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Technique and results of operative transluminal angioplasty in 81 consecutive patients
Insights
Operative transluminal angioplasty during coronary bypass surgery successfully treated distal coronary artery disease in 71% of lesions. This technique improves graft runoff for arteries otherwise untreatable.
Area of Science:
- Cardiovascular Surgery
- Interventional Cardiology
- Vascular Biology
Background:
- Multivessel coronary artery disease often involves distal lesions unsuitable for bypass grafting.
- Limited treatment options exist for small or inaccessible coronary arteries.
Purpose of the Study:
- To evaluate the safety and efficacy of operative transluminal angioplasty for distal coronary artery disease during coronary bypass surgery.
- To determine factors influencing success rates and outcomes.
Main Methods:
- Ninety-three transluminal angioplasty attempts were performed on 81 patients undergoing coronary bypass.
- A 2 mm balloon catheter was used; lesions were selected based on size and location.
- Postoperative angiography assessed lesion success and graft patency.
Main Results:
- Successful dilatation was achieved in 75 lesions (81%).
- Complete stenosis alleviation occurred in 71% of successfully dilated lesions.
- Lesion length was inversely proportional to success; calcification had no impact. No deaths occurred.
Conclusions:
- Operative angioplasty is a safe and effective adjunct to coronary bypass for specific distal lesions.
- The technique enhances distal runoff for bypass grafts in arteries otherwise bypassed.
- Careful patient and lesion selection are crucial for optimal outcomes.
Abstract:
Eighty-one consecutive patients with distal multivessel coronary artery disease underwent 93 attempts at operative transluminal angioplasty at the time of coronary bypass operation. Lesions chosen for angioplasty were those in coronary arteries that otherwise would not have been bypassed because of small size and/or inaccessible location; 53% involved the distal anterior descending artery. A guide wire-tipped catheter with a 2 mm balloon was found to be the more satisfactory of the two devices used. An operative "successful" dilatation was achieved with 75 lesions (81%). Eighteen "unsuccessful" dilatations occurred primarily because of inability to transverse the lesions with the catheter. Postoperative angiography was performed in 29 patients to study 31 lesions. In 20 of 28 "successfully" dilated lesions (71%), the stenoses were completely alleviated. Three lesions were found unimproved and in two lesions, the coronary arteries were occluded distally. Two bypass grafts, involving two lesions with extensive dilatation, were closed. Two patients had definite perioperative myocardial infarction, and there were no deaths in this series. Whereas calcification did not influence success, the length of the lesion was inversely proportional to a successful dilatation. Operative dilatation of short coronary distal lesions is safe, has a high percentage of success, and offers a larger distal runoff for coronary bypass grafts. Areas of normal coronary arteries should not be dilated. Careful attention to detail and proper selection of the lesions to be dilated are required. The technique should be used only to dilate arteries that otherwise would not accept a bypass graft.