Five-year Clinical follow-up after Revascularization for Chronic Total Coronary Artery Occlusion / 대한구급학회지

BACKGROUND: Chronic total occlusion (CTO) has been considered as an unsuitable lesion for percutaneous coronary intervention (PCI) because of technical difficulty and low success rate. Owing to technical advances and increased operator's experience, PCI has been attempted in a large number of patients with CTO in recent years, but there are few long-term follow-up reports for PCI to CTO. METHODS: We analyzed 83 patients (59.7+/-9.2 years, 28 female) with CTO on diagnostic coronary angiogram at the Heart Center and Coronary Care Unit of Chonnam National Hospital from January 1996 to July 1997. The patients were divided into two groups according to revascularization by PCI or CABG (coronary artery bypass graft): the revascularized group (received PCI or CABG, Group I) and non-revascularized group (Group II). RESULTS: PCI was tried in 46 patients and successful in 33 patients (71.7% of the success rate). Eleven patients (13.3%) were treated with the coronary artery bypass graft (CABG) and 31 (37.3%) patients were medically treated. During 5-year clinical follow-up 11 patients died [13.1%; cardiac death 6 (7.1%), non-cardiac death 5 (6.0%)] and the major adverse cardiac events occurred to 24 (28.6%) patients. Cardiac death occurred to one patient of the Group I and 5 patients of Group II (p=0.06). The mean survival time was significantly different (57.8+/-9.2 months in Group I and 50.9+/-19.5 months in Group II, p=0.038). CONCLUSIONS: Revascularization for CTO prolonged the mean survival time of the patients on long- term clinical follow-up.

A Case of Successful Brachytherapy Using Local Delivery of 99mTc-HMPAO for the Recurrent Coronary Stent Restenosis

A percutaneous coronary intervention (PCI) is known to be one of the effective methods for the treatment of coronary artery disease. However, restenosis remains a major limitation of PCI. Recently vascular brachytherapy has been introduced for the prevention of recurrent restenosis following PCI, especially after stenting.We report a case of a 64-year-old man suffering from an acute myocardial infarction due to total occlusion of the proximal right coronary artery (RCA) and critical stenosis in the proximal left circumflex artery (LCX). After successful PCI for RCA occlusion and LCX stenosis, restenosis developed in both arteries on follow-up coronary angiogram. Simple balloon dilation for the proximal RCA edge restenosis, and cutting balloon angioplasty for the instent restenosis, were performed. The follow-up angiogram revealed no restenosis in the RCA or second instent restenosis in the LCX. A vascular brachytherapy using local delivery of 99mTc-HMPAO was performed for this recurrent lesion. A one-year follow-up angiogram, after local radioisotope delivery, revealed a patent stent without restenosis in the LCX.

A case of acute myocardial infarction in an eighteen-year-old male patient / 대한내과학회지

Recently the incidence of coronary artery diseases in young patients has been increased in Korea, which may be related with the changes in dietary habits, stress and smoking. This report presents an 18-year-old male patient who suffered from acute non-ST elevation myocardial infarction. He had a history of 1.5 pack-years smoking, but no other risk factors. Depression of ST segments more than 3 mm in V1-6, I and aVL was documented on a twelve-lead electrocardiogram. Two-Dimensional echocardiography revealed hypokinetic anteroseptal wall motion, and myocardial SPECT demonstrated severe, reversible perfusion defects in the anteroseptal wall. A diagnostic coronary angiogram and an intravascular ultrasound revealed total occlusion in the proximal left anterior descending coronary artery due to heavy atheromatous plaque. The lesion was treated successfully by a coronary balloon and stent. He has no major adverse cardiovascular event on nine-month clinical follow-up after discharge.