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Percutaneous peripheral interventions in patients with multivessel coronary artery disease
Stanisław Bartuś1, Zbigniew Siudak, Michał Brzeziński
1Institute of Cardiology, Collegium Medicum, Jagiellonian University, Kraków, Poland.
Insights
Multilevel angioplasty for patients with multi-vessel coronary artery disease (CAD) and peripheral artery disease shows increased peripheral adverse events but remains a safe alternative to surgery.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary artery disease (CAD) frequently coexists with peripheral artery disease (PAD).
- Comorbidities, including severe CAD, often disqualify patients from surgical treatment of limb ischemia.
- Multilevel intervention addresses both coronary and peripheral arterial disease simultaneously.
Purpose of the Study:
- To compare the risks of multilevel intervention in patients with multi-vessel coronary artery disease (MVD) versus single-vessel disease (SVD).
- To evaluate in-hospital and long-term outcomes of combined coronary and peripheral angioplasty.
- To assess the safety and efficacy of angioplasty in patients with disseminated atherosclerosis.
Main Methods:
- Retrospective analysis of 116 patients with PAD and CAD undergoing simultaneous peripheral and coronary angioplasty.
- Patients were stratified into two groups: single-vessel disease (SVD) and multi-vessel disease (MVD) based on coronary angiography.
- Data collected from January 2003 to June 2009.
Main Results:
- The MVD group (60 patients) experienced significantly more major adverse peripheral events (20% vs. 1.8%, p=0.002), including repeat angioplasty, stroke/TIA, and amputation, compared to the SVD group (56 patients).
- While major adverse cerebrovascular and cardiac events trended higher in the MVD group, this difference was not statistically significant (13.3% vs. 3.6%, p=0.061).
Conclusions:
- Percutaneous angioplasty of lower limb arteries in MVD patients is an effective and relatively safe treatment.
- This approach offers a viable alternative to surgical intervention for patients with disseminated atherosclerosis.
- Multilevel intervention demonstrates potential for managing complex PAD and CAD cases.
Background:
coronary artery disease (CAD) is often accompanied by peripheral artery disease. There are patients who are disqualified from surgical approach in the treatment of limb ischaemia due to many comorbidities including severe CAD.
Aim:
to examine whether multilevel intervention (peripheral and coronary) in patients with multi-vessel CAD (MVD) carries a higher in-hospital and long-term risk in comparison to patients with a single vessel disease (SVD).
Methods:
data on consecutive patients with peripheral artery disease and CAD (acute coronary syndrome) were gathered in our department from January 2003 till June 2009. All patients included in the study had peripheral and coronary angioplasty performed during the same index hospital stay. Patients were divided into two groups: those with SVD and those with MVD in coronary angiography.
Results:
there were 116 patients included in the study - 56 patients in the SVD group and 60 patients in the MVD group. The frequency of major adverse cerebrovascular and cardiac events during long-term follow up tended to be higher in patients with MVD, however the difference did not reach statistical significance (MVD vs SVD: 13.3% vs 3.6%, p = 0.061). There were significantly more major adverse peripheral events such as repeat percutaneous transluminal angioplasty, stroke/transient ischaemic attack and lower limb amputation in the MVD group than in the SVD patients (20% vs 1.8%, p = 0.002).
Conclusions:
percutaneous angioplasty of lower limb arteries in patients with MVD seems to be an effective and relatively safe method of treatment of patients with disseminated atherosclerosis and an alternative to surgical treatment.
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