Related Experiment Videos
[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.
Insights
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.
Abstract:
The unprotected left main stenosis still represents one of the contraindications of PTCA; recently developed concepts using percutaneous bypass techniques have not changed this fact so far. However, following bypass grafting the procedure can be done with low risk and may improve prognosis in case of later bypass occlusion. This study should clarify whether a higher rate of bypass occlusion is caused by postsurgical left main PTCA. From October 1981 to January 1991 a left main stenosis was dilated in 41 patients, 2 weeks to 12 years (mean 3.5 years) after bypass grafting. To date, 17/65 venous bypass grafts were already occluded, and 72.4% of the patients suffered from typical angina. In 34/41 patients (82.9%) PTCA was successful, severe complications (death, emergency surgery or myocardial infarction) did not occur and clinical improvement was achieved in 80% of symptomatic patients. Four months later, 26/34 patients (76.5%) had angiographic follow-up. Fifteen restenoses were found and a second PTCA was performed in 9/15. None of the venous bypass grafts, open at the time of the first PTCA, was occluded at follow-up. In one case PTCA of the left main stenosis turned out to be life-saving 7 years later because an occlusion of RCA- and LCX-bypasses occurred and the LAD graft showed a subtotal thrombosis. It is concluded that PTCA of left main stenosis after bypass grafting is a safe procedure and does not lead to a higher rate of venous bypass occlusions. A prognostic indication seems to be justified.