Improved procedural results of coronary angioplasty with intravascular ultrasound-guided balloon sizing : The CLOUT pilot trial
Background Indiscriminate use of balloons larger than the angiographic reference segment lumen results in high rates of ischemic complications after percutaneous transluminal coronary angioplasty (PTCA). We hypothesized that angiographically unsuspected atheromatous remodeling with vessel expansion...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 1997-04, Vol.95 (8), p.2044-2052 |
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| container_title | Circulation (New York, N.Y.) |
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| creator | STONE, G. W HODGSON, J. M ST GOAR, F. G FREY, A MUDRA, H SHEEHAN, H LINNEMEIER, T. J |
| description | Background
Indiscriminate use of balloons larger than the angiographic reference segment lumen results in high rates of ischemic complications after percutaneous transluminal coronary angioplasty (PTCA). We hypothesized that angiographically unsuspected atheromatous remodeling with vessel expansion (the Glagov phenomenon) at and adjacent to PTCA target lesions would safely accommodate oversized balloons in selected patients undergoing PTCA with intravascular ultrasound (IVUS) guidance.
Methods and Results
After angiographically guided PTCA of 104 lesions in 102 patients, IVUS was performed, and if atheromatous remodeling was present, PTCA was repeated with larger balloons sized halfway between the lumen and external elastic membrane. Plaque occupied a mean of 51±15% of the angiographically “normal” reference segments. Further balloon upsizing by 0.25 to 1.25 mm was therefore performed in 76 lesions (73%), increasing the nominal balloon-to-artery ratio from 1.12±0.15 after standard PTCA to 1.30±0.17 after IVUS-guided PTCA (
P |
| doi_str_mv | 10.1161/01.CIR.95.8.2044 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_journals_212737777</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>19644678</sourcerecordid><originalsourceid>FETCH-LOGICAL-c291t-995223257e47d6ae4cf4ee6a5f69baa50b9e05c8c67ea4c31294426dc41fa1db3</originalsourceid><addsrcrecordid>eNo9kM1LAzEQxYMoWKt3j0G87prP3Y03KX4UCoLUc5hmszUSNzXZrdSL_7qRFucyDLz3hvdD6JKSktKK3hBazuYvpZJlUzIixBGaUMlEISRXx2hCCFFFzRk7RWcpveez4rWcoJ_5xyaGrW1xXsa2YwSPo02jHxIOHTYhhh7iDkO_dmHjIQ07_OWGN-z6IcIWkhk9RJz1EVIY-7ZYj67NeSvwPoQeJ_ft-jW-xcs3i2eL59cl3jgfBjxEB_4cnXTgk7047Cl6fbhfzp6KxfPjfHa3KAxTdCiUkoxxJmsr6rYCK0wnrK1AdpVaAUiyUpZI05iqtiAMp0wJwarWCNoBbVd8iq72ubnm52jToN_DGPv8UjPKal7nySKyF5kYUoq205voPnJ7TYn-o6wJ1ZmyVlI3-o9ytlwfcjMJ8F2E3rj072MVb5ho-C9aun98</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>212737777</pqid></control><display><type>article</type><title>Improved procedural results of coronary angioplasty with intravascular ultrasound-guided balloon sizing : The CLOUT pilot trial</title><source>American Heart Association Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><source>Journals@Ovid Complete</source><creator>STONE, G. W ; HODGSON, J. M ; ST GOAR, F. G ; FREY, A ; MUDRA, H ; SHEEHAN, H ; LINNEMEIER, T. J</creator><creatorcontrib>STONE, G. W ; HODGSON, J. M ; ST GOAR, F. G ; FREY, A ; MUDRA, H ; SHEEHAN, H ; LINNEMEIER, T. J</creatorcontrib><description>Background
Indiscriminate use of balloons larger than the angiographic reference segment lumen results in high rates of ischemic complications after percutaneous transluminal coronary angioplasty (PTCA). We hypothesized that angiographically unsuspected atheromatous remodeling with vessel expansion (the Glagov phenomenon) at and adjacent to PTCA target lesions would safely accommodate oversized balloons in selected patients undergoing PTCA with intravascular ultrasound (IVUS) guidance.
