Percutaneous transluminal balloon

Marmur JD, Merlini PA, Sharma SK, et al. Thrombin generation in human coronary arteries after percutaneous transluminal balloon angioplasty. J Am Coll Cardiol 1994 24 1484-1491. 

GPIIb/IIIa antagonists have to be administered parenterally. They are currently used prophylactically during intracoronary interventions such as percutaneous transluminal revascularization with balloon angioplasty or intracoronary stenting, as well as to treat acute coronary syndromes like unstable angina and acute myocardial infarction. The main complications... 

Percutaneous coronary intervention (PCI) is one of a host of techniques performed by using a catheter inserted via a major limb artery that aims to relieve nanowing of coronary arteries. For example, percutaneous transluminal coronary angioplasty (PTCA) is the classic PCI that uses a catheter-directed balloon to dilate a stenotic coronary artery, and more recent PCIs include stent implantation, rotational atherectomy, and laser angioplasty. 

Maillard L, Hamon M, Khalife K, et al. A comparison of systematic stenting and conventional balloon angioplasty during primary percutaneous transluminal coronary angioplasty for acute myocardial infarction. J Am Coll Cardiol 2000 35 1729-1736. 

Waksman R, Kosinski AS, Klein L, et al. Relation of lumen size to restenosis after percutaneous transluminal coronary balloon angioplasty. Lovastatin Restenosis Trial Group, Am J Cardiol 1996 78 221-224. 

In the past, several clinical studies with corticosteroids failed to demonstrate a significant reduction in coronary restenosis after percutaneous transluminal coronary angioplasty (35,36). However, as we mentioned previously, after balloon angioplasty, there were other mechanisms involved in the pathophysiology of coronary restenosis (such as acute wall recoil or chronic remodeling) that explained the negative results of those studies (35,36). 

Abbreviations BMS, bare-metal stents ICB, intracoronary brachytherapy N/A, results not published NS, not statistically significant (P > 0.05) PCI, percutaneous coronary intervention FTCA, percutaneous transluminal coronary angioplasty POBA, plain old balloon angioplasty. 

PCI, percutaneous coronary intervention PES, paclitaxel-eluting stent PTCA, percutaneous transluminal coronary angioplasty FTCA balloon angioplasty rotational atherectomy directional atherectomy, or excimer laser angioplasty SES, sirolimus-eluting stent. 

More recently, LMWHs are being used for specific indications such as percutaneous transluminal coronary angioplasty (PTCA), as adjuncts to thrombolytic agents in disseminated intravascular coagulation (DIC) and the hypercoagulable state. A recent study has reported on the inhibition of cellular proliferation after experimental balloon angioplasty by LMWH in rabbits (25). There are several other indications such as the treatment of cardiovascular disorders where these agents may also prove to be useful. 

Oxygen deprivation follows when blood flow is compromised by a local, temporary circulatory blockade that may occur naturally as a result of stenosis, stroke, or a myocardial infarction (heart attack) or may accompany therapeutic interventions, such as percutaneous transluminal coronary angioplasty (PTCA). Packed RBCs are not useful for restoration of oxygen delivery in these situations, because they are too large to traverse the constricted vessels or too viscous and fragile to be pumped through a perfusion balloon catheter. A number of preclinical studies in this area are summarized below. 

Percutaneous transluminal angioplasty or balloon dilation of the coronary artery results in a dramatic clinical response in many patients. Long-term benefit, however, is dependent on the progression of the disease at the dilated site °. The factors which determine the rate of progression of the disease or the development of acute coronary occlusion are not known but pathological evidence of severe trauma with deposition of platelets and endothelial loss at the angioplasty site suggest that eicosanoids may be important . ... 

Before percutaneous transluminal coronary angioplasty, coronary sinus concentrations of adenosine and hypoxanthine were 176 34nMol and 723 73nMol, respectively (Bardenheuer etal. 1994). 30 s after balloon deflation adenosine concentrations were enhanced in close proportion to the duration of coronary occlusion 326 47nM [30 s], 531 80nM [60 s], and 793 150 nM [90 s], respectively. During reperfusion similar results were also obtained in the case of hypoxanthine and uric acid. 

Tubing is used in many industries for the transport of fluids. One of the more interesting applications is heat shrinkable tubing, which is made by extrusion, followed by crosslinking and expansion. Another important use is in the medical industry as catheter tubing. One of the more sophisticated medical devices based on polymeric tubing is the balloon catheter used for percutaneous transluminal coronary angioplasty. 

Acute myocardial infarction can be limited by streptokinase which dissolves fresh clots and opens the artery, but muscle death and necrosis causes a mechanical defect. Subsequent infarcts cause further muscle death and ultimately lead to defective ventricular function and cardiac failure. There is the need for simple alarm systems to detect acute myocardial infarction and less traumatic invasive procedures to dissolve the clot and dilate the artery immediately. Coronary arteries ramify and branch in 3-dimensional space and the present generation of balloon catheters for percutaneous transluminal coronary angioplasty carries a small but definite risk. New, non-traumatic guidewires, low profile dilatation systems and more powerful dilatation balloons which will not rupture the artery are needed. 

Henry M, Rath PC, Lakshmi G, Henry I, Hugel M (2004) Percutaneous transluminal angioplasty using a new peripheral cutting balloon for stenosis of arch vessels in aorto arteritis. Int Angiol 23 403-409... 

Moreover, ECP using 8-MOP and UVA radiation has been evaluated during a clinical trial to analyze its efficacy for the treatment of clinical restenosis after percutaneous transluminal coronary angioplasty [260]. After this study, ECP has been shown to be effective in reducing restenosis in patients undergoing balloon percutaneous transluminal coronary angioplasty with and without stent deployment. However, the use of this procedure in this com-phcation needs further investigations. 

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