Comparative study of the angiographic morphology of coronary artery lesions treated with PTCA, directional coronary atherectomy, or high-speed rotational ablation.

To evaluate trends in morphology-based intervention selection, series of 110 consecutive procedures of each of three devices, percutaneous transluminal balloon coronary angioplasty (PTCA), directional coronary atherectomy (DCA), or high-speed rotational ablation (HSRA), were reviewed. PTCA was used mainly in discrete, concentric, smooth, ACC/AHA type A and B1 lesions. PTCA was used less frequently on a bend, branching points or in calcified lesions. Using PTCA as a reference, DCA was used more often for the treatment of discrete, proximal, eccentric, and noncalcified lesions, often complicated with thrombus and located on straight segments. HSRA was used more frequently in diffuse, calcified multiple complicated and B2+C type lesions with frequent side branches and bend points. These results suggest that directional atherectomy and rotational ablation may be helpful in expanding the capacity of the operator to approach prognostically unfavorable lesions.

Coronary stenting with a new ultra-short balloon expandable device: early and late animal results.

The early and late effects of a new balloon-expandable coronary stent (Boneau II) were studied in 16 adult mongrel dogs. Thirty-three balloon-expandable stents were deployed using standard transfemoral coronary angioplasty technique. Single stents were placed in eight dogs and multiple (two to four) stents were placed in eight dogs. Intravenous heparin (3,000 units) was administered at the beginning of the procedure. Aspirin, dipyridamole, dextran, and warfarin were not administered before or after the procedure. All stent deployments were successful. Angiographic or pathologic examinations were performed within 24 hr of deployment on two of the dogs, at 2 weeks on two of the dogs, at 2 months on three of the dogs, at 6 months on six of the dogs, and at 1 year on three of the dogs. All successfully deployed stents were noted to be widely patent. There was no evidence of side-branch vessel occlusion. There was no evidence of acute or late vessel thrombosis. Histologic examination at 2 months showed a mean intimal thickness of 153 microns. The stainless steel Boneau II coronary stent is relatively short and easily deployed. This balloon-expandable coronary stent was successfully deployed in normal canine arteries without the use of anticoagulation or antiplatelet therapy before or after the procedure. The Boneau II intracoronary stent has a very low thrombogenic potential in dogs.

The balloon on a wire device: a new ultra-low-profile coronary angioplasty system/concept.

A new ultra-low-profile coronary angioplasty device, a "balloon probe," is presented. This device consists of a balloon on a coronary guidewire and is the lowest profile dilatation system presently available. The balloon material is polyethylene terephthalate, a new polymer with high inflation pressure limits and very low compliance. This report discusses this device and its usage in coronary artery disease.