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[Percutaneous transluminal coronary angioplasty in patients with high risk bypass surgery]
B Norwa-Otto1, M Dabrowski, J Jodkowski
1Kliniki Kardiologii Ogólnej, II Samodzielnej Pracowni Hemodynamicznej Instytutu Kardiologii, Warszawie.
Insights
Incomplete percutaneous transluminal coronary angioplasty (PTCA) offers good outcomes for high-risk coronary artery bypass surgery (CABG) patients. This study shows high success rates and long-term clinical improvement in patients with unstable angina pectoris.
Area of Science:
- Cardiology
- Interventional Cardiology
Context:
- High-risk patients often face challenges with traditional Coronary Artery Bypass Grafting (CABG).
- Percutaneous transluminal coronary angioplasty (PTCA) is an alternative revascularization strategy.
- Assessing suboptimal revascularization outcomes is crucial for patient management.
Purpose:
- To evaluate the immediate and long-term results of incomplete PTCA.
- To assess PTCA efficacy in high-risk patients unsuitable for or awaiting CABG.
- To determine clinical improvement following incomplete revascularization.
Summary:
- 24 high-risk patients (unstable angina pectoris, low ejection fraction, diffuse atherosclerosis) underwent incomplete PTCA.
- Initial success rate was 100% with no serious complications.
- Long-term clinical improvement was observed in 87.5% of patients over 6 months to 4 years.
Impact:
- Incomplete PTCA can be a safe and effective strategy for selected high-risk patients.
- This approach provides good immediate and sustained clinical benefits.
- Offers a viable treatment option for patients with limited CABG candidacy.
Abstract:
The purpose of this study was to assess the immediate and long-term results of incomplete percutaneous transluminal coronary angioplasty (PTCA) in high-risk coronary artery bypass surgery (CABG) patients. 24 pts (male-22, female-2, age - 39-60 years) were divided into 2 groups: I-8 pts with unstable angina pectoris who were definitely not CABG candidates because of very low ejection fraction (LVEF < 24%) and/or diffuse coronary atherosclerosis; II-16 pts selected for CABG only after failed PTCA. From this group 12 pts with unstable angina pectoris and history of myocardial infarction were at higher CABG risk because of LVEF < 40% and diffuse coronary atherosclerosis. 4 pts were poor surgical candidates because of coexistent medical disorders. The strategy of PTCA was to dilate first the most critical (culprit) lesion, responsible for the patient symptoms, usually situated in the artery supplying large area of viable myocardium. We did not achieve: complete revascularization in all our pts (incomplete revascularization by intent). Initial success rate of the PTCA in both groups was 100%. There were no serious complications. During follow-up (6 months--4 yrs) long-term clinical improvement was observed in 7 pts from group I (87.5%) and 14 pts from group II (87.5%). We conclude, that in most pts with unstable angina pectoris and with high-risk of CABG good immediate and long-term results of incomplete PTCA can be achieved.