Related Experiment Videos
-Recanalization of chronic coronary artery occlusions: effect on clinical symptoms and left ventricular function-
Insights
Percutaneous coronary intervention for chronic total occlusions (CTO) is feasible, improving angina and left ventricular function. Dissection impacts long-term patency, suggesting repeat angiography may be beneficial.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Context:
- Chronic total occlusions (CTO) of coronary arteries present a significant challenge in interventional cardiology.
- Recanalization procedures for CTOs are debated due to varying success and restenosis rates.
Purpose:
- To evaluate the efficacy and outcomes of recanalization procedures for chronically occluded coronary arteries.
- To assess the impact of occlusion angioplasty on anginal status, exercise capacity, and left ventricular function.
Summary:
- Occlusion angioplasty was attempted in 408 patients, with a 71% primary reopening rate, highest for the left anterior descending (LAD) artery (82%).
- Follow-up angiography in 177 patients showed 45.2% of arteries remained open, 30.0% had restenosis, and 24.8% reoccluded.
- Significant improvements were observed in anginal status (61% improved by ≥1 CCS-class), exercise workload (115.8 to 136.1 watts), and left ventricular function (ejection fraction increased from 56.9% to 64.1%).
Impact:
- Occlusion angioplasty can positively influence anginal symptoms and functional status, suggesting the presence of hibernating myocardium.
- Long-term patency is influenced by dissection; 58% of vessels remained open without dissection versus 32% with dissection (NHLBI types B, C, or D).
- Repeat angiography may be indicated for patients with suboptimal primary results, particularly those with dissection, to guide further management.
Unlabelled:
Angioplasty of chronically occluded coronary arteries is discussed controversially. This study was performed to investigate the potential benefit of recanalization procedures. Between 1/91 and 10/93 occlusion angioplasty was attempted in 408 patients. 322 persons were followed with repeat angiography performed in 177 patients. Quantitative analysis of left ventricular function was performed in 34 patients before and after successful occlusion angioplasty. Primary reopening rate was about 71% with highest success rate for occluded LAD (82%). Angiographic controls showed open arteries in 80 (45.2%) patients, 53 (30.0%) had restenosis and 44 (24.8%) reocclusion. Anginal status was improved by one CCS-class or more in 197 patients (61%), mean exercise workload increased from 115.8 watts to 136.1 watts (p < 0.0001). Out of 34 patients, 25 (73.5%) showed improvement of regional ventricular function, mean ejection fraction increased from 56.9% to 64.1% (p < 0.001). Follow-up angiography revealed open arteries in 58% of patients if dissection was absent. When dissection type B, C or D NHLBI was present, only 32% of the vessels were open.
Conclusion:
In selected patients occlusion angioplasty is feasible with acceptable primary results. Anginal complaints and functional status were influenced positively, left ventricular function showed improvement indicating the presence of hibernating myocardium. In patients with suboptimal primary results (dissection) repeat angiography may be indicated.