==================================HSR37================================== 37. Percutaneous transluminal coronary angioplasty when multi-vessel disease is involved. 1 UI - 87118684 AU - Shaw RE ; Cohen F ; Fishman-Rosen J ; Murphy MC ; Stertzer SH ; Clark DA ; Myler RK TI - Psychologic predictors of psychosocial and medical outcomes in patients undergoing coronary angioplasty. AB - The relationship between psychologic variables (the match between repressive style and level of cardiac information, and anxiety level) and medical complications, re-stenosis (renarrowing), and psychosocial adjustment was studied in 97 patients undergoing percutaneous transluminal coronary angioplasty (PTCA) for treatment of narrowed coronary arteries. Three major findings emerged for outcomes measured 6 months after PTCA: repressors with a high level of cardiac information (coping style-information level mismatch) and no history of heart attack were at higher risk for late medical complications (p less than 0.001); sensitizers with a low level of cardiac information (coping style-information level mismatch) and whose PTCA was only moderately successful were at higher risk for re-stenosis of the artery previously widened during PTCA (p less than 0.01); and patients who were more anxious during hospitalization had poorer social functioning and more mood disturbance 6 months after PTCA (p less than 0.05). Thus, psychologic, information, and medical factors are important in predicting 6-month outcomes in patients undergoing PTCA. MH - *Adaptation, Psychological ; Adult ; Aged ; Angioplasty, Transluminal/ ADVERSE EFFECTS/*PSYCHOLOGY ; Coronary Arteriosclerosis/PSYCHOLOGY/ *THERAPY ; Follow-Up Studies ; Human ; Middle Age ; Prognosis ; Recurrence ; Repression ; Risk ; Support, Non-U.S. Gov't SO - Psychosom Med 1986 Nov-Dec;48(8):582-97 2 UI - 87111647 AU - Br:uckmann H ; Ringelstein EB ; Buchner H ; Zeumer H TI - Percutaneous transluminal angioplasty of the vertebral artery. A therapeutic alternative to operative reconstruction of proximal vertebral artery stenoses. AB - Percutaneous transluminal angioplasty (PTA) of the proximal vertebral artery was performed in 13 patients with stenosis of the proximal vertebral arteries. All of these patients had symptoms indicating vertebrobasilar insufficiency. PTA was performed only if an extreme reduction of the total diameter of both vertebral arteries was present. Only 13 patients have fulfilled the strict selection criteria in the last 3 years. All patients were monitored during the procedure by means of continuous-wave Doppler ultrasound and electrophysiological techniques. After PTA their neurological and vascular conditions were serially examined. Of the 13 patients, 8 showed marked improvement of both subjective and objective clinical symptoms. During an observation period of 2-25 months (average: 15 months) reocclusion of the angioplasty was observed in only 2 cases, without any additional neurological sequelae. Electrophysiological and Doppler sonographic monitoring during PTA helped to minimize the risk of angioplasty. MH - *Angioplasty, Transluminal ; Cerebral Angiography ; Cerebrovascular Disorders/RADIOGRAPHY/*THERAPY ; Constriction, Pathologic/RADIOGRAPHY/ THERAPY ; Follow-Up Studies ; Human ; *Vertebral Artery SO - J Neurol 1986 Nov;233(6):336-9 3 UI - 87102739 AU - Geschwind HJ ; Teisseire B ; Boussignac G ; Vieilledent C TI - Laser angioplasty of arterial stenoses. AB - To establish the optimal conditions for recanalization of obstructed arteries without damage to vessel walls, an Nd-YAG laser coupled to a 0.2-mm-diameter optical fiber was used on obstructed human cadaver coronary and peripheral arteries and on popliteal arteries in amputated limbs. Vaporization of atheromatous plaques was consistently obtained with energy of 360-600 J and a diluted blood perfusate (3 g/100 ml hemoglobin) at a rate of 30 ml/min. The arterial wall was protected from thermal injury by inserting the optical fiber into an inflated balloon catheter and by cooling the system with the perfusate. Since recanalization of occluded arteries was consistently obtained without damage to the arterial wall or debris and thin and flexible optical fibers were easy to guide in the arteries, percutaneous transluminal Nd-YAG laser angioplasty was used in obstructed femoral and popliteal arteries in 12 patients. The first trials in man with Nd-YAG laser showed the method to be feasible, effective, and at low risk, although further studies are required to improve penetration of the obstruction and increase the diameter tunnel. MH - *Angioplasty, Transluminal ; Arterial Occlusive Diseases/SURGERY/*THERAPY ; Constriction, Pathologic/SURGERY/THERAPY ; Fiber Optics ; Human ; *Laser Surgery