Open Access Medical Books



Edited by Thomas Forbes .

248 pages .
Open Access .

Most interventional physicians believe that Andrea Gruentzig, who performed the first successful coronary angioplasty in 1977 in Zurich, Switzerland, began the era of less invasive intervention performed via the transcatheter route. At that time, in his first case, utilizing a kitchen-built catheter, he successfully performed dilation of an 80% lesion of a 3 mm section of the left anterior descending artery. He presented his first four coronary angioplasty cases at the ““1977 American Heart Association”” meeting and the rest, they say, was history. Fascinatingly, at the 10-year anniversary of the initial patient, the patient underwent elective repeat angiography which noted that the LAD narrowing remained almost perfectly expanded. Sadly, the German cardiologist, along with his wife, tragically died in a plane crash on October 27, 1985 at the young age of 46. If he was alive today, he would be amazed at the progress being made in the angioplasty arena for the treatment of congenital and acquired vessel stenosis. Dr. Gruentzig’’s initial foray into the coronary world served as the ““launch pad”” for the development of ideas and technology in the treatment of peripheral vascular lesions.
For quite some time the treatment of coronary artery pathology has lead the way towards the development and treatment of other vascular lesions..
The past three decades has seen an explosion in interventional techniques to treat both congenital and acquired lesions in the vascular system. When I was first asked to edit this book on angioplasty, it came to my surprise that a similar book dealing with the techniques and issues of these congenital and acquired lesions had not been previously undertaken. Certainly individual chapters and reports have been written in these areas, though no formal book discussing the technical as well as current ongoing challenges in these areas have compiled in one setting.
In particular, the past decade has seen a significant advancement in balloon, wire, and catheter technology in the treatment of complicated congenital and acquired vascular lesions. This decade has born witness to the development of angioplasty procedures that many interventionalists had never imagined being able to treat via the transcatheter route, especially in the peripheral arena. The improvement of stent technology, especially regarding tracking capabilities of the newer generation stents, have played a significant role in the treatment of tortuous vascular lesions that otherwise were exclusively relegated to be treated in the surgical operating theater.
At first look, in reviewing the topics covered in this book, one’’s initial impression may be that this is a compilation of multiple different types of lesions and the treatment of these lesions. The common thread linking these procedures together relates to both the technology shared between disciplines, and the common techniques used to treat various lesions throughout the vascular system. A perfect example of this relates to chronic total obstructive lesions in the peripheral vascular system and the technique used to overcome technical challenges of a completely occluded coronary vessel.
One should not consider this textbook is a compendium of obscure interventional procedures. I believe that this textbook represents the greatest growth potential area in much of interventional cardiovascular medicine. For example, as techniques continue to improve regarding re-vascularization if distal extremities, especially in patients with peripheral vasculopathy secondary to diabetes, tens of thousands of patients will benefit from not having to undergo amputation procedures, or at least forestalling the amputation procedure until a much later time. The treatments, whether it be related to carotid stenosis, mesenteric ischemia, neural vascular spasm, or congenital vascular lesions, have the potential of reaching millions of patients every year.
This book also bridges issues related to complications or other challenges related to performing aggressive angioplasty procedures. Whether it be hyperperfusion syndrome following aggressive angioplasty or oxygen stress and altered function of platelets in patients with peripheral arterial vascular disease, not only do interventionalists need to be knowledgeable in the technique in performing an intervention, they also must have a strong understanding of what the potential ramifications are both on an anatomic and molecular level.
To end, this first edition on Angioplasty will hopefully inspire interventionalists to ““cross-link”” their experience with other interventionalists regarding the techniques used to treat complicated lesions. I personally feel that communication is the most important ally to overcoming challenges in both acquired and congenital vascular lesions. Hopefully this book will inspire this to occur between interventional radiologists, cardiologists, neurologists, and neurosurgeons. I would not be surprised, with the continued explosion of a technology in this area, that revision of this book will be required within the next 7-10 years. Finally, one would be remiss in not giving credit to Warner Forsmann for his insight in the catheterization procedure and, as previously mentioned, Andre Gruentzig in launching us into an interventional era for the treatment of vascular stenosis. On the shoulders of these two giants (and many others) we are able to proceed onto an exciting and changing world of interventional cardiology.
I would like to greatly acknowledge the authors of this book for their time in writing the chapters. Without their dedication to sharing their interventional expertise, this book would never come to fruition. I also would like to thank my lovely wife Marie who, without her dedication to raising nine children (myself included), I would never have had the remote possibility for being able to find the time to undertake this endeavor.

Dr. Thomas Forbes
Wayne State University / 
Children’’s Hospital of Michigan, Detroit


 1 Percutaneous Angioplasty and Stenting for Mesenteric Ischaemia 1 Emily He and Stephen M. Riordan

 2 Cerebral Hyperperfusion Syndrome After Angioplasty 9 D. Canovas, J. Estela, J. Perendreu, J. Branera, A. Rovira, M. Martinez and A. Gimenez-Gaibar

 3 Below the Knee Techniques: Now and Then 41 Daniel Brandão, Joana Ferreira, Armando Mansilha and António Guedes Vaz

 4 Investigation of the Oxidative Stress, the Altered Function of Platelets and Neutrophils, in the Patients with Peripheral Arterial Disease 63 Maria Kurthy, Gabor Jancso, Endre Arato, Laszlo Sinay, Janos Lantos, Zsanett Miklos, Borbala Balatonyi, Szaniszlo Javor, Sandor Ferencz, Eszter Rantzinger, Dora Kovacs, Viktoria Kovacs, Zsofia Verzar, Gyorgy Weber, Balazs Borsiczky and Erzsebet Roth

 5 Antithrombotic Therapy After Peripheral Angioplasty 89 Beniamino Zalunardo, Diego Tonello, Fabio Busato, Laura Zotta, Sandro Irsara and Adriana Visonà

 6 Evidence-Based Invasive Treatments for Cerebral Vasospasm Following Aneurysmal Subarachnoid Hemorrhage 105 Geoffrey Appelboom, Adam Jacoby, Matthew Piazza and E. Sander Connolly

 7 Angiography for Peripheral Vascular Intervention 121 Yoshiaki Yokoi

 8 Arterial Angioplasty in Congential Heart Disease 169 Thomas J. Forbes, Srinath Gowda and Daniel R. Turner

 9 Carotid Angioplasty 189 Parth Shah and Michael Dahn

 10 Revascularization of Tibial and Foot Arteries: Below the Knee Angioplasty for Limb Salvage 209 Marco Manzi, Luis Mariano Palena and Giacomo Cester

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Published by: Unknown - Wednesday, May 29, 2013