Methods and Results
After angiographically guided PTCA of 104 lesions in 102 patients, IVUS was performed, and if atheromatous remodeling was present, PTCA was repeated with larger balloons sized halfway between the lumen and external elastic membrane. Plaque occupied a mean of 51±15% of the angiographically “normal” reference segments. Further balloon upsizing by 0.25 to 1.25 mm was therefore performed in 76 lesions (73%), increasing the nominal balloon-to-artery ratio from 1.12±0.15 after standard PTCA to 1.30±0.17 after IVUS-guided PTCA (
P
<.0001). As a result, the angiographic minimal luminal diameter further increased from 1.95±0.49 to 2.21±0.47 mm, the % diameter stenosis fell from 28±15% to 18±14%, and the IVUS lumen area rose from 3.16±1.04 to 4.52±1.14 mm
2
(all
P
<.0001). The incidence of angiographic dissection was not increased after IVUS-guided balloon upsizing (37% versus 40%,
P
=.67), and major complications occurred in only 2 patients (1.9%).
Conclusions
The demonstration by IVUS of atheromatous remodeling permits the safe use of balloons traditionally considered oversized, resulting in significantly improved luminal dimensions without increased rates of dissection or ischemic complications.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/01.CIR.95.8.2044</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Biological and medical sciences ; Diseases of the cardiovascular system ; Medical sciences ; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><ispartof>Circulation (New York, N.Y.), 1997-04, Vol.95 (8), p.2044-2052</ispartof><rights>1997 INIST-CNRS</rights><rights>Copyright American Heart Association, Inc. Apr 15, 1997</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c291t-995223257e47d6ae4cf4ee6a5f69baa50b9e05c8c67ea4c31294426dc41fa1db3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,781,785,3688,27928,27929</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=2638248$$DView record in Pascal Francis$$Hfree_for_read</backlink></links><search><creatorcontrib>STONE, G. W</creatorcontrib><creatorcontrib>HODGSON, J. M</creatorcontrib><creatorcontrib>ST GOAR, F. G</creatorcontrib><creatorcontrib>FREY, A</creatorcontrib><creatorcontrib>MUDRA, H</creatorcontrib><creatorcontrib>SHEEHAN, H</creatorcontrib><creatorcontrib>LINNEMEIER, T. J</creatorcontrib><title>Improved procedural results of coronary angioplasty with intravascular ultrasound-guided balloon sizing : The CLOUT pilot trial</title><title>Circulation (New York, N.Y.)</title><description>Background
Indiscriminate use of balloons larger than the angiographic reference segment lumen results in high rates of ischemic complications after percutaneous transluminal coronary angioplasty (PTCA). We hypothesized that angiographically unsuspected atheromatous remodeling with vessel expansion (the Glagov phenomenon) at and adjacent to PTCA target lesions would safely accommodate oversized balloons in selected patients undergoing PTCA with intravascular ultrasound (IVUS) guidance.
Methods and Results
After angiographically guided PTCA of 104 lesions in 102 patients, IVUS was performed, and if atheromatous remodeling was present, PTCA was repeated with larger balloons sized halfway between the lumen and external elastic membrane. Plaque occupied a mean of 51±15% of the angiographically “normal” reference segments. Further balloon upsizing by 0.25 to 1.25 mm was therefore performed in 76 lesions (73%), increasing the nominal balloon-to-artery ratio from 1.12±0.15 after standard PTCA to 1.30±0.17 after IVUS-guided PTCA (
P
<.0001). As a result, the angiographic minimal luminal diameter further increased from 1.95±0.49 to 2.21±0.47 mm, the % diameter stenosis fell from 28±15% to 18±14%, and the IVUS lumen area rose from 3.16±1.04 to 4.52±1.14 mm
2
(all
P
<.0001). The incidence of angiographic dissection was not increased after IVUS-guided balloon upsizing (37% versus 40%,
P
=.67), and major complications occurred in only 2 patients (1.9%).
