Interventional Cardiology Frankfurt 1990: Rotational Angioplasty. Coronary Balloon Angioplasty. Coarctation of the Aorta. Valvuloplasty. Catheter Closure of Patent Ductus. Appendix

112 Pages·1990·4.83 MB·English

by  M. Kaltenbach

Martin Kaltenbach · Christian Va llbracht (Eds.)
lnterventio
al
Cardiology
F kfu 990
• Rotational Angioplasty
• coronary Balloon Angioplasty
• coarctation of the Aorta
• Valvuloplasty
• catheter Closure of Patent Ductus
• Appendix
Springer-V erlag Berlin Heidelberg GmbH
Professor Dr. med. Martin Kaltenbach
Dr. med. Christian Vallbracht
Klinikum der
Johann Wolfgang Goethe-Universität Frankfurt
Zentrum der Inneren Medizin, Abteilung für Kardiologie
Theodor-Stern-Kai 7, D-6000 Frankfurt
ISBN 978-3-540-53156-2 ISBN 978-3-662-12117-7 (eBook)
DOI 10.1007/978-3-662-12117-7
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© Springer-Verlag Ber1in Heide1berg 1990
Originally pub1ished by Springer-Verlag Berlin Heide1berg New York in 1990
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2119/3145-543210
contents
lntroduction ______________
Low Speed Rotational Angioplasty in Chronic
Peripheral Occlusions-First Long-term Results . . . 37
Evolution of Angioplasty ...................... · · · · 2 C. VALLBRACHT, F. J. ROTH, D. LIERMANN,
M. KALTENBACH and C. V ALLBRACHT H. LANDGRAF, J. KOLLATH, W. SCHOOP,
and M. KALTENBACH
Rotatlonal Angloplasty ---------
coronary Balloon Angioplasty -------
Rotationsangioplastik -
Long Wire Technique - Experience
Ein neues Katheterverfahren .................. · · · · 8
with 1000 Procedures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
M. KALTENBACH und C. V ALLBRACHT
M. KALTENBACH, C. V ALLBRACHT and G. KOBER
Rotationsangioplastik - Ein neues Verfahren
Koronarangioplastik - Ist das Rezidivrisiko
zur Gefäßwiedereröffnung und -erweitemng.
am Tage des Eingriffes voraussagbar?
Experimentelle Befunde . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Eine prospektive Untersuchung ................... . 42
C. VALLBRACHT, J. KRESS, M. SCHWEITZER,
C. VALLBRACHT, H. KLEPZIG jr., H. HOIN,
M. SCHNEIDER, TH. WENDT, M. ZIEMEN, J. KOLLATH,
M. KALTENBACHund G. KOBER
W. BAMBERG und M. KALTENBACH
Recognition of Restenosis: Can Patients be Defined
Rotationsangioplastik - Erste klinische Ergebnisse
in Whom the Exercise-ECG Result Makes
bei peripheren Gefäßverschlüssen . . . . . . . . . . . . . . . . . 15
Angiographic Restudy Unnecessary? ............. . 47
C. V ALLBRACHT, M. SCHWEITZER, J. KRESS,
C. KADEL, T. STRECKER, M. KALTENBACH
W. BAMBERG, J. KOLLATH, D. LIERMANN, C. PAASCH,
and G. KOBER
K. RAUBER, F. J. ROTH, J. PRIGNITZ, W. BEINBORN,
H. LANDGRAF, H. K. BREDDIN, w. SCHOOP,
Results of Repeat Angiography up to Eight Years
und M. KALTENBACH
Following Percutaneous Transluminal Angioplasty
51
Rotationsangioplastik - Wiedereröffnung
G. KoBER, C. VALLBRACHT, C. KAbEL
chronischer Arterienverschlüsse mit einem
and M. KALTENBACH
langsam rotierenden Katheter .................. · · · · 21
C. VALLBRACHT, D. LIERMANN, I. PRIGNITZ, B. Süss,
Mehrfachrezidive nach Ballondilatation -
H. AWISZUS, C. PAASCH, H. LANDGRAF, W. BEINBORN,
Dilatieren oder operieren? ........................ . 55
G. STICKELMANN, J. KOLLATH, F. J. ROTH, W. SCHOOP,
c. VALLBRACHT, G. KOBER, B. KUNKEL, R. HüPF,
H. K. BREDDIN und M. KALTENBACH
H. SIEVERTund M. KALTENBACH
Reopening of Chronic Coronary Artery Occlusions
Analysis of 100 Emergency Aortocoronary Bypass
by Low Speed Rotational Angioplasty ............ . 26
Operations After Percutaneous Transluminal
M. KALTENBACH and C. V ALLBRACHT
Coronary Angioplasty: Which Patients are at Risk
for Large Infarctions? ............................. . 60
Abstracts _______________ __ H. KLEPZIG jr.' G. KOBER, P. SATTER
and M. KALTENBACH
Low Speed Rotational Angioplasty in Chronic
Coronary Artery Obstmetions .................... . 35 coarctation of the Aorta--------
M. KALTENBACH and C. V ALLBRACHT
Transluminale Angioplastik der
Medium-term Results After Reopening Chronic Aortenisthmusstenose bei Jugendlichen
Coronary Artery Obstmetions by Low Speed und Erwachsenen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68
Rotational Angioplasty ........................ · · · · 36 H. SIEVERT, W.-D. BUSSMANN, w. PFOMMER,
M. KALTENBACH and C. V ALLBRACHT J. REUHL und M. KALTENBACH
