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Stenosis Morphology and Risk Assessment in Balloon Angioplasty

  • Chapter
Coronary Stenosis Morphology: Analysis and Implication

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 190))

  • 69 Accesses

Abstract

The risk of percutaneous transluminal balloon angioplasty (PTCA) includes acute vessel closure and perforation potentially leading to myocardial Infarction, need for emergency coronary artery bypass surgery and death. Factors such as the skill of the operators, availability of technology and patient selection are the major consideration in the risk assessment. From 1979-83, the operators from the National Heart, Lung and Blood Institute (NHLBI) PTCA Registry reported major adverse coronary events in 13.6% of their patients (1); with an emergent coronary artery bypass rate of 6.6% and non-fatal myocardial infarction rate of 5.5%. Subsequently, the 1985-86 NHBLI PTCA Registry documented that the emergency coronary artery by-pass and non-fatal myocardial infarction rates fell to 4.3 % and 4.3 % respectively (2). The higher incidence of the elderly, multivessel disease and poor left ventricular function in the latter group of patients may account for the lack of change in the mortality rate; which was about 1 %. Hence, with more experienced operators and better technology, the risk for a patient was reduced. In 1988, lesion morphology described on coronary angiography became the basis of risk assessment in the guidelines set up by the American College of Cardiology and American Heart Association (3) (Table 1). This recommendation was first validated by Cragg et al (4) when it was used successfully to help select patients for early hospital discharge after PTCA. Ellis et al (5) further refined the system by sub-dividing the type B lesions into Bl and B2 — Bl lesions consist of only one B characteristic and B2 lesions consist of at least two B characteristics. They demonstrated a step-wise relationship between the lesion types (A, Bl, B2 and C) with success and complication rates.

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References

  1. Cowley MJ, Dorros G, Kelsey SF, van Raden M, Detre KM. Acute coronary events associated with percutaneous transluminal coronary angioplasty. Am J Cardiol 1984; 53:12C–16C.

    Article  PubMed  CAS  Google Scholar 

  2. Detre K, Holubkor R, Kelsey S, et al. Percutaneous transluminal coronary angioplasty in 1985-1986 and 1977 to 1981: the National Heart, Lung, and Blood Institue. N Engl J Med 1988; 318:265–70.

    Article  PubMed  CAS  Google Scholar 

  3. Ryan TJ, Bauman WB, Kennedy JW, et al. Guidelines for percutaneous transluminal coronary angioplasty: A report of the American College of Cardiology/ American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Committee on Percutaneous Transluminal Coronary Angioplasty). J Am Coll Cardiol 1993; 22:2033–54.

    Article  Google Scholar 

  4. Cragg DR, Friedman HZ, Almony SC, et al. Early hospital discharge after percutaneous transluminal coronary angioplasty. Am J Cardiol 1989; 64:1270–4.

    Article  PubMed  CAS  Google Scholar 

  5. Ellis SG, Vandormael MG, Cowley MJ, et al. Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implication for patient selection. Circulation 1990; 82:1193–202.

    Article  PubMed  CAS  Google Scholar 

  6. Kahn JK, Hartzler GO. Frequency and causes of failure with contemporary balloon coronary angioplasty and implications for new technologies. Am J Cardiol 1990; 66:858–60.

    Article  PubMed  CAS  Google Scholar 

  7. Myler RK, Shaw RE, Stertzer SH, et al. Lesion morphology and coronary angioplasty: current experience and analysis. J Am Coll Cardiol 1992; 19:1641–52.

    Article  PubMed  CAS  Google Scholar 

  8. Favereau X, Corcos T, Zimarino M, et al. Is ABC classification for PTCA obsolete? Circulation 1993; 84:1–217.

    Google Scholar 

  9. Meier B. Chronic total coronary occlusion angioplasty. Cathet Cardiovasc Diagn 1989; 17:212–7.

    Article  PubMed  CAS  Google Scholar 

  10. Serruys PW, Umans V, Heyndrickx GR, et al. Elective PTCA of totally occluded coronary arteries not associated with acute myocardial infarction; short-term and long-term results. Eur Heart J 1985; 6:2–12.

    PubMed  CAS  Google Scholar 

  11. Holmes DR Jr, Vlietstra RE, Reeder GS, et al. Angioplasty in total coronary occlusion. J Am Coll Cardiol 1984: 3:845–9.

