Related Experiment Videos
The limited impact of percutaneous coronary artery angioplasty on bypass surgery
1Department of Cardiology, Cleveland Clinic Foundation, Ohio 44106.
Insights
Percutaneous transluminal coronary angioplasty (PTCA) is limited by anatomic factors in advanced coronary artery disease. PTCA is not a substitute for coronary bypass surgery in many complex cases.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) has been clinically utilized for a decade.
- Coronary bypass surgery (CABG) volumes remain high despite PTCA availability.
Purpose of the Study:
- To evaluate the anatomic limitations of PTCA.
- To determine PTCA suitability in patients undergoing CABG.
Main Methods:
- Analysis of patient data from Cleveland Clinic in 1981.
- Application of complete revascularization criteria.
- Assessment of reasons for PTCA exclusion.
Main Results:
- Only 38% of CABG patients met PTCA criteria.
- Chronic total occlusion was the primary exclusion factor.
- PTCA suitability decreased with increasing graft numbers.
Conclusions:
- Anatomic limitations, not technical challenges, restrict PTCA use.
- PTCA is less effective for extensive coronary artery disease compared to CABG.
Abstract:
Although percutaneous transluminal coronary angioplasty has been used successfully now for 10 years, coronary bypass surgery volumes have not diminished greatly. This paper examines the anatomic limitations of percutaneous transluminal coronary angioplasty. Using complete revascularization criteria, angioplasty could be used in only 38% of patients undergoing coronary bypass surgery at the Cleveland Clinic in 1981. The principal anatomic reason for rejecting patients for percutaneous transluminal coronary angioplasty was chronic total occlusion in a vessel suitable for bypass surgery. Angioplasty could be used more frequently in one- and two-vessel bypass patients than in patients receiving more grafts. Percutaneous transluminal coronary angioplasty is currently limited more by its inability to more completely revascularize advanced coronary artery disease than it is from the technical aspects of crossing or dilating stenoses.