SO - Cardiovasc Intervent Radiol 1986;9(5-6):313-7 4 UI - 87101807 AU - Korogi Y ; Takahashi M TI - Percutaneous transluminal angioplasty of totally occluded iliac arteries in high-risk patients. AB - Percutaneous transluminal angioplasty was performed successfully in five of six patients with complete iliac artery occlusion. All of the patients were at high risk because of various co-existing diseases. The length of occlusion ranged from 3.0 cm to 12.0 cm. No significant complications requiring surgery occurred during or after the procedures. Follow-up of patients revealed that the vessels were still patent after 3-22 months. Percutaneous transluminal angioplasty of totally occluded iliac arteries may represent the therapy of first choice even in the high-risk group. MH - Aged ; Aged, 80 and over ; *Angioplasty, Transluminal ; Arterial Occlusive Diseases/*THERAPY ; Case Report ; Female ; Human ; *Iliac Artery ; Male ; Middle Age ; Risk SO - Br J Radiol 1986 Dec;59(708):1167-70 5 UI - 87003324 AU - Cumberland DC ; Tayler DI ; Procter AE TI - Laser-assisted percutaneous angioplasty: initial clinical experience in peripheral arteries. AB - Experimental and animal studies have shown that laser energy can vaporize intra-vascular thrombus and atheroma, suggesting that it may have a role in percutaneous angioplasty. Argon laser energy transmitted via a flexible fibre introduced through a percutaneous catheter was used in 15 patients undergoing balloon angioplasty of femoral or popliteal arteries. Of four stenoses, laser alone produced improvement of the lumen in two. Of 11 occlusions some degree of clearance of the lumen was achieved by laser in eight prior to balloon dilatation. Extravasation of contrast medium indicating wall perforation occurred in two patients, without clinical sequelae. No other complications, such as embolism, arterial spasm or toxic effects were observed. There was one acute re-occlusion, almost certainly not related to the use of laser. There have been no late complications. The ability of laser to influence favourably vascular occlusion is confirmed, but technical advances are necessary to avoid vessel wall perforation consistently and to improve the production of an adequate lumen before its potential can be fully realized. MH - *Angioplasty, Transluminal/ADVERSE EFFECTS ; Arterial Occlusive Diseases/ RADIOGRAPHY/*THERAPY ; Femoral Artery/RADIOGRAPHY ; Human ; Lasers/ ADVERSE EFFECTS/*THERAPEUTIC USE ; Popliteal Artery/RADIOGRAPHY SO - Clin Radiol 1986 Sep;37(5):423-8 6 UI - 87003115 AU - Mallmann R ; Roth FJ TI - Treatment of neurofibromatosis associated renal artery stenosis with hypertension by percutaneous transluminal angioplasty. AB - A 12 year old girl with severe arterial hypertension was found to have neurofibromatosis associated bilateral stenoses of the main renal arteries and elevated plasma renin activity in the right main renal vein. Antihypertensive treatment was unable to normalize blood pressure. PTA of the right renal artery from a left axillary approach resulted in normalization of blood pressure and peripheral plasma renin activity. PTA seems to be an effective and safe method for treatment even of complicated forms of renal artery stenosis. MH - *Angioplasty, Transluminal ; Blood Pressure ; Case Report ; Child ; Female ; Human ; Hypertension, Renovascular/COMPLICATIONS/PHYSIOPATHOLOGY/ *THERAPY ; Neurofibromatosis/*COMPLICATIONS ; Renal Artery Obstruction/ COMPLICATIONS/PHYSIOPATHOLOGY/*THERAPY ; Renin/BLOOD SO - Clin Exp Hypertens [A] 1986;8(4-5):893-9 7 UI - 86311535 AU - Mahler F ; Triller J ; Weidmann P ; Nachbur B TI - Complications in percutaneous transluminal dilatation of renal arteries. AB - We propose a classification of the complications in renal artery percutaneous transluminal angioplasty (PTA) according to their severity and their direct or indirect relationship to PTA. Minor complications are reversible within the normal recovery period after PTA, while major complications are irreversible or reversible but necessitate extended hospitalization or surgery. The following complications are reported in the literature as being directly related to PTA: hemorrhage at the puncture site, hemorrhage from renal or access artery perforation or rupture, occlusive or nonocclusive dissection of the renal or access arteries, renal artery thrombosis, renal artery spasm or embolism leading to segmental renal infarction, peripheral artery embolisation, and balloon rupture complications. The indirectly related complications include transient or irreversible renal insufficiency, contrast media hypersensitivity, pressure-drop-related cerebral or myocardial ischemia, and anticoagulation-related hemorrhage infections. In our own series of 105 