Early Outcome of PTCA in Totally Occluded Coronary Arteries

Abstract

Background:Since percutaneous transluminal coronary angioplasty (PTCA) was first introduced in 1977 by Gruentzig as a treatment for proximal short-segmental, non-calcified, concentric isolated coronary stenosis, it has been used with increasing frequency in patients of symptomatic coronary artery disease with broader indications, including patients with multi-vessel disease, unstable angina, acute myocardial infarction and totally occluded coronary arteries. Among these, total coronary occlusion constitutes a subdivision with specific features that require separate evaluation. The purpose of this study was to determine the initial results of PTCA for total coronary occlusion.Methods:Thirty-five patients with manifested ischemic heart disease with totally occluded coronary arteries, documented by coronary angiogaphy, underwent recanalization procedure by PTCA between Jan. 1990 and Oct. 1991.Results:Thirty-five patients were comprised of 20 acute myocardial infarction (MI), 7 old MI and 8 unstable angina. Eighteen (50.1%) patients had one major atherosclerosis risk factor and 10 (29.4%) had two or more. PTCA for total coronary artery occlusion was attempted in the left anterior descending artery (LAD) in 16 patients, right coronary artery (RCA) in 11, left circumflex artery (LCx) in 2 and protected left main in one. PTCA was successful in 23 patients (66%): LAD in 11/18 (61%) and RCA 11/14 (79%), showing significantly higher success rate with RCA than LAD (p<0.05). Primary success rate of PTCA in accordance with the duration of the total occlusion estimated on the basis of clinical and angiographic data was 71% (15/21) when less than two weeks, 63% (5/8) when between 2 to 12 weeks, and 50% (3/6) longer than 12 weeks, Mean duration of the total occlusion in successful PTCA was 1.4 months (range; 10 days-5 months) and, 1.7 months (range; 3 weeks-3 years) in failed PTCA. Diameter stenosis of the lesions was significantly decreased from 100% to 19.7% after successful PTCA. There was no death but 2 patients were complicated with coronary artery embolization occluding major distal branches.Conclusion:The study suggested that PTCA of total coronary artery occlusion can be performed safely and effectively in selected cases and might be more successful in the lesion with shorter duration of occlusion.

Pro‐inflammation and pro‐fibrosis factors were highly induction in heart tissues of carotid arteries balloon‐injured animal model

“…According to our results, we found that after balloon-injured will induced cardiac hypertrophy. 18 At short-term rat carotid artery balloon injury, TGFb protein expression levels were increased at early stage and might induce collagen-producing cardiac fibrosis. During this time, cardiac hypertrophy is in company with inflammation and fibrosis.…”

“…TGFb participates in many human diseases, including cardiovascular diseases, hypertension, restenosis, atherosclerosis, cardiac hypertrophy and heart failure. 18 At short-term rat carotid artery balloon injury, TGFb protein expression levels were increased at early stage and might induce collagen-producing cardiac fibrosis. In present paper review, TGFb has important characteristics in neointima formation and the constrictive remodelling associated with angioplasty.…”