Ichiro Kubo

Long-term angiographic follow-up of lesions patent 6 months after percutaneous coronary angioplasty

To determine long-term angiographic prognosis after successful angioplasty (< 50% residual stenosis, > or = 20% reduction of stenosis, and no major complications), coronary angiography was performed 2 to 4 years after angioplasty in patients who were < or = 70 years old at the time of treatment and who showed patency (< or = 50% stenosis) 6 months after the initial procedure. Among 407 lesions that were dilated in 333 patients between 1983 and 1989, 298 (73.2%) lesions were reviewed by long-term angiography after 177 +/- 34 weeks. At long-term follow-up, 4 (1.3%) lesions were totally occluded, 3 (1.0%) had severe stenosis (> or = 75% stenosis), 9 (3.0%) had mild stenosis (> 50% to < 75% stenosis), and 282 (94.6%) were patent (< or = 50% stenosis). The percentage of stenosis of patent lesions decreased from 24% +/- 14% at 6 months to 21% +/- 13% at long-term follow-up (p < 0.0001). No specific clinical or angiographic characteristics were identified in patients with severe stenosis at long-term follow-up. These findings indicate that when patency is obtained 6 months after angioplasty, a 95% long-term patency rate with regression of stenosis can be expected.

Magnum Meier wires with Crag Fx wire catheter for total occlusive coronary arteries

Magnum Meier wire was used with Crag Fx wire catheter instead of Magnum balloon catheter to facilitate wire crossing through total occlusion by improving flexibility of the system without losing wire pushability. Of 372 coronary angioplasty procedures performed between January 1994 and April 1995, there were 12 subacute occlusions with an interval of 3 wk or less and 30 chronic occlusions with an interval of > 3 wk. Regular over-the-wire-type balloon catheters failed to dilate four subacute occlusions and nine chronic total occlusions. Magnum Meier wire with Crag Fx wire catheter was tried for one subacute occlusion and four chronic occlusions that were undilatable with a regular balloon system and successfully dilated the subacute occlusion and three of the chronic occlusions. The lesions successfully dilated by this new approach were either long or tandem lesions in vessels that were excessively tortuous or showed an acute angle at the orifice. Thus the Magnum Meier wire with Crag Fx wire catheter can be a useful tool for dilating totally occluded lesions in tortuous coronary arteries.

Long-term angiographic prognosis of lesions dilated by coronary angioplasty

BACKGROUND To examine the long-term outcome of coronary angioplasty, lesions that remained patent after 3 to 12 months were monitored angiographically at 3-year intervals. There were 252 lesions successfully dilated (from 83% +/- 13% preprocedural stenosis to 19% +/- 14% residual stenosis) between 1983 and 1986 that remained patent on follow-up angiography (23% +/- 15% stenosis) and were monitored further at our outpatient department. METHODS AND RESULTS Repeat angiography was done for 186 lesions at 2 to 4 years and showed that 179 were patent (0% to 50% stenosis), one had mild stenosis (55% to 70% stenosis), and six had severe stenosis (75% to 100% stenosis). Angiography was repeated for 138 lesions at 5 to 7 years, showing that 127 were patent, four had mild stenosis, and seven had severe stenosis. Finally, angiography was performed for 78 lesions at 8 to 10 years, showing that 63 were patent, four had mild stenosis, and 11 had severe stenosis. CONCLUSIONS Although numerous lesions were lost to follow-up, most appeared to remain patent for 4 years, after which a significant number developed restenosis.

Radiofrequency Catheter Ablation of Atrioventricular Nodal Reentrant Tachycardia in Patient with Interruption of Inferior Vena Cava

We present a 72‐year‐old man with interruption of inferior vena cava (IVC) with azygos continuation, who underwent radiofrequency catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT).

751-6 Multiple Repeat Coronary Angioplasty for Final Lesion Patency

To demonstrate that multiple repeat coronary angioplasty can be solely utilized to achieve final lesion patency after restenosis, such a protocol was prospectively applied for restenosis since 1983. Bypass surgery was only considered for 1) new left main trunk lesions, 2) symptomatic restenosis where angioplasty was either unsuccessful or unsuitable, and 3) patient preference. Between 1983 and 1992, 1455 lesions (acute myocardial infarction or total occlusion excluded) were successfully dilated for the first time. Although only 941 (68%) of the 1385 lesions studied showed satisfactory patency (≤ 70% stenosis) after the first procedure, 93% (1248/1345 studied) showed satisfactory patency after repeating angioplasty up to 3 times and 94% (1268/1354 studied) after repetition up to 6 times. Only 23 lesions 11.6%) required 4 or more procedures and 20 of them showed final patency. Disease aggravation (either impossible or failed repeat angioplasty, acute infarction, or sudden death) occurred in 43 lesions (3.2%). Bypass grafts were done for 11 lesions of 7 patients, mostly due to disease progression at the left main trunk. Dilatation (stenosis) Patent (0–50%) Mild (55-70%) Re-do(75%-) Grafts(75%-) Medical(75%-) Aggravated # Withdrawal Cumulative 0–70% No * 1st 874 67 384 9 16 32 73 941 1382 2nd 221 22 97 0 6 7 31 1184 1351 3rd 53 11 23 0 1 3 6 1248 1345 4th 11 1 8 1 0 1 0 1261 1345 5th 3 3 2 0 0 0 0 1267 1345 6th 1 0 0 1 0 0 0 1268 1345 * :1763- ∑ Withdrawal # :sudden death. acute infarction or irreversible occlusion Conclusion These findings indicate that 1) repeat angioplasty can be the main treatment strategy for restenosis, 2) multiple repeat angioplasties (up to 6 times) can be effective and rarely aggravate coronary anatomy and 3) disease aggravation must be prevented to improve the final patency rate of repeat ang ioplasty.