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Transcatheter Treatment of Coronary Artery Disease

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Coronary Heart Disease

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Abstract

This chapter describes the various methods of percutaneous coronary intervention (PCI), including balloon angioplasty, stenting, thrombectomy, and atherectomy, and the application of intravascular ultrasound. It also illustrates the use of PCI in special cases, as in acute coronary syndromes, acute myocardial infarction, chronic total occlusion, severe calcification of the coronary arteries, and aneurysmal disease. PCI is now the primary method of coronary revascularization. PCI originated as balloon angioplasty, first performed in humans by Andreas Gruntzig in 1978, but it has evolved into a variety of catheter-based methods to treat coronary disease [1]. PCI has revolutionized modern cardiovascular care, enabling patients with myocardial ischemia to be treated less invasively by avoiding a surgical approach. As experience accrued and the technology advanced, the number of patients and angiographic lesion subsets increased dramatically – up to the current era in which PCI is now more commonly performed than coronary artery bypass graft (CABG) surgery. When available and performed in experienced centers by well-trained, expert physicians and teams, it has become the procedure of choice for acute coronary syndromes, acute myocardial infarction, single-vessel coronary artery disease, and many patients with two- and three-vessel coronary artery disease. In addition, it has become the treatment of choice for saphenous vein bypass graft stenoses.

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References

  1. Andreas R, Grüntzig MD, Åke Senning MD, Siegenthaler WE. Nonoperative dilatation of coronary-artery stenosis — percutaneous transluminal coronary angioplasty. N Engl J Med. 1979;301:61–8.

    Article  Google Scholar 

  2. Tenaglia AN, Buller CE, Kisslo KB, Stack RS, Davidson CJ. Mechanisms of balloon angioplasty and directional coronary atherectomy as assessed by intracoronary ultrasound. J Am Coll Cardiol. 1992;20:685–91.

    Article  PubMed  CAS  Google Scholar 

  3. Jain A, Demer LL, Raizner AE, Hartley CJ, Lewis JM, Roberts R. In vivo assessment of vascular dilatation during percutaneous transluminal coronary angioplasty. Am J Cardiol. 1987;60(13):988–92.

    Article  PubMed  CAS  Google Scholar 

  4. Fischman DL, Leon MB, Baim DS, et al., Stent Restenosis Study Investigators. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med. 1994;331:496–501.

    Article  Google Scholar 

  5. Wilson RF, Marcus ML, Aylward PE, Talman CT, White CW. The effect of coronary angioplasty on coronary flow reserve. Circulation. 1988;77:873–85.

    Article  PubMed  CAS  Google Scholar 

  6. Manyari DE, Knudtson M, Kloiber R, Roth D. Sequential thallium-201 myocardial perfusion studies after successful percutaneous transluminal coronary artery angioplasty: delayed resolution of exercise-induced scintigraphic abnormalities. Circulation. 1988;77:86–95.

    Article  PubMed  CAS  Google Scholar 

  7. Writing Group for the Bypass Angioplasty Revascularization Investigation (BARI) Investigators. Five-year clinical and functional outcome comparing bypass surgery and angioplasty in patients with multivessel coronary disease. A multicenter randomized trial. JAMA. 1997;277:715–21.

    Article  Google Scholar 

  8. Coronary artery angiographic changes after PTCA: manual of operations NHLBI PTCA Registry. 1985;6:9.

    Google Scholar 

  9. Ellis SG, Vandormael MG, Cowley MJ, et al. Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel Angioplasty Prognosis Study Group. Circulation. 1990;82:1193–202.

    Article  PubMed  CAS  Google Scholar 

  10. Goldstein JA, Casserly IP, Katsiyiannis WT, et al. Aortocoronary dissection complicating a percutaneous coronary intervention. J Invasive Cardiol. 2003;15:89–92.

    PubMed  Google Scholar 

  11. Eberli FR, Meier B. Restenosis after angioplasty: an Achilles’ heel well covered-up [editorial]. Eur Heart J. 1998;19:976–7.

    PubMed  CAS  Google Scholar 

  12. Schwartz RS, Henry TD. Pathophysiology of coronary artery restenosis. Rev Cardiovasc Med. 2002;3 suppl 5:S4–9.

    PubMed  Google Scholar 

  13. Kastrati A, Dibra A, Mehilli J, et al. Predictive factors of restenosis after coronary implantation of sirolimus- or paclitaxel-eluting stents. Circulation. 2006;113(19):2293–300. doi:10.1161/CIRCULATIONAHA.105.601823.

