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Coronary angioplasty for chronic total occlusion reduces the need for subsequent coronary bypass surgery
R J Warren1, A J Black, P A Valentine
1Royal Melbourne Hospital, Victoria, Australia.
Insights
Coronary angioplasty for total occlusions shows a 59% success rate but high restenosis (65%), often asymptomatic. This intervention may reduce the need for coronary artery bypass surgery for symptom relief.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Total coronary artery occlusion presents a therapeutic challenge.
- Coronary angioplasty is an option for managing these occlusions.
Purpose of the Study:
- To evaluate the efficacy and restenosis rates of coronary angioplasty in total occlusions.
- To assess the long-term clinical outcomes and need for coronary artery bypass surgery.
Main Methods:
- 44 patients with total coronary occlusions (>1 week) underwent angioplasty.
- Angiographic restudy was performed in successful cases.
- Clinical follow-up assessed restenosis, symptom recurrence, and need for bypass surgery.
Main Results:
- Primary angioplasty success rate was 59%.
- Restenosis occurred in 65% of patients restudied, with 44% being asymptomatic.
- Coronary artery bypass surgery was more frequent after unsuccessful angioplasty (p=0.04).
- 35% of initially successful cases required repeat angioplasty for symptomatic restenosis.
Conclusions:
- Coronary angioplasty for total occlusions has a high restenosis rate, frequently asymptomatic.
- The procedure can decrease the need for coronary artery bypass surgery for symptom management.
Abstract:
Coronary angioplasty was performed in 44 consecutive patients with total occlusion that lasted longer than 1 week. The primary success rate was 59%. Angiographic restudy in 25 of the 26 successful patients (96%) revealed restenosis in 17 patients (65%), which was asymptomatic in seven (44%). Significant correlates of restenosis were mean luminal stenosis at the conclusion of the procedure and symptom recurrence. Clinical follow-up at a mean of 31 +/- 12 months revealed that coronary artery bypass surgery was more frequent in patients who had an unsuccessful initial angioplasty procedure (7/18 vs 3/26; p = 0.04). Nine patients (35%) who had an initially successful procedure required a second angioplasty for symptomatic restenosis. Angioplasty for totally occluded coronary arteries has a high incidence of restenosis that is often asymptomatic. This procedure can, however, lead to a reduction in the need for coronary artery bypass surgery for symptom control.