    Article  PubMed  Google Scholar 

  12. Kereiakes DJ, Selmon MR, McAuley BJ, McAuley DB, Sheehan DJ, Simpson JB. Angioplasty in total coronary artery occlusion: Experience in 76 consecutive patients. J Am Coll Cardiol 1985; 6:526–33.

    Article  PubMed  CAS  Google Scholar 

  13. Stone GW, Rutherford BD, McConahay DR, et al. Procedural outcome of angioplasty for total coronary artery occlusion: an analysis of 971 lesions in 905 patients. J Am Coll Cardiol 1990; 15:849–56.

    Article  PubMed  CAS  Google Scholar 

  14. DiSciascio G, Vetrovec GW, Cowley MJ, Wolfgang TC. Early and late outcome of percutaneous transluminal coronary angioplasty for subacute and chronic total coronary occlusion. Am Heart J 1986; 111:833–9.

    Article  PubMed  CAS  Google Scholar 

  15. Bell MR, Berger PB, Bresnahan JF, Reeder GS, Bailey KR, Holmes Jr DR. Initial and long-term outcome of 354 patients after coronary balloon angioplasty of total coronary artery occlusions. Circulation 1992; 85:1003–11.

    Article  PubMed  CAS  Google Scholar 

  16. Shimizu M, Kato O, Otsuji S, et al. Progress in initial outcome of PTCA for complete occlusion. Circulation 1993; 88:1–504.

    Google Scholar 

  17. Ivanhoe RJ, Weintraub WS, Douglas JS Jr, et al. Percutaneous transluminal coronary angioplasty of chronic total occlusions: Primay success, restenosis, and long-term clinical follow-up. Circulation 1992; 85:106–15.

    Article  PubMed  CAS  Google Scholar 

  18. Safian RD, McCabe CH, Sipperly ME, McKay RG, Bairn DS. Initial success and long-term follow-up of percutaneous transluminal coronary angioplasty in chronic total occlusions versus conventional stenoses. Am J Cardiol 1989; 61:23G–28G.

    Article  Google Scholar 

  19. Tan KH, Sulke AN, Taub NA, Watts E, Sowton E. Coronary angioplasty of chronic total occlusion: determinants of procedural success. J Am Coll Cardiol 1993; 21:76A.

    Google Scholar 

  20. Kinoshita I, Kato O, Kamide K, et al. Coronary angioplasty (PTCA) of chronic total occlusion with bridging collaterals. Circulation 1993; 88:1–505.

    Google Scholar 

  21. Katsuragawa M, Fujiwara H, Miyamae M, Sasayama S. Pathological background of percutaneous transluminal coronary angioplasty for chronic total occlusion. J Am Coll Cardiol 1993; 21:76A.

    Article  Google Scholar 

  22. Meier B. “Occlusion angioplasty”: light at the end of the tunnel or dead end? Circulation 1992; 85:1214–1216.

    Article  PubMed  CAS  Google Scholar 

  23. Dervan JP, Bairn DS, Cherniles J, Grossman W. Transluminal angioplasty of occluded arteries: use of a movable guide wire system. Circulation 1983; 68:776–84.

    Article  PubMed  CAS  Google Scholar 

  24. Ellis SG, Shaw RE, Gershony G, et al. Risk factors, time course and treatment effect for restenosis after successful percutaneous transluminal coronary angioplasty of chronic total occlusion. Am J Cardiol 1989; 63:897–901.

    Article  PubMed  CAS  Google Scholar 

  25. Warren RJ, Black AJ, Valentine PA, Manolas EG, Hunt D. Coronary angioplasty for chronic total occlusion reduces the need for subsequent coronary bypass surgery. Am Heart J 1990; 120:270–4.

    Article  PubMed  CAS  Google Scholar 

  26. Stewart JT, Williams MG, Mulcahy DA,et al. Angioplasty in chronic occlusions: risks and benefits. Circulation 1991; 84:11–332.

    Google Scholar 

  27. Haine E, Urban P, Dorsaz P-A, Meier B. Outcome and complications of 500 consecutive chronic total occlusion coronary angioplasties. J Am Coll Cardiol 1993; 21:138A.

    Google Scholar 

  28. Piante S, Laarman G, de Feyer PJ, et al. Acute complications of percutaneous transluminal coronary angioplasty for total occlusion. Am Heart J 1991: 121:417–26.