Aortenaneurysma nach Dilatation einer catheter Closure of Patent Ducuts ____
Aortenisthmusstenose . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . 71
Ein Katheter zur Darstellung des Ductus arteriosus
H. SIEVERT, J. REUHL, R. SCHRÄDER,
persistens . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92
M. KALTENBACH und W.-D. BusSMANN
H. SIEVERT, E. NIEMÖLLER, W.-D. BUSSMANN
G. KOBER, M. KALTENBACH mit techn. Ass. von
Valvuloplasty _____________ K. P. KöHLER und W. BAMBERG
Visualization of the Patent Ductus by Means of
Long-term Results of Percutaneous Pulmonary
a New Low Pressure Ballon Catheter . . . . . . . . . . . . . . 95
Valvuloplasty in adults . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
H. SIEVERT, E. NIEMÖLLER, W.-D. BUSSMANN,
H. SIEVERT, G. KOBER; W.-D. BUSSMANN,
G. KOBER and M. KALTENBACH
J. REUHL, G. CIESLINSKI, P. SATTER
and M. KALTENBACH
Transfemoraler Ductus-Botalli-Verschluß . . . . . . . . . . 99
Akut- und Langzeitergebnisse
Retrograde Mitral Valvuloplasty -
H. SIEVERT, E. NIEMÖLLER, K. P. KöHLER,
A Further Approach to Ballon
w. BAMBERG, H. HANKE, P. SATTER, M. KALTENBACH
Commissurotomy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
und W.-D. BussMANN
H. SIEVERT' P. KRÄMER, M. KALTENBACH
and G. KOBER
Appendix ________________ _
Transluminale Valvuloplastik der nicht verkalkten
Aortenstenose: Akut- und Langzeitergebnisse . . . . . 84
Koronarschemata .................................. 106
H. SIEVERT, P. KRÄMER, W.-D. BUSSMANN
( Coronary diagrams)
M. KALTENBACH und G. KoBER '
Restenosis is a Common Feature of the
Angiographic Follow-up After Ballon Valvoplasty
of Calcified Aortic Stenoses . . . . . . . . . . . . . . . . . . . . . . . . 87
H. SIEVERT, P. KRÄMER, G. KOBER,
W.-D. BUSSMANN and M. KALTENBACH
lntraductlon
Evolution of Angioplastv
M. KALTENBACH and C. VA LLBRACHT
Angioplasty evolved through a series of very unusual had become feasible only after Mason Sones had pi
ideas and their application to patients with atherosclerotic oneered selective coronary arteriography in 1957 and
heart disease. Rene Favoloro aortocoronary bypass surgery in 1967.
Charles Dotter and Melvin Judkins described in 1964 how John Simpson introduced 1982 the steerable balloon cath
peripheral arteries with atherosclerotic obstructions could eter. In 1984 the steerable system was expanded to the
be recanalized using catheters with increasing diameters long-wire technique. With this technique coronary sten
fed over a wire. They demonstrated that the reopened oses are passed by a free wire which is not bindered in
vessels were not necessarily reoccluded by thrombus any way by the balloon catheter, thus allowing optimal
formation and stayed open in the majority of patients opacification and sensitive maneuvering during the proc
(Fig. 1). ess of passing coronary obstructions (Kaltenbach).
Fig. 1. Case 1 of the first published
report of transluminal catheter dila
tation by Charles T. Dotter and
Melvin P. Judkins [1] in 1964
In 1973 Werner Porstmann introduced a nondistensible All the technical advances, achieved over 10 years have
"corset" balloon. This instrument offered the possibility led to a 90 % success rate of coronary balloon angioplasty
to widen an artery far beyond the diameter of the intro and a total of probably more than 300 000 procedures were
duced catheter. performed in 1989. Clinical experience suggests that cor
Andreas Grüntzig developed in 1974 the noncompliant onary angioplasty will become a still increasingly impor
balloon with a cylindrical shape of defined diameter re tant technique for coronary revascularization in the 1990s
sistant to high pressures. He demonstrated by systematic and that the number of patients so treated is most likely
studies that the acute and long-term results achieved with to exceed the total revascularized by surgery. In the early
this instrument in peripheral artery disease are beneficial. years of coronary angioplasty it was estirnated that 5% of
The first coronary angioplasty procedure was performed patients were treated by this procedure instead of
on September 16, 1977, in Zurich and a total of 6 patients undergoing surgery; today this figure has risen to between
were treated in 1977 in Zurich and Frankfurt (Fig. 2). 30 and 50%.
