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[Percutaneous coronary angioplasty in the elderly: a report of 2 cases in patients over 90]

A Carcagnì1, P Presbitero, L Maiello

  • 1Istituto Clinico Humanitas, Rozzano, MI.

Giornale Italiano Di Cardiologia
|March 24, 1999
PubMed

Insights

Percutaneous transluminal coronary angioplasty is a safe and effective treatment for elderly patients with coronary artery disease. This minimally invasive procedure offers a viable alternative to surgery for nonagenarians with severe blockages.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Geriatric Cardiology

Background:

  • Coronary artery disease (CAD) poses significant challenges in elderly patients, often presenting with complex comorbidities and increased surgical risks.
  • Percutaneous transluminal coronary angioplasty (PTCA) is an established revascularization strategy, but its application in nonagenarians requires careful consideration.
  • This report details the successful management of two patients in their nineties with severe CAD using interventional techniques.

Observation:

  • Two cases are presented: a 95-year-old with post-infarction angina and a 91-year-old with unstable angina, both hemodynamically stable.
  • Both patients exhibited severe stenosis in the left anterior descending coronary artery, treated successfully with angioplasty and stenting.
  • One patient experienced in-stent restenosis, managed effectively with rotational atherectomy and repeat angioplasty.

Findings:

  • PTCA and stenting were technically successful in both nonagenarian patients, leading to symptom relief.
  • Successful management of in-stent restenosis was achieved, highlighting the adaptability of interventional cardiology in complex cases.
  • Both patients remained asymptomatic at six-month follow-up, demonstrating the long-term efficacy of the procedures.

Implications:

  • Coronary revascularization via PTCA is feasible and beneficial in very elderly patients (90s) when medical therapy fails and surgical risk is high.
  • Interventional cardiology offers a crucial treatment option for nonagenarians with coronary artery disease, improving quality of life and outcomes.
  • These cases underscore the importance of individualized treatment strategies for geriatric patients with complex cardiovascular conditions.

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