    Article  PubMed  Google Scholar 

  14. Serruys PW, de Jaegere P, Kiemeneij F, et al. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. Benestent Study Group. N Engl J Med. 1994;331:489–95.

    Article  PubMed  CAS  Google Scholar 

  15. Farb A, Weber DK, Kolodgie FD, Burke AP, Virmani R. Morphological predictors of restenosis after coronary stenting in humans. Circulation. 2002;105:2974–80.

    Article  PubMed  Google Scholar 

  16. Park DW, Kim YH, Yun SC, et al. Comparison of zotarolimus-eluting stents with sirolimus- and paclitaxel-eluting stents for coronary revascularization. J Am Coll Cardiol. 2010;56:1187–95.

    Article  PubMed  Google Scholar 

  17. Shishehbor MH, Goel SS, Kapadia SR, et al. Long-term impact of drug-eluting stents versus bare-metal stents on all-cause mortality. J Am Coll Cardiol. 2008;52:1041–8.

    Article  PubMed  CAS  Google Scholar 

  18. Iakovou T, Schmidt T, Bonizzoni E, et al. Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA. 2005;293:2126–30.

    Article  PubMed  CAS  Google Scholar 

  19. Kuchulakanti PK, Chu WW, Torguson R, et al. Correlates and long-term outcomes of angiographically proven stent thrombosis with sirolimus- and paclitaxel-eluting stents. Circulation. 2006;113:1108–13.

    Article  PubMed  CAS  Google Scholar 

  20. Nakazawa G, Finn AV, Joner M, et al. Delayed arterial healing and increased late stent thrombosis at culprit sites after drug-eluting stent placement for acute myocardial infarction patients: an autopsy study. Circulation. 2008;118:1138–45.

    Article  PubMed  Google Scholar 

  21. Porto I, Selvanayagam JB, Van Gaal WJ, et al. Plaque volume and occurrence and location of periprocedural myocardial necrosis after percutaneous coronary intervention: insights from delayed-enhancement magnetic resonance imaging, thrombolysis in myocardial infarction myocardial perfusion grade analysis, and intravascular ultrasound. Circulation. 2006;114(7):662–9.

    Article  PubMed  Google Scholar 

  22. Migliorini A, Stabile A, Rodriguez AE, et al., JETSTENT Trial Investigators.. Comparison of AngioJet rheolytic thrombectomy before direct infarct artery stenting with direct stenting alone in patients with acute myocardial infarction: the JETSTENT Trial. J Am Coll Cardiol. 2010;56:1298–306.

    Article  Google Scholar 

  23. Vom Dahl J, Dietz U, Haager PK, et al. Rotational atherectomy does not reduce recurrent in-stent restenosis: results of the angioplasty versus rotational atherectomy for treatment of diffuse in-stent restenosis trial (ARTIST). Circulation. 2002;105:583–8.

    Article  PubMed  Google Scholar 

  24. Casserly IP. Orbital atherectomy – another tool in the art of peripheral arterial intervention. Catheter Cardiovasc Interv. 2009;73(3):413–4.

    PubMed  Google Scholar 

  25. Albiero R, Silber S, Di Mario C, et al. Cutting balloon versus conventional balloon angioplasty for the treatment of in-stent restenosis: results of the restenosis cutting balloon evaluation trial (RESCUT). J Am Coll Cardiol. 2004;43:943–9.

    Article  PubMed  Google Scholar 

  26. Sales FJ, Falcão BA, Falcão JL, et al. Evaluation of plaque composition by intravascular ultrasound “virtual histology:” the impact of dense calcium on the measurement of necrotic tissue. EuroIntervention. 2010;6:394–9.

    Article  PubMed  Google Scholar 

  27. Russo RJ, Silva PD, Teirstein PS, et al. AVID investigators: a randomized controlled trial of angiography versus intravascular ultrasound-directed bare-metal coronary stent placement (the AVID Trial). Circ Cardiovasc Interv. 2009;2:113–23.

    Article  PubMed  Google Scholar 

  28. Finn AV, Nakazawa G, Ladich E, Kolodgie FD, Virmani R. Does underlying plaque morphology play a role in vessel healing after drug-eluting stent implantation? JACC Cardiovasc Imaging. 2008;1:485–8.

