Percutaneous coronary intervention in patients with a single remaining vessel

Percutaneous coronary intervention in a patient's last remaining coronary conduit is perceived to be high risk, although there are no published data on outcomes in this lesion cohort. We report our experience with 16 patients who underwent intervention in their sole remaining vessel between 1998 and 2005. All patients had previously undergone coronary artery bypass grafting, had a history of myocardial infarction, had impaired left ventricular systolic function, and were symptomatic with unstable angina or minimal effort angina. There was 1 periprocedural death 10 hours after the procedure, and another patient died 4 months after the procedure. At 6-month follow-up, 2 patients had undergone target lesion revascularization. There was a significant and sustained improvement in symptom status, with 75% of patients being asymptomatic or in Canadian Cardiovascular Society class I after 6 months. Given the complexity of the patients and lesions treated in this cohort, periprocedural and long-term outcomes are acceptable with a notable improvement in symptomatic status. In conclusion, these data support percutaneous intervention as a realistic treatment option for this often highly symptomatic and difficult-to-treat patient cohort.