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[Main branch stenosis after bypass operation. Indications for elective PTCA]
C Vallbracht1, H R Fiedler, C Kadel
1Zentrum der Inneren Medizin, Abteilung für Kardiologie, Universitätsklinik Frankfurt.
Zeitschrift Fur Kardiologie
|April 1, 1993
Summary
Percutaneous transluminal coronary angioplasty (PTCA) for unprotected left main stenosis after bypass grafting is safe and does not increase bypass occlusion. This procedure may improve prognosis in patients with prior bypass surgery.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Unprotected left main stenosis is a contraindication for percutaneous transluminal coronary angioplasty (PTCA).
- Percutaneous bypass techniques have not altered this indication.
- Left main stenosis after bypass grafting may be treated with PTCA to improve prognosis.
Purpose of the Study:
- To determine if post-surgical left main PTCA increases bypass occlusion rates.
- To evaluate the safety and efficacy of PTCA for left main stenosis in patients with prior bypass grafting.
Main Methods:
- Retrospective analysis of 41 patients undergoing PTCA for left main stenosis 2 weeks to 12 years post-bypass grafting (Oct 1981 - Jan 1991).
- Assessment of bypass graft patency and clinical outcomes.
- Angiographic follow-up at 4 months post-PTCA.
Main Results:
- PTCA was successful in 82.9% of patients with no severe complications.
- 80% of symptomatic patients experienced clinical improvement.
- No venous bypass grafts open at PTCA occluded during follow-up.
- One case demonstrated a life-saving outcome 7 years post-PTCA due to bypass occlusion.
Conclusions:
- PTCA of left main stenosis after bypass grafting is a safe procedure.
- It does not increase the rate of venous bypass graft occlusion.
- PTCA may be prognostically indicated in selected patients post-bypass grafting.