Percutaneous transluminal coronary angioplasty for chronic total coronary arterial occlusion |
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| Authors: | J P Melchior B Meier P Urban L Finci G Steffenino J Noble W Rutishauser |
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| Affiliation: | 1. Department of Experimental, Diagnostic and Specialty Medicine, Section of Cardiology, University of Bologna, Bologna, Italy;2. Clinical Center of Serbia, Medical Faculty, University of Belgrade, Belgrade, Serbia;3. University of Medicine and Pharmacy “Carol Davila”, Bucharest, Romania;4. Department of Cardiology and Internal Medicine, Floreasca Emergency Hospital, Bucharest, Romania;5. University Clinic of Cardiology, Medical Faculty, University “Ss. Cyril and Methodius”, Skopje, Macedonia;6. Clinic for Cardiology, Clinical Center Kragujevac, Kragujevac Faculty of Medical Sciences, University in Kragujevac, Kragujevac, Serbia;7. University Clinical Hospital Center Bezanijska Kosa, Faculty of Medicine, University of Belgrade, Belgrade, Serbia;8. Department of Cardiology, Lithuanian University of Health Sciences, Kaunas, Lithuania;9. Clinical Center of Montenegro, Center of Cardiology, Podgorica, Montenegro;10. Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Zagreb, Croatia;11. Cardiovascular Research Center, CSIC-ICCC, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Barcelona, Spain;1. Stavanger University Hospital, Stavanger, Norway;2. Vancouver General Hospital, Vancouver, BC, Canada |
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| Abstract: | Experience is reported with 100 consecutive patients in whom percutaneous transluminal coronary angioplasty (PTCA) was attempted on chronically occluded coronary arteries that had no visible anterograde flow. Ninety-eight patients had angina and all had collateral vessels to the occluded artery on angiography. A movable guidewire/dilatation system was used in all cases. Overall initial PTCA success rate was 56% and was related to duration of occlusion (69% success rate for occlusions of 1 month or less, 50% for 1 to 6 months and 11% after 6 months). Complications were minor; no patient died or required emergency bypass operation. Of the 44 patients in whom PTCA failed, 20 underwent elective bypass surgery for relief of angina and 24 were treated medically. Follow-up at a mean of 8 months (range 1 to 48) was available for 49 of the 56 patients in whom PTCA was successful: 40 had subjective improvement, 6 no change and 3 felt worse. Control angiography was carried out in 40 of the 56 patients with primary success and showed long-term success in 18 and reocclusion or significant stenosis in 22. Of these 22, 11 were successfully treated by a second PTCA, 2 underwent operation and 9 were treated medically. Recanalization of totally occluded coronary arteries with no forward flow has a lower initial success rate (56%) than PTCA for stenoses and the recurrence rate is higher (55%), but effective relief of angina is achieved in successful cases. The risk of serious complications appears to be low. |
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