    Article  Google Scholar 

  29. Savage MP, Goldberg S, Hirshfeld JW, et al. Clinical and angiographic determinants of primary coronary angioplasty success. J Am Coll Cardiol 1991; 17:22–8.

    Article  PubMed  CAS  Google Scholar 

  30. Tan K, Sulke N, Taub N, Sowton E. Clinical and lesion morphology determinants of coronary angioplasty success and complication: current experience. J Am Coll Cardiol 1995; 25:855–65.

    Article  PubMed  CAS  Google Scholar 

  31. Pinkerton CA, Slack JD, van Tassel JW, Orr CM. Angioplasty for dilation of bifurcation stenoses. Am J Cardiol 1985; 55:1626–8.

    Article  PubMed  CAS  Google Scholar 

  32. Weinstein JS, Bairn DS, Slipperly ME, McCabe CH, Lorell BH. Salvage of branch vessels during bifurcation lesion angioplasty: acute and long-term follow-up. Cathet Cardiovasc Diagn 1991; 22:1–6.

    Article  PubMed  CAS  Google Scholar 

  33. Arora RR, Raymond RE, Dimas AP, Bhadwar K, Simpfendorfer C. Side branch occlusion during coronary angioplasty: incidence, angiographic characteristics, and outcome. Cathet Cardiovasc Diagn 1989; 18:210–2.

    Article  PubMed  CAS  Google Scholar 

  34. Mathias DW, Mooney JF, Lange HW, Goldenberg IF, Gobel FL, Mooney MR. Frequency of success and complications of coronary angioplasty of a stenosis at the ostium of a branch vessel. Am J Cardiol 1991; 67:491–5.

    Article  PubMed  CAS  Google Scholar 

  35. Meier B, Gruentzig AR, King SB III, et al. Risk of side branch occlusion during coronary angioplasty. Am J Cardiol 1984; 53:10–4.

    Article  PubMed  CAS  Google Scholar 

  36. Vetrotec GW, Cowley MJ, Wolfgang TC, Ducey KC. Effects of percutaenous transluminal coronary angioplasty on lesion-associated branches. Am Heart J 1985; 109:921–5.

    Article  Google Scholar 

  37. Shiu MF, Singh A. Spontaneous recanalisation of side branches occluded during percutaenous transluminal angioplasty. Br Heart J 1985; 54:215–7.

    Article  PubMed  CAS  Google Scholar 

  38. Saltissi S, Webb-Peploe MM, Coltart DJ. Effect of variation in coronary artery anatomy on distribution of stenotic lesions. Br Heart J 1979; 42:186–91.

    Article  PubMed  CAS  Google Scholar 

  39. Mabin TA, Holmes DR Jr, Smith HC, et al. Intracoronary thrombus: role in coronary occlusion complicating percutaneous transluminal coronary angioplasty. J Am Coil Cardiol 1985; 5:198–202.

    Article  CAS  Google Scholar 

  40. Manzo K, Nesto R, Sassower M, et al. Coronary lesion morphology by angioscopy vs angiography: the ability of angiography to detect thrombi. J Am Coll Cardiol 1994; 23:406A.

    Article  Google Scholar 

  41. Deligonul U, Gabliani GI, Caralis DG, Kern MJ, Vandormael MG. Percutaneous transluminal coronary angioplasty in patients with intracoronary thrombus. Am J Cardiol 1988; 62:474–6.

    Article  PubMed  CAS  Google Scholar 

  42. Arora RR, Platko WP, Badwar K, Simpfendorfer C. Role of intracoronary thrombus in acute complications during percutaneous transluminal coronary angioplasty. Cathet Cardiovasc Diagn 1989; 16:226–9.

    Article  PubMed  CAS  Google Scholar 

  43. Mooney MR, Mooney JF, Goldenberg IF, Almquist AK, Van Tassel RA. Percutaneous transluminal coronary angioplasty in the setting of large intracoronary thrombi. Am J Cardiol 1990; 65:427–31.

    Article  PubMed  CAS  Google Scholar 

  44. Hillegass WB, Ohman EM, O’Hanesian MA, et al. The effect of preprocedural intracoronary thrombus on patient outcome after percutaneous coronary intervention. J Am Coll Cardiol 1995; 25:94A.

    Article  Google Scholar 

  45. Ellis SG, Roubin GS, King III SB, et al. Angiographic and clinical predictors of acute closure after native vessel coronary angioplasty. Circulation 1988; 77:372–9.

