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Acute reocclusion during percutaneous transluminal coronary angioplasty: immediate and long-term outcome
K R Buccino1, A S Brenner, K F Browne
1Cardiovascular Division, Watson Clinic, Lakeland, Florida.
Insights
Aggressively redilating total coronary artery occlusions during percutaneous transluminal coronary angioplasty (PTCA) often leads to successful reperfusion. This approach achieves long-term restenosis rates comparable to standard PTCA procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Acute total coronary artery occlusion during percutaneous transluminal coronary angioplasty (PTCA) historically necessitated emergency coronary artery bypass grafting (CABG).
- Managing acute myocardial infarction (AMI) during PTCA presents unique challenges.
Purpose of the Study:
- To evaluate the efficacy of aggressive redilation for acute total occlusions occurring during PTCA.
- To compare outcomes of redilation versus CABG in elective and AMI cases.
Main Methods:
- Retrospective analysis of 211 elective and 65 AMI PTCA procedures.
- Identified 42 patients with total occlusions post-initial dilation.
- Assessed outcomes following reangioplasty, CABG, or medical management.
Main Results:
- Reangioplasty successfully reperfused the vessel in 30 of 42 patients (71%).
- Coronary artery bypass grafting (CABG) was required in 10 patients (24%), and 2 (5%) received medical treatment for acute myocardial infarction (AMI).
- Two deaths occurred due to cardiogenic shock despite successful angioplasty; 22 patients remained asymptomatic at 6-month follow-up.
Conclusions:
- Aggressive redilation of acute total occlusions during PTCA is frequently successful in achieving vessel reperfusion.
- This strategy results in long-term restenosis rates comparable to uncomplicated angioplasty.
- Redilation offers a viable alternative to CABG in select cases of acute total occlusion during PTCA.
Abstract:
Acute total occlusion of a coronary artery during percutaneous transluminal coronary angioplasty (PTCA) has previously resulted in emergency surgical intervention (CABG). We retrospectively surveyed 211 elective procedures and 65 procedures for acute myocardial infarction (AMI). There were 42 patients (pts) [29 elective (14%) and 13 AMI (20%)] in whom total occlusion occurred after initial dilation had been achieved. In 30 of 42 pts reangioplasty successfully reperfused the vessel. Ten patients (24%) required CABG and two (5%) were treated medically for AMI. Death occurred in 2 pts due to irreversible cardiogenic shock despite successful angioplasty. After 6 months follow-up 22 pts remained asymptomatic. It is concluded that aggressive redilation of total occlusions which develop during PTCA will frequently result in a successful angioplasty with a long-term restenosis rate comparable to uncomplicated angioplasty.