The Cutting Balloon--a new technology?

The Cutting Balloon consists of a standard balloon dilatation catheter with four microtome-sharp blades that incise the plaque and minimize arterial wall trauma. It was used in 31 patients; nine had calcified arteries, ten had non-compliant lesions, three had in-stent restenosis and nine had aorto-ostial lesions. Seventeen lesions were predilated, 28 were post-dilated and 18 required stent implantation. The procedure was very effective in aorto-ostial lesions, non-compliant lesions that were not responsive to high-pressure balloon dilatation, and was partially successful in calcified arteries. It has a very specific niche in selected lesions.

The Radial Artery: An Applicable Approach to Complex Coronary Angioplasty.

The purpose of this study was to assess the clinical value of the transradial approach (TRA) in coronary angioplasty. During the 18Ðmonth period from June 1994 to December 1995, 250 patients (mean age 61 +/- 11) underwent coronary angioplasty using the transradial approach. In 7 (2.8%) radial puncture was unsuccessful and in 6 (2.4%) additional femoral access was needed to complete the procedure. Ninety patients (36%) had angioplasty of two or three vessels and 49.5% had type B2 or C lesions. Sixty-five patients (22%) had additional procedures: stent implantations in 50 (16%) and rotational ablation in 15 (6%). Angiographic success was 97% and there were no deaths. Major procedural complications included: Q-wave myocardial infarction in 2 (0.8%), non-Q-wave myocardial infarction in 5 (2.0%), urgent coronary artery bypass grafting in 2 (0.8%) and CVA in 2 (0.8%). Local vascular complication included: compartment syndrome necessitating fasciotomy in 1 patient (0.4%), mild hematoma in 6 (2.4%) and a small pseudo-aneurysm treated by local compression in 4 (1.6%). Radial pulse was palpated in 93% before discharge and in 3% adequate flow could be heard with Doppler. No patient suffered from ischemia of the hand. Complex coronary angioplasty can be performed safely using the TRA with few vascular complications.

Coronary Stenting in Vessels with Marked Proximal Tortuosity Using a Sport Wire: Advantages and Pitfalls.

In this report two patients are described in whom successful deployment of a coronary stent was achieved in a very tortuous coronary artery. Deployment was performed using a special extra-support wire that straightened the proximal segment of the artery and provided the support for stent advancement. The mechanical straightening of the artery induced marked narrowing that did not respond to intracoronary nitroglycerin but disappeared after withdrawal of the wire.