Coronary angioplasty

  • Nathan E. Green
  • James T. Maddux
  • J. E. B. Burchenal
Article
  • 88 Downloads

Opinion statement

Percutaneous revascularization is a widely accepted procedure to treat patients with coronary artery disease. Since its first description in the 1970s, significant technological and pharmaceutical advances have occurred and subsequently reduced the complications associated with the procedure. Large, randomized controlled trials have provided additional evidence that percutaneous revascularization improves morbidity and mortality in patients with coronary artery disease. Over the last decade, devices designed to treat patients with more complex coronary artery disease have expanded the available therapeutic options and will likely contribute to a further decline in adverse events. Despite these advances, the management of patients with acute myocardial infarction, in-stent restenosis, and multivessel coronary artery disease remains challenging. The majority of evidence supports an early, aggressive approach in patients with acute ST-elevation and non-ST-elevation myocardial infarction. Ongoing clinical trials should help to further define the role of percutaneous interventions in the optimal management of patients with coronary artery disease.

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References and Recommended Reading

  1. 1.
    Laskey WK, Kimmel S, Krone RJ: Contemporary trends in coronary intervention: a report from the Registry of the Society for Cardiac Angiography and Interventions. Catheter Cardiovasc Interv 2000, 49:19–22.PubMedCrossRefGoogle Scholar
  2. 2.
    Dotter CT, Judkins M: Transluminal treatment of arteriosclerotic obstructions: description of a new technique and a preliminary report of its application. Circulation 1964, 30:654.PubMedGoogle Scholar
  3. 3.
    Castaneda-Zuniga WR, Formanek A, Tadavarthy M, et al.: The mechanism of balloon angioplasty. Radiology 1980, 135:565–571.PubMedGoogle Scholar
  4. 4.
    Barath P, Fishbein MC, Vari S, et al.: Cutting balloon: a novel approach to coronary angioplasty. Am J Cardiol 1991, 68:1249–1252.PubMedCrossRefGoogle Scholar
  5. 5.
    Zimarino M, Corcos T, Favereau X, et al.: Rotational coronary atherectomy with adjunctive balloon angioplasty for the treatment of ostial lesions. Cathet Cardiovasc Diagn 1994, 33:22–27.PubMedCrossRefGoogle Scholar
  6. 6.
    Teirstein PS, Warth DC, Haq N, et al.: High speed rotational coronary atherectomy for patients with diffuse coronary artery disease. J Am Coll Cardiol 1991, 18:1694–1701.PubMedCrossRefGoogle Scholar
  7. 7.
    Topol EJ, Leya F, Pinkerton CA, et al.: A comparison of directional atherectomy with coronary angioplasty in patients with coronary artery disease. The CAVEAT Study Group. N Engl J Med 1993, 329:221–227.PubMedCrossRefGoogle Scholar
  8. 8.
    Holmes DR Jr, Topol EJ, Califf RM, et al.: A multicenter, randomized trial of coronary angioplasty versus directional atherectomy for patients with saphenous vein bypass graft lesions. CAVEAT-II Investigators. Circulation 1995, 91:1966–1974.PubMedGoogle Scholar
  9. 9.
    Emanuelsson H: Future challenges to coronary angioplasty: perspectives on intracoronary imaging and physiology. J Intern Med 1995, 238:111–119.PubMedCrossRefGoogle Scholar
  10. 10.
    Nissen SE, De Franco AC, Tuzcu EM, Moliterno DJ: Coronary intravascular ultrasound: diagnostic and interventional applications. Coron Artery Dis 1995, 6:355–367.PubMedCrossRefGoogle Scholar
  11. 11.
    Yock PG, Fitzgerald PJ: Intravascular ultrasound: state of the art and future directions. Am J Cardiol 1998, 81:27E-32E. Describes the use of IVUS as an adjunctive therapy to coronary angioplasty.PubMedCrossRefGoogle Scholar
  12. 12.
