| Improved procedural results of coronary angioplasty with intravascular ultrasound-guided balloon sizing: the CLOUT Pilot Trial. Clinical Outcomes With Ultrasound Trial (CLOUT) Investigators. | |
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MedLine Citation:
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PMID: 9133514 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 mm2 (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. |
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Authors:
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G W Stone; J M Hodgson; F G St Goar; A Frey; H Mudra; H Sheehan; T J Linnemeier |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Circulation Volume: 95 ISSN: 0009-7322 ISO Abbreviation: Circulation Publication Date: 1997 Apr |
Date Detail:
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Created Date: 1997-05-16 Completed Date: 1997-05-16 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 0147763 Medline TA: Circulation Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 2044-52 Citation Subset: AIM; IM |
Affiliation:
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Cardiovascular Institute, El Camino Hospital, Mountain View, CA 94040, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Aneurysm, Dissecting / epidemiology, etiology Angioplasty, Transluminal, Percutaneous Coronary / adverse effects, instrumentation* Arteriosclerosis / pathology, radiography, therapy*, ultrasonography Coronary Angiography Coronary Disease / pathology, radiography, therapy*, ultrasonography Coronary Vessels / injuries, ultrasonography* Equipment Design Female Follow-Up Studies Humans Male Middle Aged Pilot Projects Reference Standards |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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