ABSTRACT
BACKGROUND: The cutting balloon (CB) is an emerging therapy for the treatment of instent restenosis (ISR), but its impact on the clinical outcomes of patients treated with intracoronary radiation therapy (IRT) with Sr-90 compared with conventional PTCA and IRT is not clearly defined. METHODS: We compared the baseline demographics, angiographic characteristics and clinical outcomes of 102 consecutive patients with ISR treated either with CB+IRT (n=45) or with conventional PTCA+IRT (n=57). The combined endpoint was the occurrence of major adverse cardiac events (MACE), which was defined as a composite of death, myocardial infarction (MI) or target vessel revascularization (TVR) at 6 months. RESULTS: The CB+IRT group had a shorter mean lesion length (14.3+/-6.5 vs. 21.1+/-15.7, P=.009), and greater utilization of glycoprotein IIb/IIIa inhibitors during the procedure (48.9% vs. 26.3%, P=.02) compared to the PTCA+IRT group. There were no significant differences in the baseline demographics, angiographic and procedural results, or subsequent MACE at 6 months between the two groups. CONCLUSION: The strategy of CB+IRT using Sr-90 for ISR is associated with similar procedural and clinical outcomes compared to conventional PTCA+IRT. Further study is warranted to determine which patient subgroups would derive the most benefit from this approach.
Subject(s)
Beta Particles/therapeutic use , Graft Occlusion, Vascular/therapy , Stents , Strontium Radioisotopes/therapeutic use , Aged , Angioplasty, Balloon , Blood Vessel Prosthesis Implantation , Clinical Trials as Topic , Female , Follow-Up Studies , Graft Occlusion, Vascular/etiology , Humans , Male , Middle Aged , Myocardial Infarction/etiology , Myocardial Infarction/therapy , Platelet Glycoprotein GPIIb-IIIa Complex/therapeutic use , Prospective Studies , Random Allocation , Stents/adverse effects , Treatment OutcomeSubject(s)
Brachytherapy/methods , Coronary Restenosis/prevention & control , Coronary Restenosis/radiotherapy , Heart Transplantation , Stents/adverse effects , Angioplasty, Balloon, Coronary , Beta Particles/therapeutic use , Cardiac Catheterization/methods , Female , Follow-Up Studies , Humans , Male , Middle Aged , Myocardial Ischemia/therapy , Treatment OutcomeABSTRACT
We report a case of a 70-year-old male who was undergoing elective angioplasty of the left anterior descending coronary artery. During the procedure, a coronary guidewire became unraveled after positioning an undeployed stent; we describe its successful retrieval by removal of the undeployed stent. Although sidebranch protection and placement of a stent with the guidewire left in place is commonly performed without complication, it should be realized that this practice is not without hazard because of the unusual, but serious consequences that could ensue if the entrapped wire were to unravel.
