Comparison of immediate and in-hospital results of conventional balloon and perfusion balloon angioplasty using intracoronary ultrasound

Angiographic studies have demonstrated that perfusion balloon percutaneous transluminal coronary angioplasty (PTCA) may result in modestly improved lu minal gains and fewer major dissections than conventional balloon PTCA. How ever, intracoronary ultrasound (ICUS), which is more sensitive than angiogr aphy in evaluating the incidence, extent, and severity of dissection, was n ot used. We randomized 48 patients with 54 coronary stenoses to conventiona l or perfusion balloon PTCA. Four 2-minute inflations were permitted with c onventional balloon PTCA. Two 10-minute inflations were allowed with perfus ion balloon PTCA. Quantitative coronary angiography and ICUS were performed before and after treatment. In-hospital clinical events were recorded. Con ventional and perfusion balloon PTCA achieved similar improvements in lumen diameter (1.25 +/- 0.51 vs 1.28 +/- 0.51 mm) and reductions in percent ste nosis (-45 +/- 21% vs -44 +/- 15%) by quantitative coronary angiography. Co mparable gains in lumen diameter (0.62 +/- 0.39 vs 0.50 +/- 0.38 mm) and lu men area (2.70 +/- 1.96 vs 2.05 +/- 1.52 mm(2)) were observed on ICUS. Angi ography demonstrated similar rates of any dissection (36% vs 21%) and major dissection (12% vs 7%). ICUS identified a similar incidence of any dissect ion (60% vs 76%) and type II dissection (52% vs 62%). The relative dissecti on area was also similar (9.2 +/- 5.6% vs 7.8 +/- 5.8%). One conventional b alloon patient experienced postprocedural chest pain. No patient in either group died, or had myocardial infarction, abrupt closure, or urgent revascu larization. (C)1999 by Excerpta Medico, Inc.