    Wolfe MW, Roubin GS, Schweiger M, et al.: Length of hospital stay and complications after percutaneous transluminal coronary angioplasty. Clinical and procedural predictors. Heparin Registry Investigators. Circulation 1995, 92:311–319.PubMedGoogle Scholar
  13. 13.
    Kent KM, Bentivoglio LG, Block PC, et al.: Long-term efficacy of percutaneous transluminal coronary angioplasty (PTCA): report from the National Heart, Lung, and Blood Institute PTCA Registry. Am J Cardiol 1984, 53:27C-31C.PubMedCrossRefGoogle Scholar
  14. 14.
    Ellis SG, Cowley MJ, Whitlow PL, et al.: Prospective case-control comparison of percutaneous transluminal coronary revascularization in patients with multivessel disease treated in 1986–1987 versus 1991: improved in-hospital and 12-month results. Multivessel Angioplasty Prognosis Study (MAPS) Group. J Am Coll Cardiol 1995, 25:1137–1142.PubMedCrossRefGoogle Scholar
  15. 15.
    Hillegass WB, Califf RM: Restenosis: the clinical issues. In Textbook of Interventional Cardiology. Edited by Topol EJ. Philadelphia, PA: WB Saunders Company;1994:415–435.Google Scholar
  16. 16.
    Ferguson JJ, Barasch E, Wilson JM, et al.: The relation of clinical outcome to dissection and thrombus formation during coronary angioplasty. Heparin Registry Investigators. J Invasive Cardiol 1995, 7:2–10.PubMedGoogle Scholar
  17. 17.
    Black AJ, Namay DL, Niederman AL, et al.: Tear or dissection after coronary angioplasty. Morphologic correlates of an ischemic complication. Circulation 1989, 79:1035–1042.PubMedGoogle Scholar
  18. 18.
    Piana RN, Paik GY, Moscucci M, et al.: Incidence and treatment of " no-reflow" after percutaneous coronary intervention. Circulation 1994, 89:2514–2518.PubMedGoogle Scholar
  19. 19.
    Ellis SG, Ajluni S, Arnold AZ, et al.: Increased coronary perforation in the new device era. Incidence, classification, management, and outcome. Circulation 1994, 90:2725–2730.PubMedGoogle Scholar
  20. 20.
    Mintz GS, Popma JJ, Pichard AD, et al.: Arterial remodeling after coronary angioplasty: a serial intravascular ultrasound study. Circulation 1996, 94:35–43.PubMedGoogle Scholar
  21. 21.
    Bittl JA: Advances in coronary angioplasty. N Engl J Med 1996, 335:1290–1302. [Published erratum appears in N Engl J Med 1997, 336:670.]PubMedCrossRefGoogle Scholar
  22. 22.
    Teirstein PS, Massullo V, Jani S, et al.: Catheter-based radiotherapy to inhibit restenosis after coronary stenting. N Engl J Med 1997, 336:1697–1703.PubMedCrossRefGoogle Scholar
  23. 23.
    Morice MC, Serruys PW, Sousa JE, et al.: A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. The RAVEL trial. N Engl J Med 2002, 346:1773–1780. Describes use of the new sirolimus drug-eluting stents.PubMedCrossRefGoogle Scholar
  24. 24.
    Pocock SJ, Henderson RA, Rickards AF, et al.: Metaanalysis of randomised trials comparing coronary angioplasty with bypass surgery. Lancet 1995, 346:1184–1189.PubMedCrossRefGoogle Scholar
  25. 25.
    Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators [no authors listed]. N Engl J Med 1996, 335:217–225. [Published erratum appears in N Engl J Med 1997, 336:147.]Google Scholar
  26. 26.
    Bentivoglio LG, Detre K, Yeh W, et al.: Outcome of percutaneous transluminal coronary angioplasty in subsets of unstable angina pectoris. A report of the 1985–1986 National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. J Am Coll Cardiol 1994, 24:1195–1206.PubMedCrossRefGoogle Scholar
  27. 27.
    Boden WE, O’Rourke RA, Crawford MH, et al.: Outcomes in patients with acute non-Q-wave myocardial infarction randomly assigned to an invasive as compared with a conservative management strategy. Veterans Affairs Non-Q-Wave Infarction Strategies in Hospital (VANQWISH) Trial Investigator. N Engl J Med 1998, 338:1785–1792. [Published erratum appears in N Engl J Med 1998, 339:1091.]PubMedCrossRefGoogle Scholar
  28. 28.
