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Acute occlusion in multiple lesion coronary angioplasty: frequency and management
G Gaul1, J Hollman, C Simpfendorfer
1Department of Cardiology, Cleveland Clinic Foundation, Ohio 44106.
Insights
Multilesion angioplasty, including multivessel and single vessel procedures, showed similar acute occlusion rates. Intimal tearing was a key factor in delayed occlusions, with multivessel angioplasty patients needing more emergency surgeries.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Vascular Surgery
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for coronary artery disease.
- Multilesion angioplasty, involving multiple lesions in one or more vessels during a single session, is increasingly performed.
- Understanding the risks associated with different multilesion angioplasty strategies is crucial for patient safety.
Purpose of the Study:
- To compare the rates and causes of acute occlusion in patients undergoing multivessel angioplasty versus multilesion single vessel angioplasty.
- To identify factors contributing to acute occlusion during and after percutaneous transluminal coronary angioplasty.
- To assess the need for emergency surgery following acute occlusions in these patient groups.
Main Methods:
- Retrospective analysis of 3,548 patients undergoing percutaneous transluminal coronary angioplasty.
- Classification of 714 patients with multilesion angioplasty into multivessel (348 patients) and multilesion single vessel (366 patients) groups.
- Comparison of acute occlusion rates, timing, causes, and subsequent management between the two groups.
Main Results:
- Overall acute occlusion rate was 3.1% per patient and 1.9% per lesion.
- Acute occlusion rates were similar between multivessel (2.9% per patient, 1.7% per vessel) and multilesion single vessel (3.3% per patient, 2.1% per lesion) groups.
- Intimal tearing was a significant factor in delayed occlusions (12/16 patients), particularly in the multilesion single vessel group. Multivessel angioplasty patients experienced more hypotension-related occlusions during the procedure.
- Five multivessel patients required emergency surgery compared to one in the single vessel group. Left circumflex vessels had a higher occlusion rate in the single vessel multilesion group.
Conclusions:
- Multilesion angioplasty strategies, whether multivessel or multilesion single vessel, exhibit comparable acute occlusion rates.
- Intimal tearing is a critical predictor of delayed acute occlusion, especially in the multilesion single vessel context.
- While overall occlusion rates are similar, multivessel angioplasty may be associated with a higher need for emergency surgical intervention in cases of acute occlusion.
Abstract:
Among 3,548 patients undergoing a percutaneous transluminal coronary angioplasty procedure, 714 had multilesion angioplasty (1,550 lesions) in a single session. Acute occlusion occurred in 22 patients (3.1%) and 29 lesions (1.9%). The patients were classified into a group undergoing multivessel angioplasty (348 patients, 785 lesions) and a group undergoing multilesion single vessel angioplasty (366 patients, 765 lesions). The rate of acute occlusion was similar in both patient groups. The multivessel angioplasty group had a 2.9% rate per patient (n = 10) and a 1.7% rate per vessel; the multilesion single vessel group had a 3.3% rate per patient (n = 12) and a 2.1% rate per lesion. Five of the 10 patients from the multivessel group with acute occlusion, but only 1 of the 12 patients with occlusion in the single vessel multilesion group, required emergency open heart surgery. No patient in either group died as a consequence of coronary angioplasty. Occlusion occurred during angioplasty in 15 of the 22 patients, and 1 to 24 h after angioplasty in 7 of 22 patients. In the group with multivessel angioplasty, acute occlusion during the procedure was mainly linked with hypotension during the second vessel dilation, whereas in this group with delayed vessel closure and in the multilesion single vessel group, existence of intimal tearing constituted the most important factor for acute occlusion (12 of 16 patients). Closure of vessel per major coronary system was evenly distributed in the multivessel group, whereas significantly more left circumflex vessels closed in the single vessel multilesion group (6.1% versus 1.3% in the left anterior descending coronary artery and 1.1% in the right coronary artery; p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)