    Article  PubMed  CAS  Google Scholar 

  46. Kent KM, Bentivoglio LG, Block PC, et al. Percutaneous transluminal coronary angioplasty: report from the Registry of the National Heart, Lung, and Blood Institute. Am J Cardiol 1982; 49:2011–9.

    Article  PubMed  CAS  Google Scholar 

  47. Ambrose JA, Almeida OD, Ratner D, et al. Heparin adminstered prior to angioplasty does not decrease angioplasty complications — TAUSA trial results. Circulation 1994; 90:1–374.

    Article  Google Scholar 

  48. Schieman G, Cohen BM, Kozina J, et al. Intracoronary urokinase for intracoronary thrombus accumulation complicating percutaneous transluminal coronary angioplasty in acute ischemic syndromes. Circulation 1990; 82:2052–60.

    Article  PubMed  CAS  Google Scholar 

  49. Torre SR, Ambrose JA, Sharma SK, et al. Adjuvant intracoronary urokinase worsens the procedural outcome for PTCA of complex lesions in unstable angina: results of the Throbolysis and Angioplasty in Unsatble Angina Trial (TAUSA). J Am Coll Cardiol 1994; 23:105A.

    Google Scholar 

  50. The EPIC Investigators. Use of a monoclonal antibody directed against the platelet glycoprotein Ilb/IIIa receptor in high-risk coronary angioplasty. N Engl J Med 1994; 330:956–61.

    Article  Google Scholar 

  51. Den Heijer P, Foley DP, Escaned J, et al. Angioscopic versus angiographic detection of intimal dissection and intracoronary thrombus. J Am Coll Cardiol 1994; 24:649–54.

    Article  Google Scholar 

  52. Teirstein PS, Schatz RA, Johnson AD, et al. Angioscopic versus angiographic detection of thrombus and dissection during coronary intervention. J Am Coll Cardiol 1993; 21:79A.

    Article  Google Scholar 

  53. Ellis SG, Topol EJ. Results of percutaneous transluminal coronary angioplasty of high-risk angulated stenoses. Am J Cardiol 1990; 66:932–7.

    Article  PubMed  CAS  Google Scholar 

  54. Savas V, Puchrowicz S, Williams L, Grines CL, O’Neill WW. Angioplasty outcome using long balloons in high risk lesions. J Am Coll Cardiol 1992; 19:34A.

    Article  Google Scholar 

  55. Honye J, Mahon DJ, Jain A, et al. Morphological effects of coronary balloon angioplasty in vivo assessed by intravascular ultrasound imaging. Circulation 1992; 85:1012–25.

    Article  PubMed  CAS  Google Scholar 

  56. Richardson PD, Davies MJ, Born GVR. Influence of plaque configuration and stress distribution on fissuring of atherosclerotic plaque. Lancet 1989; 2:941–4.

    Article  PubMed  CAS  Google Scholar 

  57. Sarembock IJ, LaVeqau PJ, Sigal SL, et al. Influence of inflation pressure and balloon size on the development of intimal hyperplasia after balloon angioplsty: a study in the atherosclerotic rabbit. Circulation 1989; 80:1029–40.

    Article  PubMed  CAS  Google Scholar 

  58. Mintz GS, Popma JJ, Pichard AD, et al. Patterns of target lesion calcification in coronary artery disease. A statistical analysis of intravascular ultrasound and coronary angiography in 1155 lesions. Circulation 1995; 91:1959–65.

    Article  PubMed  CAS  Google Scholar 

  59. Maclsaac AI, Bass TA, Buchbinder M, et al. High speed rotational atherectomy: outcome of calcified and non-calcified cornary artery lesions. J Am Coll Cardiol (accepted).

    Google Scholar 

  60. Levine S, Mehta S, Krauthamer D, Margolis JR. Excimer laser coronary angioplasty of calcified lesions. J Am Coll Cardiol 1991; 17:206A.

    Article  Google Scholar 

  61. Meier B, Gruentzig AR, Hollman J, Ischinger T, Bradford JM. Does length or eccentricity of coronary stenoses influence the outcome of transluminal diatation? Circulation 1983; 67:497–9.

    Article  PubMed  CAS  Google Scholar 

  62. Fitzgerald PJ, Ports PA, Yock PG. Contribution of localized calcium deposits to dissection after angioplasty. An observational study using intravascular ultrasound. Circulation 1992; 86:64–70.