    Invasive compared with non-invasive treatment in unstable coronary-artery disease: FRISC II prospective randomised multicentre study. Fragmin and Fast Revascularisation during Instability in Coronary artery disease Investigators [no authors listed]. Lancet 1999, 354:708–715.Google Scholar
  29. 29.
    Cannon CP, Weintraub WS, Demopoulos LA, et al.: Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med 2001, 344:1879–1887.PubMedCrossRefGoogle Scholar
  30. 30.
    Weaver WD, Simes RJ, Betriu A, et al.: Comparison of primary coronary angioplasty and intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review. JAMA 1997, 278:2093–2098. [Published erratum appears in JAMA 1998, 279:1876.]. Meta-analysis of 10 randomized trials comparing the use of PTCA or thrombolytic therapy in patients with acute MI.PubMedCrossRefGoogle Scholar
  31. 31.
    Antoniucci D, Santoro GM, Bolognese L, et al.: A clinical trial comparing primary stenting of the infarct-related artery with optimal primary angioplasty for acute myocardial infarction: results from the Florence Randomized Elective Stenting in Acute Coronary Occlusions (FRESCO) trial. J Am Coll Cardiol 1998, 31:1234–1239.PubMedCrossRefGoogle Scholar
  32. 32.
    Antoniucci D, Valenti R, Trapani M, Moschi G: Current role of stenting in acute myocardial infarction. Am Heart J 1999, 138:S147-S152.PubMedCrossRefGoogle Scholar
  33. 33.
    Stone GW, Grines CL, Cox DA, et al.: Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. N Engl J Med 2002, 346:957–966.PubMedCrossRefGoogle Scholar
  34. 34.
    Anderson HR: The Danish Multicenter Randomized Study on Thrombolytic Therapy versus Acute Coronary Angioplasty in Acute Myocardial Infarction-2 (DANAMI-2). Paper presented at the ACC 51st Annual Scientific Session. Atlanta, GA; March 20, 2002.Google Scholar
  35. 35.
    Serruys PW, Herrman JP, Simon R, et al.: A comparison of hirudin with heparin in the prevention of restenosis after coronary angioplasty. Helvetica Investigators. N Engl J Med 1995, 333:757–763.PubMedCrossRefGoogle Scholar
  36. 36.
    Bittl JA, Strony J, Brinker JA, et al.: Treatment with bivalirudin (Hirulog) as compared with heparin during coronary angioplasty for unstable or postinfarction angina. Hirulog Angioplasty Study Investigators. N Engl J Med 1995, 333:764–769.PubMedCrossRefGoogle Scholar
  37. 37.
    Burchenal JE, Marks DS, Tift MJ, et al.: Effect of direct thrombin inhibition with bivalirudin (Hirulog) on restenosis after coronary angioplasty. Am J Cardiol 1998, 82:511–515.PubMedCrossRefGoogle Scholar
  38. 38.
    Platelet glycoprotein IIb/IIIa receptor blockade and low-dose heparin during percutaneous coronary revascularization. The EPILOG Investigators [no authors listed]. N Engl J Med 1997, 336:1689–1696.Google Scholar
  39. 39.
    Kong DF, Califf RM, Miller DP, et al.: Clinical outcomes of therapeutic agents that block the platelet glycoprotein IIb/IIIa integrin in ischemic heart disease. Circulation 1998, 98:2829–2835. Meta-analysis of randomized GP IIb/IIIa inhibitor trials demonstrating clinical benefit in patients with acute coronary syndromes.PubMedGoogle Scholar
  40. 40.
    Mehta SR, Yusuf S, Peters RJ, et al.: Effects of pretreatment with aspirin and clopidogrel followed by longterm therapy in patients undergoing percutaneous coronary intervention. Lancet 2001, 358:527–533.PubMedCrossRefGoogle Scholar
  41. 41.
    Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST segment elevation. The CURE Investigators [no authors listed]. N Engl J Med 2001, 345:494–502.Google Scholar

Copyright information

© Current Science Inc 2003

Authors and Affiliations

  • Nathan E. Green
    • 1
  • James T. Maddux
    • 1
  • J. E. B. Burchenal
    • 1
  1. 1.Cardiac Catheterization LaboratoryUniversity of Colorado Health Science CenterDenverUSA

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