Commentary - Case Reports in Surgery and Invasive Procedures (2022) Volume 6, Issue 1
Clinical significance and complications in angioplasty, comparison of balloon angioplasty with directional atherectomy for lesions the treatment of coronary artery disease.
Division of Cardiovascular Medicine, John Radcliffe Hospital, Oxford OX3 9DU, England, United Kingdom
- *Corresponding Author:
- Johnson Maryam
Division of Cardiovascular Medicine,
John Radcliffe Hospital, Oxford OX3 9DU,
Received: 15-Dec-2021, Manuscript No. AACRSIP-22-54189; Editor assigned: 17- Dec-2021, PreQC No. AACRSIP-22-54189 (PQ); Reviewed: 31-Dec-2021, QC No. AACRSIP-22-54189; Revised: 04-Jan-2022, Manuscript No. AACRSIP-22-54189(R); Published: 11-Jan-2022, DOI:10.35841/aacrsip- 6.1.101
Citation: Maryam J. Clinical significance and complications in angioplasty, comparison of balloon angioplasty with directional atherectomy for lesions the treatment of coronary artery disease. Case Rep Surg Invasive Proced. 2022; 6(1):101
Angioplasty with or without stenting is a nonsurgical procedure used to open clogged or narrow coronary arteries due to underlying atherosclerosis. The procedure involves introducing an inflatable balloon-tipped catheter through the skin in extremities and inflating the balloon once it traverses the stenosed arterial site. It presses the intraluminal plaque of atherosclerosis against the arterial wall and widens the luminal diameter. Thereby it normalizes the blood flow to the myocardium and achieves the goal of angioplasty or percutaneous coronary intervention (PCI) by alleviating the chest pain. The PCI concept was introduced 40 years ago with the introduction of "plain old balloon angioplasty" (POBA) without stenting. In the mid-1980s, POBA use was limited because of an early complication of vascular recoil property and restenosis after balloon deflation which led to the invention of bare metal stents (BMS). During the procedure, professionals use a tube-like metallic meshwork, and its scaffolding properties counteract vascular recoil property, thereby avoiding the early restenosis of POBA due to vascular recoil. However, long-term, in situ BMS, can induce wall stress, endothelial discontinuity, and permanent presence of the metallic foreign body in arteries leading to inflammation with fibrin deposition and promoting myofibroblast migration which gives rise to in-stent restenosis (IRS) due to a mechanism of neointimal hyperplasia.
Clinical significance & complications
Coronary heart disease (CHD) is prevalent in the worldwide elderly population. The 2016 Heart Disease and Stroke Statistics update of the American heart association reported that in the United States, 15.5 million people have CHD. It is a significant cause of mortality and morbidity in developed countries with nearly one-third of all deaths in people older than 35 years of age are due to underline CHD. The mortality due to CHD has gradually declined over the last few decades due to timely percutaneous coronary intervention with stenting. Therefore, angioplasty is a breakthrough advancement in reducing morbidity and mortality. One rare but serious complication of angioplasty is iatrogenic coronary artery perforation (CAP) due to underlying complex lesion, occurring in 0.1% to 0.8 % of total cases undergoing angioplasty. CAP can be due to angioplasty guide wire perforation, balloon oversizing, and use of atherectomy devices. Management of CAP depends on the severity of the lesion, hemodynamic status, and Ellis class type of CAP. Class 1 is usually benign while class 3 is associated with higher chances of cardiac tamponade and need for emergent cardiac surgery. The mild CAP can be managed with an anticoagulation reversal (protamine sulfate in case of heparin use), prolonged balloon inflation, polytetrafluoroethylenecovered stents (CS), and trans-catheter embolization by autologous fat particles. CS use comes with the cost of stent thrombosis, and few cases of coronary arteriovenous fistula have also been reported due to CS failure. Complication of CAP is ST-segment elevation myocardial infarction, and early or delayed cardiac tamponade with or without hemodynamically instability which can require emergent pericardiocentesis .
The substantial clinical and economic impact of restenosis has been a major impetus for the development of alternative percutaneous techniques for coronary revascularization. The directional coronary-atherectomy catheter pioneered by Simpson was the first “non-balloon” device approved for the treatment of coronary artery disease in North America. Although many atherectomy procedures have been performed with this catheter, no controlled comparison with conventional balloon angioplasty was carried out before regulatory approval .
Correlation of balloon angioplasty with directional atherectomy
The cutting Balloon (CB) is a unique inflatable catheter with three or four atherotomes (microsurgical sharp edges) fortified longitudinally to its surface, reasonable for making discrete longitudinal entry points in the atherosclerotic objective coronary section during inflatable expansion. With the cutting inflatable, the expansion in the vessel lumen measurement is acquired in a more controlled design and with a lower swell expansion tension than customary percutaneous transluminal coronary angioplasty (PTCA) - this controlled dilatation could decrease the degree of vessel divider injury and the occurrence of restenosis. CABG coronary conduit sidestep unite surgery CBA cutting inflatable angioplasty CI confidence interval CK creatine kinase CKMB creatine kinase-myocardial band ISR in-stent restenosis IVUS intravascular ultrasound MACE major antagonistic heart events MI myocardial infarction MLD minimal lumen diameter NQMI non-Q-wave myocardial infarction OR odds ratio PTCA percutaneous transluminal coronary angioplasty QCA quantitative coronary angiography QMIQ-wave myocardial infarction ROTA rotational atherectomy STENT additional stenting TLR target injury revascularization. Cutting inflatable (InterVentional Technologies, San Diego, California) is a regular inflatable catheter 10 or 15 mm long with three (on more modest inflatable sizes) or four microblades (on swell sizes >3.5 mm in distance across). These cutting edges, mounted longitudinally on the outer layer of inflatable, are 0.25 mm in tallness and three to multiple times more keen than traditional careful edges (9). During enlargement, the gadget produces three or four endovascular careful entry points. The CBA was performed with various expansions, expanding the inflatable tension, as a rule up to 12 atm .
With the extended use of coronary stenting past the measures for consideration in the randomized preliminaries, stent restenosis arose as a new "sickness substance." With north of 800,000 stents every year in the U.S., and a stent restenosis occurrence of 20% to half of sores, obviously in-stent restenosis (ISR) is a huge issue . The most well-known methodology to treat ISR is percutaneous transluminal coronary angioplasty (PTCA), yet long haul results are inadmissible, with a high repeat rate, especially after treatment of diffuse (sore length >10 mm) ISR . Extra stent implantation (STENT) may have merit since it decreases intense force and helps tissue expulsion; in any case, this intense advantage didn't convert into worked on long haul result. Atheroablative treatments (i.e., rotational atherectomy [ROTA] and excimer laser angioplasty) have been utilized trying to diminish the pace of repeat. Notwithstanding, the helpful impact of these gadgets was not demonstrated. Ongoing reports proposed that cutting inflatable angioplasty (CBA) may be of advantage in the treatment of ISR, diminishing the requirement for rehash revascularization methods. Cutting inflatable angioplasty .
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