ABSTRACT
BACKGROUND: Balloon rupture is a potential complication of coronary angioplasty. The literature is inconsistent regarding associated adverse consequences. The experience of St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, with balloon rupture is reviewed. PATIENTS AND METHODS: All patients who underwent percutaneous coronary intervention complicated by balloon rupture at St Paul's Hospital from April 1992 to March 1996 were identified from the hospital's database (Seattle Systems, Seattle, Washington). Procedural logs, database records, clinical charts and all cineangiograms were reviewed in detail. RESULTS: A total of 2984 patients had percutaneous coronary revascularization and 110 patients experienced balloon rupture. These occurred in 101 (92%) native coronary arteries and 9 (8%) occurred in saphenous vein grafts. Stents were deployed in 44 (40%) patients; 34 of the stents used were half Johnson & Johnson PS153 stents (Johnson & Johnson Interventinal Systems, Peterborough, Ontario). An event-free postangioplasty course during the index hospitalization was observed in 102 patients (93%); eight patients (7%) had one or more important adverse events postprocedure. These included three deaths (one following a dissection and out-of-catheterization laboratory occlusion, a second following an abrupt occlusion of another target artery and emergency bypass surgery, and another with cardiogenic shock postmyocardial infarction and an unaltered course following angioplasty); one urgent bypass surgery after a left main dissection; and two nonfatal myocardial infarctions (one patient had tamponade and one patient experienced congestive heart failure). Four of the eight events were directly related to the procedure. The rate of death and emergency bypass surgery with balloon rupture did not differ from that of patients without balloon rupture in the authors' centre (1.8% versus 1.4%, not significant). CONCLUSIONS: The majority of patients did not experience any adverse clinical outcomes and demonstrated good angiographic results after balloon rupture. The data did not detect an excess of major adverse events beyond that expected in a diverse general angioplasty population.
Subject(s)
Angioplasty, Balloon, Coronary/adverse effects , Coronary Disease/surgery , Equipment Failure , HumansABSTRACT
In a single-center experience, initial failure of attempted stent delivery was relatively infrequent (2.7%) but was associated with increased need for urgent coronary bypass surgery. Delivery failure was more likely with coiled stents and dislodgment from the delivery balloon was more likely with hand-mounted or radiolucent stents.
Subject(s)
Coronary Disease/therapy , Stents , Angioplasty, Balloon, Coronary/instrumentation , Angioplasty, Balloon, Coronary/methods , Coronary Artery Bypass , Coronary Disease/surgery , Coronary Vessels , Databases as Topic , Equipment Design , Equipment Failure , Humans , Incidence , Retrospective Studies , Stents/adverse effects , Surface Properties , Treatment Failure , Treatment OutcomeABSTRACT
OBJECTIVE: To evaluate whether percutaneous coronary rotational atherectomy (RA) improves quality of life. DESIGN: Prospective sequential study of the first 20 patients who had RA at St Paul's Hospital, Vancouver from November 1993 to April 1994. SETTING: Tertiary care teaching hospital. PATIENTS: There were nine males and 11 females with a mean age of 68 +/- 9.3 years. All had angina pectoris with type B or C coronary lesions. INTERVENTIONS: RA was performed using the Rotablator device. RESULTS: The procedure was angiographically successful in 20 patients and clinically successful in 18 patients. Two patients who sustained acute myocardial infarctions underwent coronary bypass surgery. Before RA there was one patient in Canadian Cardiovascular Society angina class I, five patients in class II, 12 in class III, and two in class IV. At six months' follow-up there were 11 patients in class I, seven in class II and two in class III. The mean Duke Activity Status Index improved from 21.3 +/- 15.8 (mean +/- SD) before the procedure to 36.9 +/- 15.8 (P < 0.001) at six months' follow-up. The consumption of anti-anginal medications also decreased. CONCLUSIONS: RA was associated with improved functional status and quality of life in patients having angina pectoris with type B or C coronary lesions.
