Clinical evaluation of transradial revascularization of cutting balloon for in-stent restenosis

Objective The purpose of this study was to evaluate the feasibility and efficacy of transradial reangioplasty of cutting balloon (CBA) for in stent restenosis(ISR) lesions.Methods Thirty patients with recurrence angina pectoris who were angiographically proven ISR (7.2±5.3) months after stent implatation, male 29 and female 1,age ( 59.8 ±10.5 ) years, were enrolled in this study during January 2001 Sept 2002. The diameter and length of original stent were ( 3.18 ±0.29)mm and ( 18.2 ±3.3)mm . The degree and length of ISR lesions were 90.2% ±9.3% and ( 14.6 ±3.1)mm. There were 16 lesions of ISR in proximal middle section of LAD ,4 lesions of ISR in middle section of LCX and 10 lesions in middle distal section of RCA. 17 ISR lesions involved in the proximal or distal section of stent. Average TIMI grade of ISR vessels was 2.7 ±0.3 , and all ISR lesions were suitable for CBA. The strongest pulse site of radial artery in right wrist was as the puncture point, and guiding catheter(ZUMA 2.0 , JL 4.0 , JR4.0 Medtronic USA; XB3.5 , XBLAD3.5,Cordis,USA) was inserted along super sliding guidewire with 6F radial artery sheath(Cordis,USA). The spasm of radial artery was prevented by administration of nitroglycerin, lidocaine and diltiazem through guiding catheter at the brachil artery level. The good coaxle to target coronary ostium and strongly back up for guiding catheter were maintained by deep seating manipulation of guiding catheter or using strong back up guiding catheter in new design, and then BMW or Intermidiate guidewire(ACS Guident,USA) were inserted to the distal of ISR lesions.The diameter of the selected cutting balloon for ISR should be in the ratio of 1:1.25 for the reference stent size.The CBA were performed from distal to proximal of ISR lesion under fluoroscopy with slowly inflating the cutting balloon(1atm/5sec) to 6 8 atm.The duration for every protocal in transradial CBA were respectively recorded,including the time of transradial puncture and sheath inserting,the time of guiding catheter manipulated into target coronary ostium,the time of cutting balloon inserted to target lesion,the time of inflation/deflation of cutting balloon,the time of fluoroscopy, total manipulation duration, the total volume of contrast medium and the incidence of radial artery spasm.The result of CBA was evaluated by QCA system. The complication of radial artery in 1 month follow up after CBA procedure were recorded. Results Transradial CBA procedure in thirty patients with ISR were performed successfully. Residual stenosis after procedure was 12.6% ±4.2% while 6 stents overlapped the original stents without the complications of acute dissection, no reflow and thrombosi. Average time of radial artery puncture ,the time of guiding catheter manipulated into target coronary ostium and cutting balloon located at the target lesion were ( 2.1 ±1.0)min , ( 4.1 ± 0.6)min and ( 4.4 ±1.2)min , respectively.Average inflation pressure and time were ( 6.2 ±2.0) atm and (64±16)s, while average deflation time of cutting balloon was (33±4)s. Average fluoroscopy time,total duration of procedure, the volume of contrast medium were (22± 0.4)min , (51±14)min and (212±48)ml, respectively.The stay of hospitalization was ( 5.2 ± 2.3) days.The transradial sheath was taken out once the procedure finished, and the access site was suppression with a few minutes while the infusion of heparin could be continued with no postural limitation. There was no significant difference between pre procedure and 1 month follow up in the time of Allen's test,inner diameters of right radial artery as well as the peak of blood velocity.No complication, such as radial artery bleeding,pseadul anearysm,occlusion were found.Conclusions Revascularization of cutting balloon for ISR by transradial artery approach is feasible and effective for ISR base on strength backing up of 6F large lumen guiding catheter with few complications of access vessels.