Biomedical subjects
Publications and source records attributed to A Grüntzig.
Percutaneous transluminal dilatation of an atherosclerotic stenosis of the superior mesenteric artery was done in a 65-year-old woman with abdominal angina. The patient was relieved of abdominal pain immediately after the dilatation.
Eight patients with unilateral renovascular hypertension underwent percutaneous transluminal dilatation. In seven, renal-artery stenoses were caused by atherosclerotic lesions and in one, by fibromuscular hyperplasia. After a 6-month follow-up period, three patients were cured of hypertension anf four showed improvement. Only one patient failed to respond: Failure was caused by an occluded left renal artery 3 months after the procedure. Renal angiographic studies were repeated in six patients after 6 months of follow-up and showed patent vessels in five and reoccurrence of a slight renal-artery stenosis in one. In one patient angiographic control studies done after 3 months showed an occluded renal artery. In five patients mean pressure gradient across the renal-artery stenoses was 89 +/- 22.8 mm Hg before percutaneous transluminal dilatation and 16.4 +/- 18.5 mm Hg after being controlled for 6 months. Our results indicate that percutaneous transluminal dilatation may be valuable in the treatment of renovascular hypertension.
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Since September 1977 until July 1979, 82 patients with various coronary lesions have undergone percutaneous transluminal coronary angioplasty (PTCA). By this technic, a catheter system is introduced through a systemic artery under local anesthesia to dilate a stenotic artery by controlled inflation. In 60 patients (73%) anatomical and hemodynamic success could be noted, which led to improvement in clinical parameters e.g. reduction of coronary narrowing of the transluminal diameter from a mean of 82 +/- 11% to 34 +/- 16% (p less than 0.001) and reduction of trans-stenotic coronary gradient from 56 +/- 15 to 19 +/- 12 mmHg (p less than 0.001). Nine patients, three of whom had signs of transmural myocardial infarction on the ECG had undergone emergency surgery for a coronary by-pass, this been due to the deterioration of clinical condition after the attempt to carry out coronary angioplasty. 42 out of 60 treated patients had at least one late control. 33 showed an improvement in cardiac efficiency campared with the pre-dilatation period. Patients with uncalcified single-vessel stenosis, less than 1 cm in length and a short history of pain appear to be most suitable for the procedure. More cases and follow-up datas are necessary to evaluate the efficiency of this new technic as compared with current medical and surgical treatments of ischemic heart disease.
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Percutaneous transluminal dilation (PTD) of coronary artery stenosis is performed by means of a balloon-tipped catheter introduced from a peripheral artery. It was attempted in 45 patients; stenosis was passed in 33 and was successfully dilated in 28 patients (62%). The method failed in 17 patients: in 6 of them an abrupt closure of a stenosed artery or a beginning infarction necessitated an emergency revascularization. There were no deaths or serious complications, but an infarction developed in 1 patient despite immediate bypass grafting. PTD was successful in 5 out of 7 patients who had recurrent angina after previous coronary bypass grafting: in 2 of them stenosis of a distal coronary artery and in 3 a stenosed bypass graft were dilated. PTD is a new method of treatment of coronary artery disease and is an addition rather than an alternative to coronary bypass grafting. The best results can be expected in patients with single-vessel disease, with a short history of angina (less than 1 year), and with narrow, noncalcified proximal stenosis. Some late complications of bypass grafting are also amenable to this method of treatment.
Percutaneous transluminal dilatation (PTD) of coronary stenosis is performed by means of a balloon-tipped catheter introduced from a peripheral artery. PTD was attempted in 56 patients; stenosis was successfully dilated in 38 patients (68%). The method failed in 18 patients: in 6 (11%) of them an abrupt closure of the stenosed artery or a beginning infarction necessitated an emergency revascularization. There were no serious complications or deaths; one patient developed a transmural infarction in spite of the immediate bypass grafting. PTD was also successful in 6 out of 9 patients with recurrent angina following previous coronary bypass grafting. Intraoperative dilatation by coronary arteriotomy was attempted in 6 patients, but the results were inconclusive. PTD is a new method of treatment of coronary artery disease; it represents an addition rather than an alternative to coronary bypass grafting. The decision for PTD should be made jointly by cardiologist and surgeon; the ideal patient has a short history of angina with narrow, proximal stenosis without any calcifications. Cardiosurgical standby is mandatory during PTD; the results are best and the risk lowest in patients with single vessel disease.
