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Angiographic follow-up after multivessel percutaneous transluminal coronary angioplasty
Insights
Multivessel percutaneous transluminal coronary angioplasty (PTCA) shows a high restenosis rate, especially in chronic total occlusions. Complete revascularization improves long-term outcomes, reducing restenosis and need for further procedures.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Multivessel coronary artery disease often requires complex interventions.
- Percutaneous transluminal coronary angioplasty (PTCA) is a common revascularization strategy.
- Assessing long-term outcomes and restenosis after multivessel PTCA is crucial.
Purpose of the Study:
- To evaluate the efficacy and restenosis rates of multivessel PTCA.
- To identify predictors of restenosis after the procedure.
- To compare clinical outcomes based on the completeness of revascularization.
Main Methods:
- Prospective study of 100 consecutive patients undergoing multivessel PTCA.
- Assessment of primary success, complications, and angiographic restenosis.
- Clinical follow-up at 24 months to evaluate outcomes and need for repeat procedures.
Main Results:
- Primary success achieved in 85% of patients; 8% experienced complications.
- Angiographic restenosis occurred in 51% of patients and 33% of arteries at follow-up.
- Restenosis rates were higher for chronic total occlusions and the LAD artery.
- Incomplete revascularization was associated with significantly worse clinical outcomes.
Conclusions:
- Multivessel PTCA has a substantial rate of angiographic restenosis.
- Higher residual stenosis and coronary wedge pressure predict restenosis.
- Complete revascularization is associated with better long-term clinical results and fewer repeat interventions.
Abstract:
In 100 consecutive patients undergoing multivessel percutaneous transluminal coronary angioplasty (PTCA), dilation was attempted in 207 arteries. Primary success was achieved in 85 patients. Complications occurred in 8 patients: acute myocardial infarction in 5 and need for emergency coronary artery bypass surgery in 5. Control angiography was done in 77 of 85 patients (91%) with primary success at a mean of 12 +/- 6 months. Complete revascularization had been achieved in 59 patients and incomplete revascularization in 18. Angiographic restenosis was found in 39 of 77 patients (51%) and in 47 of 143 arteries (33%) at 9 +/- 7 months. The restenosis rate was 57% for chronic total occlusions (8 of 14) and 30% for stenoses (39 of 129). The restenosis rate was significantly higher for the left anterior descending coronary artery (40%) than for the left circumflex coronary artery (21%). However, the significance was lost after exclusion of chronic total occlusions. A higher residual stenosis and a high coronary wedge pressure were predictors for restenosis. Restenosis was clinically silent in 14 patients (18%). Repeat PTCA was done in 19 patients with recurrence and elective surgery in 8. Clinical follow-up was available in all patients at 24 +/- 12 months. Patients with incomplete revascularization had less favorable clinical follow-up results than patients with complete revascularization: 44% (8 of 18) vs 81% (48 of 59) were asymptomatic (p less than 0.005), and 28% (5 of 18) vs 5% (3 of 59) had undergone elective bypass surgery during follow-up (p less than 0.005). Most patients with restenosis after multivessel PTCA had only 1-vessel restenosis and only 7% had restenosis of all lesions.