Related Experiment Videos
Percutaneous transluminal angioplasty in patients with prior myocardial revascularization surgery
C A Pinkerton1, J D Slack, C M Orr
1Indiana Heart Institute, St. Vincent Hospital and Health Care Center, Indianapolis 46260.
Insights
Balloon angioplasty effectively treats recurrent ischemia after bypass surgery, offering a high success rate and acceptable risk. Restenosis remains a challenge, but this procedure provides a viable option for selected patients.
Area of Science:
- Cardiology
- Vascular Surgery
Background:
- Coronary artery bypass grafting (CABG) is standard for coronary artery occlusive disease.
- Recurrent myocardial ischemia can occur post-CABG due to graft disease or progression of native vessel disease.
Purpose of the Study:
- To evaluate the efficacy and safety of balloon angioplasty in patients with prior myocardial revascularization surgery.
- To assess outcomes including success rates, restenosis, and complications.
Main Methods:
- Retrospective analysis of 236 patients who underwent angioplasty after previous revascularization surgery.
- Procedures performed between September 1980 and June 1987.
- Outcomes assessed included primary success, clinical restenosis, and need for emergency surgery.
Main Results:
- High primary success rate of 93% for angioplasty in post-CABG patients.
- Overall clinical restenosis rate was 39%, with similar rates for saphenous vein grafts, native vessels, and internal mammary arteries.
- Emergency revascularization surgery was required in 3% of patients, with a mortality rate of 0.4%.
Conclusions:
- Balloon angioplasty is a safe and effective option for relieving recurrent myocardial ischemia in patients with prior bypass surgery.
- High initial success rates and acceptable risks are achievable.
- Early restenosis is a significant limitation requiring further management strategies.
Abstract:
Direct myocardial revascularization surgery using either the saphenous vein or internal mammary artery has become the definitive surgical treatment for coronary artery occlusive disease. Certain patients who have undergone these procedures, however, have recurrent myocardial ischemia due to progression of disease in unbypassed vessels, to obstruction in the arteries distal to the insertion of the bypass conduit, or to disease of the conduit itself. Balloon angioplasty may be used to relieve myocardial ischemia in these situations; however, initial studies suggested a low primary success rate coupled with excessive mortality and morbidity. Improvements in patient selection, equipment and technical expertise now allow angioplasty to be performed in this patient population with results comparable to that in the general coronary angioplasty population. Of the 3,016 angioplasty procedures performed between September 1980 and June 1987, 236 patients had previously undergone revascularization surgery. The primary success rate was 93% (390 of 419 stenoses successfully dilated). Overall, clinical restenosis was observed in 39%, including a 43% restenosis rate in patients undergoing only saphenous vein graft angioplasty. This did not differ appreciably from the restenosis rate in postbypass patients undergoing angioplasty of only native vessels (37%) or internal mammary arteries (42%). Emergency revascularization surgery was required in 7 of 236 patients (3%), each of whom had myocardial infarction. One of 236 patients (0.4%) died. Thus, angioplasty may be used to relieve recurrent myocardial ischemia in patients with prior direct myocardial revascularization procedures with a high initial success rate and acceptable risk. Early (less than 6 months) restenosis is not infrequent and remains the largest obstacle to a satisfactory clinical outcome.(ABSTRACT TRUNCATED AT 250 WORDS)