SINGLE DEVICE APPROACH TO ULTRASOUND-GUIDED PERCUTANEOUS TRANSLUMINALCORONARY ANGIOPLASTY AND STENTING - INITIAL EXPERIENCE WITH A COMBINED INTRACORONARY ULTRASOUND VARIABLE DIAMETER BALLOON

We evaluated the use of both intracoronary ultrasound (ICUS) informati on and unique balloon characteristics provided by a combined ICUS/vari able diameter balloon catheter during coronary interventions to achiev e the maximal residual lumen using the least number of devices, In 47 patients, 64 coronary lesions were treated with either sequential perc utaneous transluminal coronary angioplasty (PTCA) (n = 40) or stenting (primary [n = II], secondary [n = 7]), The result after PTCA was judg ed satisfactory if the lumen cross sectional area (by ICUS) in the les ion exceeded 65% of the mean reference area, Stent implantation was ju dged according to revised MUSIC trial criteria, PTCA or stenting was s uccessful in all 64 lesions using 47 combination devices and 10 conven tional balloons (mean number of balloons per lesion: 0.90), PTCA group : diameter stenosis decreased from 78 +/- 11 to 23 +/- 13% following i nflation at 10.3 +/- 3.0 atm, ICUS lumen area was 4.6 +/- 1.9 mm(2) (p roximal reference: 7.4 +/- 3.3 mm(2), distal reference: 5.7 +/- 1.8 mm (2)) resulting in a residual area stenosis of 28 +/- 15%, Stent group: diameter stenosis was reduced from 77 +/- 14 to 10 +/- 10% after sten ting. ICUS defined minimal lumen area in the stent was 8.2 +/- 2.2 mm( 2) (proximal reference: 8.7 +/- 2.6 mm(2), distal reference: 8.0 +/- 2 .2 mm(2)) resulting in a residual area stenosis of 7.2 +/- 14.6%. No p atient death, myocardial infarction, or emergency surgery occurred and only one target lesion required re-PTCA during hospitalization. In co nclusion, use of a combined ICUS/variable diameter balloon catheter al lows a single device strategy for ICUS-guided PTCA and stenting in the majority (84%) of unselected lesions. (C) 1997 Wiley-Liss, Inc.