Three patients with hypertension due to renal artery stenoses were treated by percutaneous transluminal angioplasty with the coaxial-balloon-catheter system as it is used for the dilatation of coronary arteries. The pressure gradients before and after dilatation are recorded. Pressure of the three patients came directly after treatment down significantly. Reduction of antihypertensive drug therapy was possible in two patients, one patient is without therapy 4 weeks after the procedure.
Recanalization of superficial femoral artery occlusions and of stenoses in the superficial femoral and pelvic arteries using the Grüntzig balloon catheter are described. Among patients successfully treated, 2 year patency rates of 72% and 87% for superficial femoral and iliac artery lesions, respectively, were achieved by this method. The catheter is now commercially available in the United States and Europe.
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Percutaneous transluminal dilatation was performed in 5 patients with unilateral atherosclerotic renovascular disease and one patient with occlusion of a renal artery. Hemodynamic activity of the stenosis was documented by determination of pre- and poststenotic blood pressure values and by measurement of renal plasma flow. Flowing transluminal dilatation all patients showed a significant drop in blood pressure and antihypertensive treatment could be reduced or even discontinued. Only one patient became hypertensive again 3 months after the dilatation procedure. In this patient both the reduction of renal plasma flow and the delayed nephrographic effect on the stenotic side in the intravenous urogram were interpreted as symptoms of a recurrence of significant renal artery stenosis. In 2 of the six patients with impaired kidney function glomerula filtration are increased, as documented by a decrease in serum creatinine values. The results show that percutaneous transluminal dilatation may be a valuable method in the management of renovascular hypertension.
The technique of percutaneous transluminal dilatation of coronary artery stenosis consists of a catheter system introduced via the femoral artery under local anesthesia. A preshaped guiding catheter is positioned in the orifice of the coronary artery and through this a dilatation catheter is inserted into the branches if the artery. This dilatation catheter (outer diameter 0.5--1.25 mm) is equipped with a sausage-shaped distensible segment (balloon) at the tip. The balloon is inflated to a pressure of 5 atm. This pressure compresses the atherosclerotic material in a direction perpendicular to the wall of the vessel, therby dilating the lumen. Up to now 29 patients have been treated with primary success in 23 (79%) and long-lasting success in 21 (72%). Three patients underwent emergency coronary surgery to avoid infarction. Dilatation is indicated in patients with disabling angina which jeopardizes their quality of life and with coronary lesions which are proximal, subtotal, concentric and non-calcified.
Percutaneous transluminal dilatation of a left sided renal artery stenosis was performed in a 61 year old patient with hypertension. Biochemical and hemodynamic activity of the renal artery stenosis was demonstrated by measurement of renal venous renin-activity and determination of renal plasma flow and of pre- and poststenotic blood pressure values. Shortly after the dilatation procedure hypertension disappeared and renal plasma flow increased. The described procedure might be an alternative method to renal vascular surgery.
Percutaneous transluminal dilatation of a left-sided renal-artery stenosis was done in a 61-year-old patient with hypertension. Shortly after dilatation blood-pressure fell to normal and renal plasma flow increased. Dilatation might be an alternative to renal vascular surgery in severe renal hypertension.
A case of a 66 year old patient with multiple injuries is reported. A combination of conventional trauma treatment and percutaneous transluminal angioplasty (PTR) of a segmented superficial femoral artery occlusion prevented leg amputation. When the patient died 8 weeks later from trauma sequelae the successful recanalization was demonstrated in histopathology investigation. It is concluded that PTR is an ideal accessory to the present therapeutic spectrum in vascular surgery.
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