ABSTRACT
The role of percutaneous transluminal coronary angioplasty (PTCA) in the management of chronically occluded coronary arteries is still controversial. Percutaneous transluminal coronary angioplasty of chronic total occlusion is associated with relatively low success rates and a high incidence of restenosis. The purpose of this analysis was to determine, from the records of our institution, the efficacy and long-term outcome of angioplasty performed for chronic total occlusion defined as complete occlusion (Thrombolysis in Myocardial Infraction [TIMI] grade 0). PTCA was performed in 212 consecutive patients with chronically occluded coronary arteries and was successful in 125 (59%) patients. Complications were not observed. Successful initial PTCA was related to the clinical duration of occlusion and the type of guidewire (the primary success rate with the conventional guidewire was 49 (48%) versus 76 (69.1%) with Magnum Meier System p < 0.01). Repeat angiography was performed for 65 (52.0%) consecutive patients with successful initial PTCA and demonstrated restenosis in 34 (52.3%). 17 patients were successfully treated by a second PTCA. Restenosis or reocclusion was not clearly related to the residual stenosis post PTCA. In addition, the grade of collateral supply was not different in the vessels with and without restenosis.
Subject(s)
Coronary Thrombosis/therapy , Adult , Angioplasty, Balloon, Coronary , Coronary Angiography , Coronary Thrombosis/diagnostic imaging , Female , Humans , Male , Middle Aged , Recurrence , Treatment Outcome , Vascular PatencyABSTRACT
Coronary angiography as the "golden standard" in diagnostic imaging, guiding and assessing the results of interventional therapy has well known limitations inherent to the two dimensional imaging of three dimensional structures. Intravascular ultrasonography provides cross-sectional images of coronary artery, allowing an accurate calculation of cross-sectional luminal area and assessment of the degree of eccentricity of plaque and its structure including fissures, dissections and intracoronary thrombi. Case 1: Coronary angiography was performed in a 60 y. male patient with unstable angina revealing only a 40% stenosis in proximal LAD. The inconsistency of clinical presentation with angiography findings led to perform an intravascular ultrasound (IVUS) examination of LAD. The angiographic 40% stenosis was found to be over 80% on IVUS. Subsequent PTCA procedure led to a good IVUS and clinical result with no obvious changes in angiography. Case 2: PTCA of 80% Cx stenosis was performed with good immediate angiographic result, without dissection nor residual stenosis. However, IVUS immediately after PTCA assessed a dissection of the plaque with a flap protruding into the lumen. The patient was sent back to coronary angiography several hours later with clinical and ecg symptoms of acute myocardial ischemia. An important, occlusive dissection was found at the PTCA site. Angioplasty was performed again restoring a wide lumen at intervention site. IVUS was able to clarify the ambiguous angiographic findings with an important impact on interventional therapy. The immediate results of invasive procedures were readily and safely assessed by intravascular ultrasound.
