Related Experiment Videos
Percutaneous transluminal coronary angioplasty for chronic dialysis patients
S Takeshita1, T Isshiki, H Tagawa
1Department of Cardiology, Mitsui Memorial Hospital, Tokyo, Japan.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) is a viable initial treatment for hemodialysis patients with angina. However, restenosis rates are high, especially with longer dialysis history, suggesting surgery may be better in such cases.
Area of Science:
- Cardiology
- Nephrology
- Vascular Medicine
Background:
- Accelerated atherosclerosis causes significant mortality in hemodialysis patients, with coronary artery disease being a major contributor.
- The efficacy of percutaneous transluminal coronary angioplasty (PTCA) in this patient population is not well-established.
- Medically refractory angina pectoris is common in patients undergoing chronic hemodialysis.
Purpose of the Study:
- To evaluate the feasibility and outcomes of PTCA in patients on chronic hemodialysis.
- To determine the success rates and restenosis rates of PTCA in this specific cohort.
- To identify factors associated with restenosis after PTCA in hemodialysis patients.
Main Methods:
- PTCA was performed on 15 hemodialysis patients experiencing medically refractory angina.
- Angiographic success was defined as successful stenosis treatment after PTCA.
- Restenosis rates and recurrence of angina were monitored post-procedure.
Main Results:
- Angiographic success was achieved in 76% of attempted stenoses after the initial PTCA.
- Restenosis occurred in 38% of treated lesions, significantly linked to longer dialysis history and lower inflation pressure.
- Repeat PTCA procedures showed high rates of angina recurrence and further restenosis, particularly in patients with longer dialysis histories.
Conclusions:
- PTCA serves as a reasonable initial therapeutic strategy for hemodialysis patients with angina, especially those with a shorter dialysis history.
- High restenosis rates in patients with longer dialysis histories or after repeat procedures suggest that coronary bypass surgery should be considered.
- Further research is warranted to optimize PTCA outcomes and patient selection in this high-risk group.
Abstract:
Accelerated forms of atherosclerosis continue to be responsible for considerable morbidity and mortality among patients on chronic hemodialysis, and coronary artery disease is responsible for approximately 20-30% of the deaths of such patients. The suitability of such patients for percutaneous transluminal coronary angioplasty (PTCA), however, remains unknown. Accordingly, the purpose of this study was to evaluate the feasibility of PTCA in a group of chronic dialysis patients. PTCA was performed on a total of 15 dialysis patients with medically refractory angina pectoris. Angiographic success was obtained in 16 of 21 (76%) stenoses attempted after the first PTCA. Restenosis was observed in 6 of 16 (38%) lesions, which was significantly related to longer dialysis history (p less than 0.01), and low maximal inflation pressure (p < 0.05). Five of the 6 patients with restenosis underwent a second PTCA, however, all 4 patients with successful second PTCA developed recurrence of angina. Three of 4 patients with a second episode of restenosis underwent a third PTCA, and angina recurred in 2. Thus, PTCA is a reasonable initial strategy for patients with chronic hemodialysis, especially when dialysis history is short. For restenotic lesions and when there is a long dialysis history, restenosis rates are high and coronary bypass surgery should be considered.