Conclusions
The demonstration by IVUS of atheromatous remodeling permits the safe use of balloons traditionally considered oversized, resulting in significantly improved luminal dimensions without increased rates of dissection or ischemic complications.</description><subject>Biological and medical sciences</subject><subject>Diseases of the cardiovascular system</subject><subject>Medical sciences</subject><subject>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>1997</creationdate><recordtype>article</recordtype><recordid>eNo9kM1LAzEQxYMoWKt3j0G87prP3Y03KX4UCoLUc5hmszUSNzXZrdSL_7qRFucyDLz3hvdD6JKSktKK3hBazuYvpZJlUzIixBGaUMlEISRXx2hCCFFFzRk7RWcpveez4rWcoJ_5xyaGrW1xXsa2YwSPo02jHxIOHTYhhh7iDkO_dmHjIQ07_OWGN-z6IcIWkhk9RJz1EVIY-7ZYj67NeSvwPoQeJ_ft-jW-xcs3i2eL59cl3jgfBjxEB_4cnXTgk7047Cl6fbhfzp6KxfPjfHa3KAxTdCiUkoxxJmsr6rYCK0wnrK1AdpVaAUiyUpZI05iqtiAMp0wJwarWCNoBbVd8iq72ubnm52jToN_DGPv8UjPKal7nySKyF5kYUoq205voPnJ7TYn-o6wJ1ZmyVlI3-o9ytlwfcjMJ8F2E3rj072MVb5ho-C9aun98</recordid><startdate>19970415</startdate><enddate>19970415</enddate><creator>STONE, G. W</creator><creator>HODGSON, J. M</creator><creator>ST GOAR, F. G</creator><creator>FREY, A</creator><creator>MUDRA, H</creator><creator>SHEEHAN, H</creator><creator>LINNEMEIER, T. J</creator><general>Lippincott Williams & Wilkins</general><general>American Heart Association, Inc</general><scope>IQODW</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>U9A</scope></search><sort><creationdate>19970415</creationdate><title>Improved procedural results of coronary angioplasty with intravascular ultrasound-guided balloon sizing : The CLOUT pilot trial</title><author>STONE, G. W ; HODGSON, J. M ; ST GOAR, F. G ; FREY, A ; MUDRA, H ; SHEEHAN, H ; LINNEMEIER, T. J</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c291t-995223257e47d6ae4cf4ee6a5f69baa50b9e05c8c67ea4c31294426dc41fa1db3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>1997</creationdate><topic>Biological and medical sciences</topic><topic>Diseases of the cardiovascular system</topic><topic>Medical sciences</topic><topic>Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>STONE, G. W</creatorcontrib><creatorcontrib>HODGSON, J. M</creatorcontrib><creatorcontrib>ST GOAR, F. G</creatorcontrib><creatorcontrib>FREY, A</creatorcontrib><creatorcontrib>MUDRA, H</creatorcontrib><creatorcontrib>SHEEHAN, H</creatorcontrib><creatorcontrib>LINNEMEIER, T. J</creatorcontrib><collection>Pascal-Francis</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>STONE, G. W</au><au>HODGSON, J. M</au><au>ST GOAR, F. G</au><au>FREY, A</au><au>MUDRA, H</au><au>SHEEHAN, H</au><au>LINNEMEIER, T. J</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Improved procedural results of coronary angioplasty with intravascular ultrasound-guided balloon sizing : The CLOUT pilot trial</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><date>1997-04-15</date><risdate>1997</risdate><volume>95</volume><issue>8</issue><spage>2044</spage><epage>2052</epage><pages>2044-2052</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Background
Indiscriminate use of balloons larger than the angiographic reference segment lumen results in high rates of ischemic complications after percutaneous transluminal coronary angioplasty (PTCA). We hypothesized that angiographically unsuspected atheromatous remodeling with vessel expansion (the Glagov phenomenon) at and adjacent to PTCA target lesions would safely accommodate oversized balloons in selected patients undergoing PTCA with intravascular ultrasound (IVUS) guidance.
Methods and Results
After angiographically guided PTCA of 104 lesions in 102 patients, IVUS was performed, and if atheromatous remodeling was present, PTCA was repeated with larger balloons sized halfway between the lumen and external elastic membrane. Plaque occupied a mean of 51±15% of the angiographically “normal” reference segments. Further balloon upsizing by 0.25 to 1.25 mm was therefore performed in 76 lesions (73%), increasing the nominal balloon-to-artery ratio from 1.12±0.15 after standard PTCA to 1.30±0.17 after IVUS-guided PTCA (
P
<.0001). As a result, the angiographic minimal luminal diameter further increased from 1.95±0.49 to 2.21±0.47 mm, the % diameter stenosis fell from 28±15% to 18±14%, and the IVUS lumen area rose from 3.16±1.04 to 4.52±1.14 mm
2
(all
P
<.0001). The incidence of angiographic dissection was not increased after IVUS-guided balloon upsizing (37% versus 40%,
P
=.67), and major complications occurred in only 2 patients (1.9%).
Conclusions
The demonstration by IVUS of atheromatous remodeling permits the safe use of balloons traditionally considered oversized, resulting in significantly improved luminal dimensions without increased rates of dissection or ischemic complications.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><doi>10.1161/01.CIR.95.8.2044</doi><tpages>9</tpages></addata></record> |
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| source | American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete |
| subjects | Biological and medical sciences Diseases of the cardiovascular system Medical sciences Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects) |
| title | Improved procedural results of coronary angioplasty with intravascular ultrasound-guided balloon sizing : The CLOUT pilot trial |
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