Angioplasty in total coronary artery occlusion: experience in 76 consecutive patients

The influence of multiple clinical, angiographic and technical variables on the outcome of percutaneous transluminal coronary angioplasty was evaluated in a group of 76 consecutive patients with total coronary artery occlusion. Angioplasty was performed successfully in 53% of these patients. The likelihood of successful angioplasty was favorably influenced by: 1) a history of prior myocardial infarction in the distribution of the occluded arterial segment (p = 0.03); 2) an estimated maximal duration of arterial occlusion of less than 20 weeks (p less than 0.001); and 3) a length of nonvisualized arterial segment distal to the point of occlusion of less than 1.5 cm (p = 0.03). The outcome of coronary angioplasty was not significantly influenced by the vessel involved, the location of the occlusion within an involved vessel, the morphology of the occlusion (tapered versus abrupt) or the age and sex of the patient. There were no deaths and no vascular perforations. Four patients had recurrent coronary occlusion within 24 hours of the procedure; in three of these, recurrent occlusion was successfully treated with reangioplasty and in one, emergent surgical revascularization was performed. Embolic occlusion of an arterial branch distal to the point of total coronary occlusion occurred in 4 of the 40 successfully recanalized arteries. Seventy-five percent of patients having successful recanalization of an occluded coronary artery were free of the anginal symptoms that had prompted performance of the procedure at a mean follow-up period of 7.3 months. Thus, angioplasty of a total coronary artery occlusion can be performed safely and effectively, particularly in patients with a history of prior myocardial infarction, a brief estimated duration of coronary occlusion and a short nonvisualized occluded arterial segment.