Sequential multivessel coronary angioplasty assessed by thallium-201 tomography

In 11 patients with multivessel coronary artery disease, SPECT thallium-201 imaging was performed prior to and within 3 days after each of two sequential percutaneous transluminal coronary angioplasties on separate days designed to achieve total revascularization. Thallium-201 SPECT was analyzed quantitatively, and an ischemic score for the vascular bed(s) supplied by the dilated vessel(s) was derived. For the vessels dilated during the first procedure the mean diameter stenosis was 80 +/- 8%, reduced to 27 +/- 9%. For the second procedure mean stenosis was reduced from 67 +/- 10% to 26 +/- 6%. For the two procedures, the mean thallium scores decreased from 298 +/- 225 to 115 +/- 130 (P less than .001) and from 135 +/- 129 to 46 +/- 60 (P less than .001), respectively. Of 10 patients with abnormal thallium-201 SPECT prior to angioplasty, nine improved after the first procedure, and seven improved further following the second procedure. Thus, utilizing staged angioplasty with a strategy of dilating the most severe lesion first, thallium-201 SPECT documented progressive improvement in myocardial perfusion.