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Review
. 2003 May 24;326(7399):1137-40.
doi: 10.1136/bmj.326.7399.1137.

ABC of interventional cardiology: percutaneous coronary intervention. II: the procedure

Ever D Grech  1
Affiliations
Review

ABC of interventional cardiology: percutaneous coronary intervention. II: the procedure

Ever D Grech. BMJ. .
No abstract available

PubMed Disclaimer

Figures

Figure 1
Figure 1
Percutaneous coronary intervention in progress. Above the patient's chest is the x ray imaging camera. Fluoroscopic images, electrocardiogram, and haemodynamic data are viewed at eye level screens. All catheterisation laboratory operators wear lead protection covering body, thyroid, and eyes, and there is lead shielding between the primary operator and patient
Figure 2
Figure 2
Equipment commonly used in percutaneous coronary interventions
Figure 3
Figure 3
Deployment of a balloon-mounted stent across stenotic lesion. Once the guide catheter is satisfactorily engaged, the lesion is crossed with a guidewire and the balloon-mounted stent positioned to cover the lesion (A). It may be necessary to pre-dilate a severe lesion with a balloon to provide adequate passageway for the balloon and stent. The balloon is inflated to expand the stent (B). The balloon is then deflated (C) and withdrawn leaving the guidewire (D), which is also removed once the operator is satisfied that a good result has been obtained
Figure 4
Figure 4
Example of a femoral artery closure device. The Angio-Seal device creates a mechanical seal by sandwiching the arteriotomy between an anchor placed against the inner arterial wall (A) and collagen sponge (B), which both dissolve within 60-90 days
Figure 5
Figure 5
The cutting balloon catheter. The longitudinal cutting blades are exposed only during balloon inflation (top left). In this case (top right) a severe ostial in-stent restenosis in the right coronary artery (arrow) was dilated with a short cutting balloon (bottom left), and a good angiographic result was obtained (arrow, bottom right)
Figure 5
Figure 5
The cutting balloon catheter. The longitudinal cutting blades are exposed only during balloon inflation (top left). In this case (top right) a severe ostial in-stent restenosis in the right coronary artery (arrow) was dilated with a short cutting balloon (bottom left), and a good angiographic result was obtained (arrow, bottom right)
Figure 5
Figure 5
The cutting balloon catheter. The longitudinal cutting blades are exposed only during balloon inflation (top left). In this case (top right) a severe ostial in-stent restenosis in the right coronary artery (arrow) was dilated with a short cutting balloon (bottom left), and a good angiographic result was obtained (arrow, bottom right)
Figure 5
Figure 5
The cutting balloon catheter. The longitudinal cutting blades are exposed only during balloon inflation (top left). In this case (top right) a severe ostial in-stent restenosis in the right coronary artery (arrow) was dilated with a short cutting balloon (bottom left), and a good angiographic result was obtained (arrow, bottom right)
Figure 9
Figure 9
Focal in-stent restenosis. A 2.0 mm stent had been deployed six months earlier. After recurrence of angina, angiography showed focal in-stent restenosis (arrow, top left). This was confirmed with intravascular ultrasound (top right), which also revealed that the stent was underexpanded. The stent was further expanded with a balloon catheter, with a good angiographic result (arrow, bottom left) and an increased lumen diameter to 2.7 mm (bottom right)
Figure 9
Figure 9
Focal in-stent restenosis. A 2.0 mm stent had been deployed six months earlier. After recurrence of angina, angiography showed focal in-stent restenosis (arrow, top left). This was confirmed with intravascular ultrasound (top right), which also revealed that the stent was underexpanded. The stent was further expanded with a balloon catheter, with a good angiographic result (arrow, bottom left) and an increased lumen diameter to 2.7 mm (bottom right)
Figure 9
Figure 9
Focal in-stent restenosis. A 2.0 mm stent had been deployed six months earlier. After recurrence of angina, angiography showed focal in-stent restenosis (arrow, top left). This was confirmed with intravascular ultrasound (top right), which also revealed that the stent was underexpanded. The stent was further expanded with a balloon catheter, with a good angiographic result (arrow, bottom left) and an increased lumen diameter to 2.7 mm (bottom right)
Figure 9
Figure 9
Focal in-stent restenosis. A 2.0 mm stent had been deployed six months earlier. After recurrence of angina, angiography showed focal in-stent restenosis (arrow, top left). This was confirmed with intravascular ultrasound (top right), which also revealed that the stent was underexpanded. The stent was further expanded with a balloon catheter, with a good angiographic result (arrow, bottom left) and an increased lumen diameter to 2.7 mm (bottom right)
Figure 13
Figure 13
Diagrammatic representation of the Novoste Beta Cath system used for vascular brachytherapy. Pre-dilatation of the in-stent restenosis with a balloon catheter is usual and is followed by positioning of the radiation source train, containing strontium-90, at the site for less than 5 minutes
Figure 14
Figure 14
Angiogram showing late “candy wrapper” edge effect (arrows) because of new restenosis at the edges of a segment treated by brachytherapy
Figure 15
Figure 15
Top left: four months after two stents (yellow lines) were deployed in the proximal and middle right coronary artery, severe diffuse in-stent restenosis has occurred with recurrent angina. Top right: two sirolimus coated Cypher stents (red lines) were deployed within the original stents. Bottom: after six months there was no recurrence of restenosis, and the 51 year old patient remained asymptomatic
Figure 15
Figure 15
Top left: four months after two stents (yellow lines) were deployed in the proximal and middle right coronary artery, severe diffuse in-stent restenosis has occurred with recurrent angina. Top right: two sirolimus coated Cypher stents (red lines) were deployed within the original stents. Bottom: after six months there was no recurrence of restenosis, and the 51 year old patient remained asymptomatic
Figure 15
Figure 15
Top left: four months after two stents (yellow lines) were deployed in the proximal and middle right coronary artery, severe diffuse in-stent restenosis has occurred with recurrent angina. Top right: two sirolimus coated Cypher stents (red lines) were deployed within the original stents. Bottom: after six months there was no recurrence of restenosis, and the 51 year old patient remained asymptomatic
Figure 18
Figure 18
The incidence of restenosis is particularly high with percutaneous revascularisation of small vessels. A small diseased diagonal artery (arrows, top left) in a 58 year old patient with limiting angina was stented with a sirolimus coated Cypher stent (red line, top right). After six months, no restenosis was present (left), and the patient remained asymptomatic
Figure 18
Figure 18
The incidence of restenosis is particularly high with percutaneous revascularisation of small vessels. A small diseased diagonal artery (arrows, top left) in a 58 year old patient with limiting angina was stented with a sirolimus coated Cypher stent (red line, top right). After six months, no restenosis was present (left), and the patient remained asymptomatic
Figure 18
Figure 18
The incidence of restenosis is particularly high with percutaneous revascularisation of small vessels. A small diseased diagonal artery (arrows, top left) in a 58 year old patient with limiting angina was stented with a sirolimus coated Cypher stent (red line, top right). After six months, no restenosis was present (left), and the patient remained asymptomatic
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References

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