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[Protective function of collaterals in percutaneous transluminal coronary angioplasty]
N Reifart1, H Störger, W Preusler
1Rotes-Kreuz-Krankenhaus, Frankfurt/Main.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) appears safe for patients with visible coronary collaterals, reducing the need for surgical standby. Myocardial infarction is rare when collaterals are present during PTCA.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is increasingly used for treating angina pectoris and stress-induced ischemia.
- Identifying patients who can undergo PTCA without surgical standby is crucial for cost-effectiveness.
Purpose of the Study:
- To evaluate the safety of PTCA in patients with varying degrees of coronary collateral circulation.
- To determine if the presence of collaterals influences the risk of myocardial infarction during PTCA.
Main Methods:
- Studied 82 patients with angina and ischemia but no transmural myocardial infarction.
- Measured angina pectoris, ST-segment displacement, and aortic pressure during PTCA.
- Classified patients into three groups based on coronary collateral (CL) presence and retrograde filling.
Main Results:
- Myocardial infarction occurred in over 80% of patients without visible CL during vessel occlusion.
- Myocardial infarction was rare in patients with visible CL.
- PTCA in vessels with retrograde filling via collaterals was associated with a low risk of infarction.
Conclusions:
- PTCA of vessels with retrograde filling via collaterals appears safe.
- The presence of collaterals significantly reduces the risk of myocardial infarction during PTCA.
- Further randomized studies are needed to confirm the necessity of surgical standby in patients with collaterals.
Unlabelled:
With increasing application of PTCA, it will become necessary to identify patients (p) who can be dilated without expensive surgical standby. In 82 p with angina pectoris and stress-induced ischemia and without transmural myocardial infarction, the following parameters were measured during coronary angioplasty (PTCA): angina pectoris (AP), epicardial ST-segment displacement (via long wire), and aortic pressure. In 26 p, the affected vessel showed retrograde filling (A) via collaterals (CL). In 24 p CL were identified without retrograde filling (B) and 32 p were without CL (C). The balloon was inflated three to eight times over periods of 30 to 90 s. [table; see text]
Conclusions:
In vessel occlusion caused by PTCA, a myocardial infarction will occur in more than 80% of p without visible CL, and rarely in the presence of CL. Therefore, PTCA of vessels with retrograde filling appears safe. Furthermore randomized studies are necessary to determine if strict surgical standby is required in such cases.