Coronary angioplasty through a new 6 French guiding catheter.

Coronary angioplasty through smaller-diameter guiding catheters using predominantly fixed-wire balloon systems has been possible, but has had some limitations. The purpose of this prospective, nonrandomized study was to investigate the results of percutaneous transluminal coronary angioplasty using a new 6F guiding catheter with over-the-wire balloon systems. Coronary angioplasty using over-the-wire balloon systems through a new 6F guiding catheter was evaluated in 79 lesions in 70 patients and then compared to randomly selected procedures using 7F guiding catheters in 70 patients performed over the same time period. Coronary angioplasty through 6F guiding catheters and over-the-wire balloons including 8 long (30-mm) and 3 perfusion balloons was successful in 94.9% of lesions and in 94% of patients. Coronary angioplasty through 7F guiding catheters was successful in 97.5% of lesions and in 97.1% of patients, respectively. Success rates between 6F and 7F guiding catheter groups were similar overall and for proximal, mid, distal, or complex (total, subtotal, or length > 10-mm) lesions. There were no failures to withdraw the deflated balloon into the 6F guiding catheter. Vessel opacification after dilatation with the guidewire across the lesion was similar between the 6F and 7F guiding catheter groups. The mean change in hematocrit for the 6F procedures (-1.4 +/- 3.7%) was significantly lower than for the 7F procedures (-3.3 +/- 3.2%, P < 0.001). Coronary angioplasty using a variety of over-the-wire balloon catheters through a new 6F guiding catheter is feasible with success rates comparable to 7F guiding catheters. Angioplasty with this 6F guiding catheter reduces procedural blood loss compared to larger-lumen guiding catheters.

Placement and angiographic patency of the Strecker coronary stent.

The Strecker stent is a newer, balloon-expandable vascular prosthesis consisting of a single tantalum filament knitted into a flexible mesh tube. To test the placement characteristics and patency of this device, we implanted 29 stents in the coronary arteries of 24 juvenile Yorkshire swine. Seventeen stents were placed in the left anterior descending artery, and 12 were placed in the left circumflex system. All stents were deployed successfully. Four animals died within the first 24 hr of anesthesia-related complications. The remaining animals were sacrificed at 24 hr, 1 week, 2 weeks, or 4 weeks. Follow-up angiography demonstrated the patency of all stents. There were no episodes of stent migration or side branch occlusion. The Strecker stent has several favorable characteristics, including its unique delivery system, ease of deployment, flexibility, radiopacity, and radial strength. There was 100% patency at up to 4 weeks in this animal model. Further studies are required to define whether the knitted mesh design offers any advantage over previous models.

Coronary artery fistula diagnosed by transesophageal echocardiography.

Coronary artery fistulas have been traditionally diagnosed by angiography. This report describes a congenital and a traumatic coronary artery fistula diagnosed by transesophageal echocardiography. Transesophageal echocardiography was superior to transthoracic echocardiography in both cases and to angiography in one case. Transesophageal echocardiography may now be the procedure of choice in diagnosing coronary fistula.

Fragmentation and embolization of a plastic-coated guidewire.

We report a case of fragmentation and embolization to the pulmonary artery of sheared pieces of a recently introduced hydrophilic plastic-coated guidewire. The propensity for this to occur, the lack of initial recognition, and the ability to retrieve the fragments by catheter techniques are emphasized. As these guidewires are more frequently used, physicians should be aware of this potential complication.

Coronary angioplasty using an autoperfusion balloon catheter through a 6 French guiding catheter.

Use of 6 French guiding catheters for elective percutaneous transluminal coronary angioplasty has been limited by lack of a compatible autoperfusion balloon catheter for management of complications such as acute vessel closure and large subintimal dissections. We describe the successful use of a lower profile autoperfusion balloon catheter through large internal lumen 6F guiding catheters for elective coronary angioplasty. These cases demonstrate the feasibility of the use of autoperfusion balloon catheters with 6F guiding catheters in elective, and presumably also in emergent, settings.

Percutaneous transluminal coronary angioplasty through 6F diagnostic catheters: a feasibility study.

This study evaluated the feasibility of performing coronary angioplasty through 6F diagnostic catheters by mainly using over-the-wire balloon systems on 84 lesions in 70 patients. Procedural variables, including vessel opacification and angioplasty outcome, were assessed. Changes in hematocrit after angioplasty were compared for 6F versus 7F and 8F systems. Successful 6F dilatation was performed in 72 (85.7%) of 84 lesions and 58 (82.9%) of 70 patients. Seven of the 12 lesions unable to be dilated with 6F systems were successfully dilated with larger French systems. Coronary artery opacification with the 6F catheters after balloon dilation was less than optimal with the balloon and guidewire still in the catheter. Changes in hematocrit after 6F procedures were significantly less than for 8F procedures (-2.1% vs -4.2%, respectively, p < 0.01) but not for 7F procedures (-2.4%, p = not significant). Potential cost savings for angioplasty with 6F diagnostic catheters could be significant. Thus angioplasty with over-the-wire balloon systems in which 6F nontapered diagnostic catheters are used can be performed safely and with less procedural blood loss than with 8F systems. Significant problems encountered with the current catheter design were poor vessel opacification after balloon dilation and difficulties with balloon retraction.

Increased risk of coronary artery dissection during coronary angiography with 6F catheters.

The use of smaller sized catheters for coronary angiography (CA) is increasing, but little is known about the safety of CA with 6F catheters. The authors reviewed all cases of CA in which 6F and 8F catheters were used in adult patients between 1988 and June, 1990. There were 597 patients in the 6F group and 2,409 patients in the 8F group. Cases of CA with 6F catheters were more likely to be elective (95% vs 87%), to have no coronary disease (35% vs 24%), and to be performed by nonfirst-year fellows (70% vs 54%) when compared with CA with 8F catheters. There were 5 cases of coronary artery dissection. The incidence of dissections was significantly higher (p = .007) in the 6F group (0.67%) than in the 8F group (0.04%). The incidence of dissections was highest for first-year fellows using 6F catheters (1.7%), which was significantly higher (p = .008) than for first-year fellows using 8F catheters. The incidence of major vascular complications tended to be lower (p = .068) in the 6F group (0.17%) than in the 8F group (0.95%). In summary, CA with 6F catheters is associated with an increased risk of coronary artery dissection, particularly with less experienced operators, but tends to be associated with a lower risk of major vascular complications.

Coronary angioplasty following cardiac transplantation: a case report and review of the literature.

A 23-year-old man underwent successful percutaneous transluminal coronary angioplasty of a severe stenosis of the left anterior descending artery 25 months after orthotopic heart transplantation. Four months later restenosis of the same lesion was treated by repeat PTCA. Angiography 11 months later showed no restenosis. In selected cases, PTCA may be useful in treating allograft coronary disease.

Metoclopramide-induced tardive dyskinesia: a case report.

A case of tardive dyskinesia developed in a patient who had been treated with metoclopramide for 8 months. Acute extrapyramidal side effects are also possible with this medication. Guidelines for the use of metoclopramide are presented with special emphasis on patients with renal insufficiency and the elderly. The importance of consultation-liaison psychiatrists' familiarity with the neurologic side effects of this commonly prescribed drug used in general medical practice is emphasized.