[Excimer laser assisted angioplasty. Immediate results in the treatment of complex coronary lesions]. / Angioplastie assistée par laser Excimer. Résultats immédiats dans le traitement des lésions coronaires complexes.

Transluminal coronary angioplasty (TCA) with pulsed excimer laser (CVX 300 Spectranetics) was performed in 89 patients (age 63.7 years); CCS I: 6; CCS II: 12; CCS III: 40; CCS IV: 31; instable: 58%. There was a previous history of myocardial infarction (MI) in 27 cases, TCA (9 restenoses) in 24 cases, 19 bypass graft procedures, 13 failures of TCA. The lesions (n = 90) affected the left main coronary artery: 1 case; the left anterior descending artery: 37 cases; the left circumflex: 8 cases; the right coronary: 28 cases and there were saphenous vein grafts in 16 cases. The lesions were classified B2 (ACC/AHA) in 56 cases and type C in 34 cases. There were 24 lesions > 10 mm, 15 > 20 mm; calcification in 49 cases; excentric in 65 cases; ostial in 9 cases; affecting bifurcations in 13 cases; affecting collateral vessels in 16 cases; chronic occlusions in 12 cases and restenoses of stents in 4 cases. Multifiber catheters: 1.4 mm (50), 1.7 mm (41) and 2 mm (3), were used to deliver energies of 43.3 mj/m2 (+/- 8.1 mj) with an average of 5.2 +/- 1.2 applications persite, and 2.7 +/- 1.1 passages. A balloon dilatation was performed after laser angioplasty in 96% of cases. The following results were observed: success of laser angioplasty (20% reduction of stenosis) in 95.5%, a successful procedure (residual stenosis less than 50% without major complications) in 95.5%, and a clinical success (no pathological Q wave or non-Q wave infarction, bypass graft, or repeat TCA): 92.1%. The following complications were observed: death = 0, non-Q wave infarction 2.2%, emergency bypass surgery in 1 case with Q wave infarction: 1.1%. The use of laser angioplasty may be proposed in the following indications: long, moderately calcified lesion, ostial lesions, complete occlusions, bypass graft disease, failure of angioplasty. In addition to these indications, we propose the treatment of restenosis on stents. The main disadvantage of the Excimer Laser is the poor cost/benefit ratio, given the relatively small number of indications.

[Value of the combined Lastac laser-angioplasty technic in symptomatic superficial femoral occlusion]. / Intérêt de la technique combinée Lastac laser-angioplastie dans les occlusions fémorales superficielles symptomatiques.

The results of peripheral transluminal angioplasty are satisfactory in stenotic arteries but those observed in the recanalisation of occluded peripheral arteries are not so good. There would therefore seem to be a good therapeutic opportunity for laser between angioplasty and surgery for patients with symptomatic arterial occlusion. The authors report their experience with the Lastac laser in 12 patients with symptomatic superficial femoral arterial occlusion. This is a no-contact laser. All patients had surgical indications in case of failure to recanalise by laser, despite collateral circulation by the profunda artery which was inadequate on effort leading to claudication and a limited walking perimeter. After 1 initial failure, 11 successful procedures were performed. There were no perforations due to the Argon laser beam but 2 were observed with the guide wire which was rapidly sealed by the balloon catheter. A surgical haematoma at the percutaneous puncture point resulted in 1 reocclusion during the patient's hospital period so that the 11 technical successes became 10 clinical successes. At medium-term follow-up, one asymptomatic occlusion had occurred and one restenosis was successfully redilated. The advantages of a continuous Argon "Lastac" laser compared with a contact laser are its capacity for auto-control, its coaxial fibre placement and the absence of direct contact with the lesion. The coaxial fibre arrangement plays an important role in preventing vascular perforation. These factors enable it to be used with more safety in patients with arterial occlusion.

[Transluminal coronary angioplasty using a percutaneous axillary route with an arterial sheath]. / Angioplastie coronaire transluminale par voie percutanée axillaire avec introducteur artériel.

Out of 1400 percutaneous transluminal coronary angioplasties (PTCA), 23 (1.6 p. 100) were performed by the left percutaneous axillary approach because the bifemoral approach could not be used. There were 18 patients (17 men, 1 woman) with a mean age of 58 years. The coronary vessels dilated were the anterior interventricular artery (n = 4), the circumflex artery (n = 9) and the right coronary artery (n = 10), i.e. a total of 25 stenoses. The success rate in procedures was 83 p. 100 (19/23), and the primary success rate in patients was 83.3 p. 100 (15/18): Despite a good initial result, one patient developed inferior myocardial infarction as a result occlusion of a dominant distal circumflex artery, due to protamine administration immediately after the procedure. Another failure ascribable to the approach was due to selective catheterization being impossible. The mean duration of TCA was 38 min. In every cases the arterial introducer was withdrawn after neutralization with protamine. There were 4 cases of restenosis (25 p. 100) :3 were treated by a second PTCA using the percutaneous axillary approach and 1 by surgery. The method has the following disadvantages: (1) neutralization with protamine is mandatory (we had 1 case of occlusion with infarction after protamine in this series); (2) it is imperative to prevent the formation of a blood collection that would infiltrate the brachial plexus; for this purpose, the axillary cavity must be compressed effectively after PTCA and the puncture area must be watched for 24 to 48 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

[Intracavitary extraction of fragments of intracardiac catheters using a pigtail catheter. Apropos of 14 operations]. / Extraction endocavitaire de fragments de cathéters intracardiaques à l'aide d'une sonde "queue de cochon". A propos de 14 interventions.

Endocavitary extraction of intracardiac fragments of intravenous catheters was attempted in 14 patients over a 7 year period. The fragments were recovered in 13 cases under local anaesthesia without complications. The average duration of the procedure was less than 15 minutes. The technique requires a pigtail catheter, a material which is usually readily available in all catheter laboratories. This simple procedure may prevent complications and enable some patients to avoid surgery.

[Azygography in pre-operative investigation of cancer of the esophagus : a report on 24 cases (author's transl)]. / L'azygographie : sa place dans le bilan pré-opératoire du cancer de l'oesophage. A propos de 24 cas.

The value of azygography for detecting extension of cancer of the middle third of the esophagus was assessed in 24 patients. The examination was conducted using the retrograde approach, and results were compared with those obtained by the esophagogram and on tracheobronchial fibroscopy. Compression of the azygos vein is a good indicator of the size of the tumor, which can also be evaluated from esophageal transit examinations. The vein can be invaded or even thrombosed due to severe regional spread but this does not mean that excision of the tumor is impossible. The results of azygography alone, therefore, are not a valid reason for contra-indicating esophagectomy. In case of doubt, tracheobronchial fibroscopy appears to be more suitable for deciding whether the tumor is operable, but azygography can assist in making this decision.