    Article  PubMed  CAS  Google Scholar 

  63. de Feyter PJ, van den Brand M, Jaarman G, et al. Acute artery occlusion during and after percutaneous transluminal coronary angioplasty. Frequency, prediction, clinical course, management, and follow-up. Circulation 1991; 83:927–36.

    Article  PubMed  Google Scholar 

  64. The SHK, Gussenhoven EJ, van Strijen M, et al. Can intravascular ultrasound predict clinical outcome following percutaneous transluminal angioplasty. J Am Coll Cardiol 1994; 23:242A.

    Article  Google Scholar 

  65. Tenaglia AN, Buller CE, Kisslo KB, Stack RS, Davidson CJ. Mechanisms of balloon angioplasty and directional atherectomy as assessed by intracoronary ultrasound. J Am Coll Cardiol 1992; 20:685–691.

    Article  PubMed  CAS  Google Scholar 

  66. Hinohara T, Rowe MH, Robertson GC, et al. Effect of lesion characteristics on outcome of directional coronary atherectomy. J Am Coll Cardiol 1991; 17:1112–20.

    Article  PubMed  CAS  Google Scholar 

  67. Tenaglia AN, Zidar JP, Jackman JD Jr, et al. Treatment of long coronary artery narrowings with long angioplasty balloon catheters. Am J Cardiol 1993; 71:1274–7.

    Article  PubMed  CAS  Google Scholar 

  68. Goudreau E, DiSciascio G, Kelly K, et al. Coronary angioplasty of diffuse coronary artery disease. Am Heart J 1991; 121:12–9.

    Article  PubMed  CAS  Google Scholar 

  69. Detre KM, Holmes DR Jr, Holubkov R, et al. Incidence and consequences of periprocedural occlusion. The 1985-1986 National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry. Circulation 1990; 82:739–50.

    Article  PubMed  CAS  Google Scholar 

  70. Cannon AD, Roubin GS, Hearn JA, et al. Acute angiographic and clinical results of long balloon percutaneous transluminal coronary angioplasty and adjuvant stenting for long narrowings. Am J Cardiol 1994; 73:635–41.

    Article  PubMed  CAS  Google Scholar 

  71. Cates CU, Knopf WD, Lembo NJ, et al. The 80 mm ballon: the first 95 vessel cumulative experience. J Am Coll Cardiol 1994; 23:58A.

    Google Scholar 

  72. Topol EJ, Ellis SG, Fishman J, et al. Multicenter study of percutaneous transluminal angioplasty for right coronary artery ostial stenosis. J Am Coll Cardiol 1987; 9:1214–8.

    Article  PubMed  CAS  Google Scholar 

  73. Bedotto JB, McConahay DR, Rutherford BD, et al. Balloon angioplasty of aorta coronary ostial stenosis revisited. Circulation 1991; 84:11–251.

    Google Scholar 

  74. CASS Principal Investigators and their Associates. Coronary artery surgery study (CASS): a randomized trial of coronary bypass surgery: survival data. Circulation 1983; 68:939–50.

    Article  Google Scholar 

  75. Loop FD, Lytle BW, Cosgrove DM, et al. Reoperation for cornary atherosclerosis. Changing practice in 2509 consecutive patients. Ann Surg 1990; 212:378–84.

    Article  PubMed  CAS  Google Scholar 

  76. Douglas JS Jr, Gruentzig AR, King SB III, et al. Percutaneous transluminal coronary angioplasty in patients with prior coronary bypass surgery. J Am Coll Cardiol 1983; 2:745–54.

    Article  PubMed  Google Scholar 

  77. Block PC, Cowley MJ, Kaltenbach M, Kent KM, Simpson J. Percutaneous angioplasty of stenoses of bypass grafts or of bypass graft anastomotic sites. Am J Cardiol 1984; 53:666–8.

    Article  PubMed  CAS  Google Scholar 

  78. El Gamal M, Bonnier H, Michels R, Heijman J, Stassen E. Percutaneous transluminal angioplasty of stenosed aortocoronary bypass grafts. Br Heart J 1984; 52:617–20.

    Article  PubMed  Google Scholar 

  79. Corbelli J, Franco I, Hollman J, Simpfendorfer C, Galan K. Percutaneous transluminal coronary angioplasty after previous coronary artery bypass surgery. Am J Cardiol 1985; 56:398–403.

