen Eingriffen

Koronate Mikroembolisierung — Bedeutung bei akuten koronaren Syndromen und bei interventionellen Eingriffen

Hochfrequenz-Rotationsatherektomie bei koronarer Herzkrankheit

Neue Erkenntnisse zur Pathogenese und Ätiologie der koronaren Herzerkrankung

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