    Article  PubMed  Google Scholar 

  29. Vlaar PJ, Svilaas T, Damman K, et al. Impact of pretreatment with clopidogrel on initial patency and outcome in patients treated with primary percutaneous coronary intervention for ST-segment elevation myocardial infarction: a systematic review. Circulation. 2008;118:1828–36.

    Article  PubMed  CAS  Google Scholar 

  30. Weisz G, Moses JW. Contemporary principles of coronary chronic total occlusion recanalization. Catheter Cardiovasc Interv. 2010;75 suppl 1:S21–7.

    Article  PubMed  Google Scholar 

  31. Paizis I, Manginas A, Voudris V, Pavlides G, Spargias K, Cokkinos DV. Percutaneous coronary intervention for chronic total occlusions: the role of side-branch obstruction. EuroIntervention. 2009;4:600–6.

    Article  PubMed  Google Scholar 

  32. Hodgson JM. Oh no, even stenting is affected by calcium [editorial]. Cathet Cardiovasc Diagn. 1996;38:236–7.

    Article  PubMed  CAS  Google Scholar 

  33. Rathore S, Matsuo H, Terashima M, et al. Rotational atherectomy for fibro-calcific coronary artery disease in drug eluting stent era: procedural outcomes and angiographic follow-up results. Catheter Cardiovasc Interv. 2010;75:919–27.

    PubMed  Google Scholar 

  34. Bajaj S, Parikh R, Hamdan A, Bikkina M. Covered-stent treatment of coronary aneurysm after drug-eluting stent placement: case report and literature review. Tex Heart Inst J. 2010;37:449–54.

    PubMed  Google Scholar 

  35. Baim DS, Wahr D, George B, et al. Saphenous vein graft Angioplasty Free of Emboli Randomized (SAFER) Trial investigators: randomized trial of a distal embolic protection device during percutaneous intervention of saphenous vein aorto-coronary bypass grafts. Circulation. 2002;105(11):1285–90.

    PubMed  Google Scholar 

  36. Kelbaek H, Terkelsen CJ, Helqvist S, et al. Randomized comparison of distal protection versus conventional treatment in primary percutaneous coronary intervention: the drug elution and distal protection in ST-elevation myocardial infarction (DEDICATION) trial. J Am Coll Cardiol. 2008;51:899–905.

    Article  PubMed  Google Scholar 

  37. Roffi M, Mukherjee D. Current role of emboli protection devices in percutaneous coronary and vascular interventions. Am Heart J. 2009;157:263–70.

    Article  PubMed  Google Scholar 

  38. Stone GW, Rogers C, Hermiller J, et al. FilterWire EZ Randomized Evaluation Investigators: randomized comparison of distal protection with a filter-based catheter and a balloon occlusion and aspiration system during percutaneous intervention of diseased saphenous vein aorto-coronary bypass grafts. Circulation. 2003;108:548–53.

    Article  PubMed  Google Scholar 

  39. Mauri L, Cox D, Hermiller J, et al. The PROXIMAL trial: proximal protection during saphenous vein graft intervention using the Proxis embolic protection system: a randomized, prospective, multicenter clinical trial. J Am Coll Cardiol. 2007;50:1442–9.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Cardiovascular Medicine, University of Minnesota, Minneapolis, MN, USA

    Robert F. Wilson MD

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  1. Robert F. Wilson MD
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Correspondence to Robert F. Wilson MD .

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Editors and Affiliations

  1. Edgcumbe Place 6, St. Paul, 55116, Minnesota, USA

    Zeev Vlodaver

  2. University of Minnesota, Delaware Street S.E. 420, Minneapolis, 55455, Minnesota, USA

    Robert F. Wilson

  3. 4-112 Nils Hasselmo Hall, University of Minnesota, Church Street S.E. 312, Minneapolis, 55455, Minnesota, USA

    Daniel J. Garry

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Wilson, R.F. (2012). Transcatheter Treatment of Coronary Artery Disease. In: Vlodaver, Z., Wilson, R., Garry, D. (eds) Coronary Heart Disease. Springer, Boston, MA. https://doi.org/10.1007/978-1-4614-1475-9_21

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  • DOI: https://doi.org/10.1007/978-1-4614-1475-9_21

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  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-1-4614-1474-2

  • Online ISBN: 978-1-4614-1475-9

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