Related Experiment Videos
[Anatomical limitations for the performance of angioplasty in coronary multivessel disease]
W A Pimentel Filho1, E Ascer, J R Buchler
1Hospital Israelita Albert Einstein, SP.
Insights
Anatomical factors limit coronary angioplasty in patients with multivessel disease after bypass surgery. However, this procedure can benefit a selected 35.5% of patients for whom complete or incomplete revascularization is achievable.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is a standard treatment for multivessel disease.
- Coronary angioplasty (percutaneous coronary intervention) is an alternative revascularization strategy.
- Anatomical limitations can affect the success of coronary angioplasty in patients with prior CABG.
Purpose of the Study:
- To evaluate the anatomical limitations of coronary angioplasty in patients with multivessel disease who have previously undergone bypass surgery.
- To identify patient subgroups who may benefit from coronary angioplasty as an alternative to further surgical intervention.
Main Methods:
- Retrospective analysis of 380 patients with multivessel disease and prior CABG.
- Coronary arteriography was used to assess coronary artery anatomy and stenosis distribution.
- Patients were categorized based on the possibility of complete revascularization, incomplete revascularization, or no indication for angioplasty.
Main Results:
- 65.5% of patients had no indication for coronary angioplasty due to anatomical factors like chronic obstruction, diffuse disease, or left main disease.
- 35.5% of patients were suitable for coronary angioplasty, with potential for complete (21%) or satisfactory incomplete (14.5%) revascularization.
- Among suitable patients, 71.8% had two-vessel disease, 18.6% had three-vessel disease, and 9.6% had four or more vessels involved.
Conclusions:
- Significant anatomical limitations exist for coronary angioplasty in patients with multivessel disease and prior bypass surgery.
- Coronary angioplasty is a viable option for a select subgroup (35.5%) of these patients, offering potential for effective revascularization.
- Careful pre-procedural assessment is crucial to determine angioplasty suitability and optimize patient selection.
Purpose:
To study anatomical limitation of coronary angioplasty, as alternative therapy in patients with multivessel disease and submitted to bypass surgery.
Methods:
In 380 patients with multivessel disease and submitted to previous coronary bypass surgery, age ranged from 41 to 72 (average = 51) years, being 68% males. The following parameters were analyzed in the coronary arteriographies: anatomic aspects of the coronary arteries and distribution of the atherosclerotic stenosis. The patients were arranged in accordance to the criteria: complete revascularization, incomplete and no indication for coronary angioplasty.
Results:
The patients were arranged in 3 different groups: I-80 (21%) patients included those in whom complete revascularization would be possible; II--55 (14.5%) patients in whom only incomplete revascularization but satisfactory would be possible and III--245 (65.5%) those patients in whom coronary angioplasty would no have indication. The data referind the patients of groups I and II were analyzed together--135 (35.5%) and arranged according to the number of arteries involved. It was observed: two vessel disease--71.8%, three vessel--18.6% and 4 or more vessel--9.6%. In group III it was observed 51.0% of the patients with 3 or more vessel disease. The major factors to contra indicate coronary angioplasty in group III included: chronic coronary obstruction 99 (40.4%); diffuse disease 11 (4.5%); technical difficulties 10 (4.1%); left main coronary artery obstruction 5 (2%) or when two or more causes were combined 120 (49%).
Conclusions:
Patients with multivessel disease and classic indication for coronary bypass surgery, have a basic limitation for angioplasty due to several anatomic factors. However, coronary angioplasty could be beneficial for a selected group of patients (35.5%) whenever a complete or incomplete revascularization could be obtained.