PTA in 80 patients, complications occurred in 11% of which 4% were major, 1% indirectly related to PTA leading to death. In the reports available, the rate of major complication ranges between 3 and 10%, and the death rate around 1%. MH - Adult ; Angioplasty, Transluminal/*ADVERSE EFFECTS/MORTALITY ; Female ; Hemorrhage/ETIOLOGY ; Human ; Middle Age ; Renal Artery/INJURIES/ RADIOGRAPHY ; Renal Artery Obstruction/*THERAPY ; Rupture/ETIOLOGY SO - Nephron 1986;44 Suppl 1:60-3 8 UI - 86308282 AU - Braun IF ; Battey PM ; Fulenwider JT ; Per-Lee JH TI - Transcatheter carotid occlusion: an alternative to the surgical treatment of cervical carotid aneurysms. AB - The treatment of choice for various aneurysms of the common and internal carotid arteries may involve carotid artery occlusion rather than a reconstructive approach. Carotid occlusion may be accomplished either surgically or via an endovascular method. We present two cases of patients with cervical carotid artery aneurysms in which the endovascular method was used for carotid occlusion, describe our rationale for using this approach rather than surgical intervention, and discuss the role of this method of treatment for this condition. MH - Adolescence ; Aged ; Aneurysm/PATHOLOGY/RADIOGRAPHY/*THERAPY ; *Angioplasty, Transluminal/INSTRUMENTATION ; Carotid Artery Diseases/ PATHOLOGY/RADIOGRAPHY/*THERAPY ; Carotid Artery, External/RADIOGRAPHY ; Carotid Artery, Internal/RADIOGRAPHY ; Case Report ; Female ; Human ; Male SO - J Vasc Surg 1986 Sep;4(3):299-302 9 UI - 86306190 AU - Janevski BK ; Breslau PJ ; Jorning PJ TI - More accurate assessment of stenotic lesions in percutaneous transluminal angioplasty. AB - Eighty patients underwent percutaneous transluminal dilatation and recanalisation of atheromatous lesions of the arteries of the lower extremities in the University Hospital of Maastricht in the period of 1980 to 1984. Out of 80 attempted procedures of the iliac and femoro-popliteal tract 71 (89%) were technically possible and were considered initially successful. In all cases of iliac artery lesions a retrograde arteriogram was performed prior to PTA. Intra-arterial pressure measurements at rest and after hyperemia were used for exact assessment of the hemodynamic significance of the stenosis before and after PTA. A follow-up of all patients successfully treated by angioplasty was performed. The early hemodynamic success rate of PTA for iliac lesions was 90 per cent and for femoral-popliteal segment 83 per cent. There was no morbidity or mortality. The cumulative 3-year patency rate for both segments was 74 per cent. MH - Adult ; Aged ; *Angioplasty, Transluminal ; Arterial Occlusive Diseases/ PHYSIOPATHOLOGY/RADIOGRAPHY/*THERAPY ; Blood Pressure ; Female ; *Femoral Artery ; Hemodynamics ; Human ; *Iliac Artery/PHYSIOLOGY/PHYSIOPATHOLOGY/ RADIOGRAPHY ; Male ; Middle Age ; *Popliteal Artery SO - Int Angiol 1986 Apr-Jun;5(2):97-103 10 UI - 86227846 AU - Akaba N ; Ujiie H ; Umezawa K ; Miura K ; Yamamoto Y ; Horihoshi S ; Ijima H TI - Management of acute aortic dissections with a cylinder-type balloon catheter to close the entry. AB - Despite recent advances in medical treatment, an acute aortic dissection is still now often fatal because of the seriousness of its condition. The currently available therapies include blocking the progress of dissection with intensive drug therapy, a process leading to the chronic stage. However, the dissection often proceeds rapidly and may result in death. Various surgical procedures have been attempted so far, but they produce highly invasive stress and high risks. Accordingly, we designed a cylinder-type balloon catheter and developed a new closing procedure, wherein a balloon catheter is introduced and inflated at the site with an intimal tear to maintain the blood flow to the distal vessels and also to close the entry. With this procedure, the complaints will be relieved or disappear, the progress of the dissection can be stopped, and the blood flow can be restored to the reduced and collapsed true lumen. When the blood in the pseudolumen becomes coagulated and organized, the balloon is removed. If this catheter is introduced from the femoral artery (similar to an intra-aortic balloon pumping method), the invasive stress will be further reduced. This method appears to be the most useful for DeBakey type III dissections. We are now intensively studying the safe and effective application of this balloon catheter under various clinical conditions. MH - Aneurysm, Dissecting/*THERAPY ; Angioplasty, Transluminal/ *INSTRUMENTATION ; Animal ; Aorta ; Aortic Aneurysm/*THERAPY ; Dogs ; Human SO - J Vasc Surg 1986 Jun;3(6):890-4 11 UI - 86218051 AU - Erbel R ; Clas W ; Busch U ; von Seelen W ; Brennecke R ; Bl:omer H ; Meyer J TI - New balloon catheter for prolonged percutaneous transluminal coronary angioplasty and bypass flow in occluded vessels. AB - A new balloon catheter was developed for continuous perfusion of coronary arteries during angioplasty (CPC catheter). Steerable Gr:untzig 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. MH - Adult ; Angioplasty, Transluminal/*INSTRUMENTATION ; Animal ; Arterial Occlusive Diseases/*THERAPY ; Coronary Disease/*THERAPY ; Dogs ; Human ; Male ; Middle Age ; Perfusion ; Regression Analysis ; Review ; Time Factors SO - Cathet Cardiovasc Diagn 1986;12(2):116-23 12 UI - 86172141 AU - Walden R ; Siegel Y ; Rubinstein ZJ ; Morag B ; Bass A ; Adar R TI - Percutaneous transluminal angioplasty. A suggested method for analysis of clinical, arteriographic, and hemodynamic factors affecting the results of treatment. AB - Sixty-nine percutaneous transluminal angioplasties (PTAs) were performed in the iliac and the femoral arteries of 54 patients. The main factors that might affect the results were reviewed: associated diseases, severity of ischemic symptoms, location and type of lesions (stenosis or occlusion and their length), and presence of disease distal to the site dilated. The vascular status of the patients in our series was more severe than in most others. Improvement at follow-up (average 15 months) was maintained in 74% of 66 radiographically successful PTAs. Poor runoff was the only factor found to affect the outcome deleteriously. Intra-arterial pressure measurements performed during the procedure and vascular laboratory studies were most valuable in assessing immediate and long-term results. Wide variations in results of PTA published in the literature are due to differences in methods of selection, evaluation, and reporting. A plea is made for future presentations of PTA series in an analyzable and comparable way, including and correlating all relevant variables as in the model suggested by the present study. MH - Adult ; Aged ; *Angioplasty, Transluminal ; Arteriosclerosis/PATHOLOGY/ RADIOGRAPHY/*THERAPY ; Female ; Femoral Artery/PATHOLOGY/RADIOGRAPHY ; Follow-Up Studies ; Hemodynamics ; Human ; Iliac Artery/PATHOLOGY/ RADIOGRAPHY ; Leg ; Male ; Middle Age SO - J Vasc Surg 1986 Apr;3(4):583-90 13 UI - 86155268 AU - Colapinto RF ; Stronell RD ; Johnston WK TI - Transluminal angioplasty of complete iliac obstructions. AB - Of 64 complete iliac obstructions, 50 (78%) were recanalized using the Gruntzig balloon catheter. Life-table analysis of the patency rate over a 4-year period gives a cumulative success rate of 78%. Only three of eight obstructions that involved both the common and external iliac arteries were successfully dilated. The only serious complication was distal embolization, which occurred in two cases (3.1%). Although the procedure is difficult, with a relatively low technical success rate, the high cumulative patency rate should make it an option in the treatment of all patients with totally occluded iliac artery segments. MH - Adult ; Aged ; *Angioplasty, Transluminal ; Arteriosclerosis/*THERAPY ; Female ; Follow-Up Studies ; Human ; *Iliac Artery ; Male ; Middle Age SO - AJR 1986 Apr;146(4):859-62 14 UI - 86121715 AU - Vitek JJ ; Keller FS ; Duvall ER ; Gupta KL ; Chandra-Sekar B TI - Brachiocephalic artery dilation by percutaneous transluminal angioplasty. AB - Percutaneous transluminal angioplasty (PTA) was used to dilate stenotic lesions in 38 brachiocephalic arteries in 36 patient. Complete evaluation of the central nervous system blood supply is a prerequisite for the brachiocephalic PTA when cerebral symptoms are present. The femoral artery is the best vascular entry site; use of digital subtraction angiography equipment for arterial mapping is helpful. Balloon diameter should be the same as or slightly wider than the diameter of the normal artery adjacent to the stenotic segment. Spasm was successfully treated with intraarterial injection of nitroglycerin. The only drug therapy consistently used with PTA was aspirin. Complete dilation of the stenosis is the best prevention of thrombotic or embolic complications. In properly selected cases, proximal subclavian artery stenoses can be safely dilated, and the balloon can eventually be placed across the origin of the vertebral artery. Because of potential complications associated with brachiocephalic PTA, indications must be well established, and interventions should not be performed on marginal or asymptomatic stenoses. MH - Aged ; Angiography ; Angioplasty, Transluminal/*METHODS ; Arterial Occlusive Diseases/*THERAPY ; Carotid Artery Diseases/*THERAPY ; Female ; Human ; Male ; Middle Age ; *Subclavian Artery SO - Radiology 1986 Mar;158(3):779-85