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Percutaneous transluminal coronary angioplasty in chronic coronary artery occlusion
J T Stewart1, L Denne, T J Bowker
1Department of Invasive Cardiology, Royal Brompton National Heart and Lung Hospital, London, England, United Kingdom.
Insights
Percutaneous transluminal coronary angioplasty for chronic total occlusions had a low success rate, especially in the right coronary artery. However, successful procedures offered good long-term outcomes, with dissection risks similar to non-occluded vessels.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) for chronically occluded coronary arteries presents unique challenges.
- Assessing the safety and efficacy of PTCA in these complex cases is crucial for patient management.
Purpose of the Study:
- To evaluate the procedural success rate of PTCA in chronically occluded coronary arteries.
- To determine the complication rate associated with this procedure.
- To assess the long-term outcomes following PTCA for chronic total occlusions.
Main Methods:
- A retrospective review of 100 consecutive PTCA procedures for chronic total occlusion (defined as TIMI grades 0-1 flow for ≥3 months) between 1987 and 1991.
- Analysis of procedural outcomes and medium-term results in 95 patients.
- Comparison of success rates and complication rates across different coronary arteries.
Main Results:
- Procedural success was achieved in 47% of cases, with significantly lower success rates in the right coronary artery (26.8%) compared to the left anterior descending (57.1%) and left circumflex (45%) arteries.
- Procedural failure occurred in 45% of cases. Serious adverse events, including acute myocardial ischemia due to coronary dissection, occurred in 8 patients, with one death.
- At 12 months, event-free survival was significantly higher in patients with procedural success (64.1%) compared to those with unsuccessful procedures (32.6% to 25%).
Conclusions:
- PTCA for chronic total coronary occlusions demonstrates a low procedural success rate, particularly for the right coronary artery.
- Successful recanalization is associated with favorable long-term outcomes.
- The risk of coronary dissection during PTCA for chronic total occlusion is comparable to non-occluded vessels, but notably higher in the right coronary artery (13%).
Objectives:
This study was conducted to determine the procedural success rate, complication rate and long-term outcome of percutaneous transluminal coronary angioplasty in chronically occluded coronary arteries.
Background:
Coronary angioplasty of chronically occluded vessels has a lower success rate than has angioplasty of nonoccluded vessels, but it is frequently considered safe because the target vessel is already occluded. The purpose of this study was to determine the reliability of these assumptions at our institution, with the objectives stated above.
Methods:
We identified from the angioplasty data base at our institution 100 consecutive coronary angioplasty procedures performed between 1987 and 1991 for chronic total occlusion, defined as complete occlusion (Thrombolysis in Myocardial Infarction [TIMI] grades 0 and 1 flow) for > or = 3 months. The records of the 95 patients who underwent these procedures were reviewed to determine procedural outcome and medium-term results.
Results:
Procedural success was obtained in 47 occluded vessels (47%). Significantly fewer successes were obtained in the right coronary artery (26.8%) than in either the left anterior descending (57.1%) or the left circumflex (45%) coronary artery (p < 0.05). A procedural failure without serious adverse consequences occurred in 45 procedures (45%), but in eight patients (right coronary artery in five, left anterior descending artery in three) attempted recanalization was complicated by extensive coronary dissection with acute myocardial ischemia, and one of these patients died. There were no emergency operations, but elective coronary artery bypass surgery was undertaken in 26 patients (in 3 after extensive dissection, in 7 after an apparently good result and in 16 in whom the procedure failed). At 12 months after the procedure, 64.1% of those with a procedural success were event free compared with 32.6% of those whose procedure was both unsuccessful and uncomplicated (p < 0.025) and 25% of those in whom it was unsuccessful and complicated by coronary dissection (p < 0.025).
Conclusions:
In this series of recanalization of chronically occluded coronary arteries, there was a low procedural success rate, particularly for the right coronary artery. However, when procedural success was obtained, the long-term outlook was good. The overall risk of coronary dissection was comparable to the risk in nonoccluded vessels but was particularly high in the right coronary artery (13%).