This application of angioplasty to coronary artery disease
Evolution of Angioplasty
Coronary angioplasty 1977
B. A.,(J, LAD, 9/16/1977, Zürich 4 B. H.,d', LM, 11/24/1977, Frankfurt
2 M. F.,a, LM/RCA, 10/18/1977, Frankfurt 5 B.P .,a, LAD, 12/13/1977, Zürich
Fig. 2. Diagrams of the obstruc
tions in the six patients who had
angioplasty in 1977: two with
single-vessel disease (I, 6),
two with double-vessel disease
(3, 5), and two with left main di- a. a.
sease (2, 4) 3 B.A ., LAD/RCA, 11/21/1977, Zürich 6 F. H., LAD, 12/20/1977, Zürich
This increase in the percentage of patients being treated coronary artery stenosis does not recur within a few
with angioplasty is the consequence of improved tech months after successful dilatation.
niques- better guide wires, better balloon catheters- and The atherosclerotic tissue is replaced by scar tissue which
greater experience. More importantly, it is also the result halts the progression of the disease. Late recurrences at
of many observations over up to 10 years which show the site of a previous angioplasty are rare, occurring in
unequivocally that Iong-term prognosis is excellent if less than 1% of cases.
I
4 M. Kaltenbach and C. Vallbracht
These findings constitute the most important lesson from this procedure in the coronary circulation, but restenosis
our 10 years of experience with balloon angioplasty. They rate is apparently not substantially reduced. In excentric
mean that long-term results are as good as those of arterial stenoses, however, the results of atherectomy may be
aortocoronary bypass surgery and are superior to those superior to those achieved with balloon angioplasty.
of venous bypass graft operations, which suffer from a Chronic occlusions can only be reopened with presently
reocclusion rate of about 50% at 10 years. available techniques in about 50%. The success rate
Thus, whenever there is reason to believe that angioplasty markedly decreases in occlusions older than 6 months.
can be performed with a good chance of success (> 80%) This prevents the adequate treatment of patients who
and with low risk to the patient ( < 1%), this procedure is have continuing ischemia in the myocardium distal to a
to be preferred to surgery. coronary occlusion. But also if coronary occlusion brings
The challenges of the 1990s are two problems, namely about the loss of collateral flow into myocardium supplied
restenosis and chronic occlusions. by other stenosed coronary arteries, the risk of angio
Restenosis rate is still around 30%. Mechanical tools plasty in these stenosed artefies is greatly increased. In
including the implantation of stents and medications for such a situation coronary angioplasty of a critical stenosis
the prevention of restenosis have failed to reduce this rate can only be performed with low risk if the occlusion has
substantially. been reopened. Even if chronically occluded coronary
Experience with atherectomy performed with John Simp artefies are perfusing infarcted parts of the myocardium,
son's Atherocut catheter has confirmed the feasibility of reopening of such artefies might be of benefit. The re-
a
c
Fig. 3. a Chronic proximal occlusion of the LAD in a patient with stable angina pectoris. b Other vessels free, retrograde filling of the LAD
from the RCA. Left ventricle shows only slight anterior hypokinesia. c Rotational catheter in the obstruction, contrast injection through the
rotational catheter. d Recanalized LAD
EvolutiOn of Ang1oplasty
Landmarks ln the Develapment af Anglaplasty
t964 Tran Iumina! treatment of stenoses and hort arterial occlu, ions u ing a new catheter sy tem.
C. R. Dotter and M. P. Judkin (1] (Fig. 1)
t97! "Cor et'' balloon catheter for transluminal dilatation of iliac tenoses.
W. Porstmann [2]
t974 Nondi ten ible double-lumen balloon catheter for transluminal angiopla ty of peripheral
arterial stenoses.
A. Grüntzig [3]
t977 Fir t coronary angioplasty in Zurich.
A. Grüntzig [4] (Fig. 2)
t977 First coronary angioplasty in Frankfurt.
M. Kaltenbach and G. Kober [4] (Fig. 2)
t982 The steerable technique for coronary angioplasty.
J. B. Simp on [5]
t984 The long-wire technique for coronary angioplasty
M. Kaltenbach [6]
t985 Transluminal atherectomy.
J. B. Simpson [7]
t986 The monorail technique for coronary angiopla ty.
T. Bonze! [8]
t987 Low-speed rotational angioplasty.
M. Kaltenbach and C. Vallbracht [9] (Fig. 3)
maining myocardium may become better and collaterals speed drilling instruments (as described by Auth and Rit
arising from these arteries can become important, if cor chie), and Iaser catheters are used. Application of such
onary artery disease progresses in other branches. techniques in chronic occlusions which cannot be pene
Reopening of chronic occlusions can be performed with trated by a wire remains, however, problematical (Kensey
conventional guide wires. Thick guide wires are applied, 1986), particularly in tortuous vessels which can easily be
wires can be stiffened by the use of recanalization cathe perforated.
ters. If a guide wire can be advanced through the occlu If the occlusion cannot be crossed with a guide wire, a
sion, a variety of "over the wire" techniques can be ap new technique is low-speed rotational angioplasty (Kal
plied. Beside balloon angioplasty, hot-tip catheters, high- tenbach and Va llbracht 1987). Passage of the occlusion is