    Article  PubMed  CAS  Google Scholar 

  80. Cote G, Myler RK, Stertzer SH, et al. Percutaneous transluminal angioplasty of stenotic coronary artery bypass grafts: 5 years’ experience. J Am Coll Cardiol 1987; 9:8–17.

    Article  PubMed  CAS  Google Scholar 

  81. Pinkerton CA, Slack JD, Orr CM, Vantassel JW, Smith ML. Percutaneous transluminal angioplasty in patients with prior myocardial revascularization surgery. Am J Cardiol 1988; 61:15G–22G.

    Article  PubMed  CAS  Google Scholar 

  82. Cooper I, Ineson N, Demirtas E, et al. Role of angioplasty in patients with previous coronary artery bypass surgery. Cathet Cardiovasc Diagn 1989; 16:81–6.

    Article  PubMed  Google Scholar 

  83. Platko WP, Hollman J, Whitlow PL, Franco I. Percutaneous transluminal angioplasty of saphenous vein graft stenosis: long-term follow-up. J Am Coll Cardiol 1989; 14:1645–50.

    Article  PubMed  CAS  Google Scholar 

  84. Douglas JS Jr, Weintraub WS, Liberman HA, et al. Update of saphenous vein graft (SVG) angioplasty: restenosis and long term outcome. Circulation 1991; 84:11–249.

    Google Scholar 

  85. Miranda CP, Rutherford BD, McConahay DR, et al. Angioplasty of older saphenous vein grafts continues to be a sound therapeutic option. J Am Coll Cardiol 1992; 19:350A.

    Google Scholar 

  86. Webb JG, Myler RK, Shaw RE, et al. Coronary angioplasty after coronary bypass surgery: initial results and late outcome in 422 patients. J Am Coll Cardiol 1990; 16:812–20.

    Article  PubMed  CAS  Google Scholar 

  87. Meester BH, Samson M, Suryapranata H, et al: Long-term follow-up after attempted angioplasty of saphenous vein grafts: the Thoraxcenter experience 1981-1988. Eur Heart J 1991; 12:648–53.

    PubMed  CAS  Google Scholar 

  88. Dorros G, Lewin RF, Mathiak LM, et al. Percutaneous transluminal coronary angioplasty in patients with two or more previous coronary artery bypass grafting operations. Am J Cardiol 1988; 61:1243–7.

    Article  PubMed  CAS  Google Scholar 

  89. Dimas AP, Arora RR, Whitlow PL, et al. Percutaneous transluminal angioplasty involving internal mammary artery grafts. Am Heart J 1991; 122:423–9.

    Article  PubMed  CAS  Google Scholar 

  90. Holmes DR Jr, Topol EJ, Califf RM, et al. A multicenter, randomized trial of coronary angioplasty versus direnctional atherectomy for patients with saphenous vein bypass graft lesions. Circulation 1995; 91:1966–74.

    Article  PubMed  Google Scholar 

  91. Pinkerton CA, Slack JD, Orr CM, VanTassel JW. Percutaneous transluminal angioplasty involving internal mammary artery bypass grafts: a femoral approach. Cathet Cardiovasc Diagn 1987; 13:414–8.

    Article  PubMed  CAS  Google Scholar 

  92. Hill DM, McAuley BJ, Sheehan DJ, et al. Percutaneous transluminal angioplasty of internal mammary artery bypass grafts. J Am Coll Cardiol 1989; 13:221A.

    Article  Google Scholar 

  93. de Feyter PJ, Serruys P, van den Brand M, et al. Percutaneous transluminal angioplasty of a totally occluded venous bypass graft: a challenge that should be resisted. Am J Cardiol 1989; 64:88–90.

    Article  PubMed  Google Scholar 

  94. Kahn JK, Rutherford BD, McConahay DR, et al. Initial and long-term outcome of 83 patients after balloon angioplasty of totally occluded bypass grafts. J Am Coll Cardiol 1994; 23:1038–42.

    Article  PubMed  CAS  Google Scholar 

  95. Smith SH, Geer JC. Morphology of saphenous vein-coronary artery bypass grafts. Seven to 116 months after surgery. Arch Pathol Lab Med 1983; 107:13–8.

    PubMed  CAS  Google Scholar 

  96. Neitzel GF, Barboriak JJ, Pintar K, Qureshi I. Atherosclerosis in aortocoronary bypass grafts. Morphologic study and risk factor analysis 6 to 12 years after surgery. Arteriosclerosis 1986; 6:594–600.

