Copyright © 1994 by the European Society of Cardiology.
© 1994 The European Society of Cardiology
Continuous coronary perfusion balloon catheters in coronary dissections after percutaneous transluminal coronary angioplasty
Acute clinical results and 6-months follow-up
Department of Cardiology, University Hospital Essen
*ll. Medical Clinic, University of Mainz Mainz, Germany
Received 20 September 1993; revised 1 February 1994; .
Correspondence: Dr G. Görge, University Hospital, Dept, of Cardiology, Hufelandstrasse 55, 45122 Essen, Germany.
Abstract
The purpose of the study was to evaluate prospectively the effect of a continuous perfusion balloon catheter (‘High Flow CPC Mainz’, SchneiderlPfizer Europe AG, CH-8052 Zurich, Switzerland) on tolerated inflation time during elective PTCA (n=31), and its usefulness in cases of unsatisfactory morphological or functional results after PTCA (n=42). Sixty-five patients were male, eight female; their mean age was 57.6 ± 8.85 years. The target vessel was the LAD in 39 patients, the RCA in 29, the LCX in three, and bypass grafts in two. Seven patients had type A lesions, 44 type B and 22 type C, respectively. The target lesion was in the proximal third of the coronary artery in 41 patients, in the mid-third in 30, and in the distal third in two. Side branches were involved in 24 patients. The median size of the standard PTCA balloon was 3.00 mm and 3.5 mm for the CPC. Tolerated inflation time rose from 36 ±21 s to 213 ± 108 s (P<0.01). Additionally, the CPC catheter was used in 42 patients with symptomatic dissections (ST segment elevation, chest pain, or impaired contrast run-off) after PTCA. Wall wrapping by CPC was successful in 24 (57%) and unsuccessful in 18 (43%) patients. A significant difference was found for the inflation times tolerated between patients with successful (265 ± 99 s) and unsuccessful wall wrapping (161 ± 108 s; P<0.01). Of the 18 patients with unsuccessful wall wrapping, 11 (61%) required an intracoronary stent, and six patients (30%) could be managed by medical treatment alone. One patient, included in the study with TIM10 flow after intravenous thrombolysis for acute myocardial infarction, died in cardiogenic shock. Follow-up over 186 ± 39 days revealed no significant differences in clinical outcome between patients treated by the perfusion catheter alone, by acute stent implantation or conservative treatment.
Symptomatic dissections can be managed in a large number of patients by using continuous perfusion PTCA catheters. However, further larger studies will have to show if clinical outcome differs between patients treated with CPC catheters, stents, or acute bypass grafting after failed PTCA and which treatment is most suitable for the individual patient.
Key Words: Continuous perfusion catheter • coronary artery dissections • coronary stent • percutaneous transluminal coronary angioplasty • prognosis