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[Multivessel percutaneous coronary angioplasty]
Insights
Multivessel percutaneous transluminal coronary angioplasty (PTCA) is a viable alternative to coronary artery bypass surgery for select patients. This procedure offers comparable risks and satisfactory long-term outcomes without the need for surgery in many cases.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Context:
- Multivessel coronary artery disease (CAD) often necessitates complex revascularization strategies.
- Percutaneous transluminal coronary angioplasty (PTCA) has evolved as a less invasive option for CAD treatment.
Purpose:
- To evaluate the feasibility, safety, and efficacy of multivessel PTCA as an alternative to coronary artery bypass graft (CABG) surgery.
- To assess short-term and long-term outcomes, including success rates and complications, of multivessel PTCA.
Summary:
- A study involving 44 patients undergoing multivessel PTCA (average 2.2 vessels per patient) reported an 84% primary success rate per patient.
- Complications were low, including 2% mortality and 4% myocardial infarction. Lesion recurrence was 14% at follow-up, with repeat angioplasty successful in 80% of cases.
- Multivessel PTCA demonstrated comparable risks to CABG, with 2/3 of patients achieving long-term improvement without surgery.
Impact:
- Multivessel PTCA can be considered a safe and effective alternative to CABG in selected patients with multivessel coronary artery disease.
- This approach may lead to satisfactory long-term clinical improvement, potentially avoiding the need for surgical intervention.
Abstract:
Between August 1983 and October 1984, 44 patients (39 male and 5 female, mean age 53 years) underwent multivessel percutaneous transluminal coronary angioplasty involving 2 vessels in 37 (84%), 3 vessels in 4 (9%), 4 vessels in 1 (2%) and coronary artery bypass graft plus 1 or 2 vessels in 2 (5%). A mean of 2.2 vessels per patient were attempted. Dilatations of multiple stenoses in the same vessel were not included. Primary success was achieved in 87 of 97 vessels (90%) and in 37 of 44 (84%) patients. Primary success per patient was defined as primary success in all or at least in the strategic lesions associated with clinical improvement of the patient. Complications included one death (2%), emergency coronary artery bypass surgery in one (2%) and myocardial infarction in 2 (4%) patients. Five other patients underwent elective coronary artery bypass surgery. Recurrence of lesion was 14% (5/37 patients) during a follow-up period of 3 to 12 months. Repeat angioplasty was successful in 4 patients (80%) and unsuccessful in 1 patient who underwent elective surgery. It is concluded that, in selected cases, multivessel percutaneous transluminal coronary angioplasty is a feasible alternative to coronary artery bypass surgery, with comparable risks. A satisfactory long-term amelioration without coronary artery surgery can be obtained in 2/3 of patients.