    Article  PubMed  CAS  Google Scholar 

  97. Waller BF, Rothbaum DA, Gorfinkel HJ, et al. Morphologic observations after percutaneous transluminal balloon angioplasty of early and late aortocornary saphenous vein bypass grafts. J Am Coll Cardiol 1984; 4:784–92.

    Article  PubMed  CAS  Google Scholar 

  98. Lefkovits J, Holmes DR Jr, Califf RM, et al. Predictors and sequelae of distal embolization during saphenous vein graft intervention from the CAVEAT-II Trial. Circulation 1995 (accepted).

    Google Scholar 

  99. Liu MW, Douglas JS Jr, Lembo NJ, King SB III. Angiographic predictors of a rise in serum creatine kinase (distal embolization) after balloon angioplasty of saphenous vein coronary artery bypass grafts. Am J Cardiol 1993; 72:514–7.

    Article  PubMed  CAS  Google Scholar 

  100. Zir LM, Miller SW, Dinsmore RE, Gilbert JP, Harthorne JW. Interobserver variability in coronary angiography. Circulation 1976; 53:627–32.

    Article  PubMed  CAS  Google Scholar 

  101. Hackworthy RA, Sorensen SG, Fitzpatrick PG, et al. Dependence of assessment of coronary artery reperfusion during acute myocardial infarction on angiographic criteria and interobserver variability. Am J Cardiol 1988; 62:538–42.

    Article  PubMed  CAS  Google Scholar 

  102. Kleiman WS, Rodriguez AR, Raizner AE. Interobserver variability in grading of coronary arterial narrowings using the American College of Cardiology/ American Heart Association grading criteria. Am J Cardiol 1992; 69:413–5.

    Article  PubMed  CAS  Google Scholar 

  103. Popma JJ, Kennard E, Yeh W, et al. Reproducibility of qualitative and quantitative angiographic findings in the New Approaches to Coronary Intervention (NACI) Registry. J Am Coll Cardiol 1995; 25:153A.

    Article  Google Scholar 

  104. Ryan TJ, Faxon DP, Gunnar RM, et al. ACC/AHA guidelines for percutaneous transluminal coronary angioplasty: a report of the American College of Cardiology/ American Heart Association Task Force on assessment of diagnostic and therapeutic cardiovascular procedures. J Am Coll Cardiol 1988; 12:529–45.

    Article  Google Scholar 

  105. Tenaglia AN, Fortin DF, Califf RM, et al. Predicting the risk of abrupt vessel closure after angioplasty in an individual patient. J Am Coll Cardiol 1994; 24:1004–11.

    Article  PubMed  CAS  Google Scholar 

  106. Bergelson BA, Jacobs AK, Cupples LA, et al. Prediction of risk for hemodynamic compromise during percutaneous transluminal coronary angioplasty. Am J Cardiol 1992; 70:1540–5

    Article  PubMed  CAS  Google Scholar 

  107. Wolfe MW, Leya F, Bonan R, et al. Predictors of outcome after balloon angioplasty: a prospective multicenter study. Circulation 1993; 88:1–300.

    Google Scholar 

  108. Mick MJ, Piedmonte MR, Arnold AM, Simpendorfer C. Risk stratification for long term outcome after elective coronary angioplasty: a multivariate analysis of 5000 patients. J Am Coil Cardiol 1994; 24:74–80.

    Article  CAS  Google Scholar 

  109. Ellis SG, Omoigui N, Bittl JA, et al. Analysis of operator specific outcomes in interventional cardiology from a multicenter database of 4860 quality controlled procedures. Circulation 1995 (accepted).

    Google Scholar 

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  1. The Cleveland Clinic Foundation, Cleveland, Ohio, USA

    Koon-Hou Mak M.B.B.S. & Stephen G. Ellis M.D.

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  1. Department of Cardiology, Rush-Presbyterian-St. Luke’s Medical Center Rush Medical School, Chicago, IL, USA

    Lloyd W. Klein M.D.

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Mak, KH., Ellis, S.G. (1997). Stenosis Morphology and Risk Assessment in Balloon Angioplasty. In: Klein, L.W. (eds) Coronary Stenosis Morphology: Analysis and Implication. Developments in Cardiovascular Medicine, vol 190. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-6287-0_11

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