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[Chronic total coronary occlusion dis-obstruction by balloon angioplasty]
Insights
Percutaneous coronary angioplasty is effective for recent coronary artery occlusions, achieving a 69% success rate in cases less than one month old. This procedure offers good initial and medium-term results with few complications for chronic total coronary occlusion.
Area of Science:
- Cardiology
- Interventional Cardiology
Context:
- Chronic total coronary occlusion (CTO) presents a significant challenge in cardiovascular medicine.
- Percutaneous coronary angioplasty (PCA) is an established revascularization technique.
Purpose:
- To evaluate the efficacy and safety of mechanical des-obliteration using balloon angioplasty for CTO.
- To identify prognostic factors influencing successful CTO revascularization.
Summary:
- Ninety-three patients with CTO underwent attempted PCA, achieving a 55% initial success rate (residual stenosis <50%).
- Recent occlusions (<1 month) showed higher success rates (69%), while occlusions >6 months had no success.
- Favorable factors included left coronary artery occlusion and recency of occlusion; myocardial infarction presence did not impact results.
- Complications were low (7%), with no deaths or emergency surgeries. Post-procedure stress tests were largely negative (88%).
- Follow-up of successfully revascularized patients (n=43) showed 31 asymptomatic individuals. Restenosis occurred in 10 cases with 5 re-occlusions.
Impact:
- PCA for recent CTO offers good initial success rates and satisfactory medium-term clinical outcomes.
- The procedure demonstrates a favorable safety profile with minimal complications.
- Recency of occlusion is a critical factor for successful angioplasty in CTO patients.
Abstract:
Ninety-three consecutive patients with chronic total coronary occlusion underwent an attempted mechanical des-obliteration by percutaneous coronary angioplasty with a balloon catheter. The global results were 55 p. 100 initial successes (residual stenosis less than 50 p. 100). The good prognostic factors were: 1) left coronary artery, especially left circumflex artery occlusion p less than 0.50, and 2) the proximity to the date of occlusion as assessed from the clinical history or by the occurrence of occlusion between the time of diagnostic coronary angiography and angioplasty. In cases of recent occlusion dating less than one month, the success rate was high: 69 p. 100. On the other hand, there were no successes in occlusions of over 6 months standing. The presence of myocardial infarction did not influence the results. There were few complications (7 p. 100) and these did not include any deaths or cases requiring emergency surgery. Exercise stress tests were carried out after the procedure and were negative in 28 out of 32 patients (88 p. 100). Forty-three patients successfully revascularised were followed up for 1 to 48 months (average 9 months) after angioplasty. Thirty-one patients were asymptomatic. Of the 12 symptomatic patients, 7 underwent exercise stress tests (6 positive) and all had control angiography which showed restenosis in 10 cases with 5 occlusions. Percutaneous coronary angioplasty of recent total coronary occlusions gives good initial results without major complications, and the medium term clinical results are satisfactory.