Lesion morphology and coronary angioplasty: Current experience and analysis

Abstract

From July 1, 1990 to February 28, 1991, 533 consecutive patients with 764 target vessels and 1,000 lesions underwent coronary angioplasty. Procedural success was achieved in 92.3%, untoward (major cardiac) events occurred in 3% (0.8% myocardial infarction, 1.3% emergency coronary bypass grafting and 0.9% both; there were no deaths). An unsuccessful uncomplicated outcome occurred in 4.7%. Lesion analysis using a modified American College of Cardiology/American Heart Association classification system showed that 8% were type A, 47.5% were type B and 44.5% were type C (36% of type B and 11% of type C were occlusions). Angioplasty success was achieved in 99% of type A, 92% of type B and 90% of type C lesions (A vs. B, p less than 0.05; B vs. C, p = NS; A vs. C, p less than 0.01). Untoward events occurred in 1.2% of type A, 1.9% of type B and 2% of type C lesions (p = NS). An unsuccessful uncomplicated outcome occurred in 0% of type A, 6% of type B and 7% of type C lesions (A vs. B, p less than 0.05; B vs. C, p = NS; A vs. C, p less than 0.05). Among the unsuccessful uncomplicated outcome group, occlusion occurred in 49%: 38% of type B and 59% of type C lesions. With B1 and B2 subtypes, success was obtained in 95% and 89.5% and untoward events occurred in 1.5% and 2.3% and an unsuccessful uncomplicated outcome in 3.7% and 8%, respectively. C1 and C2 subtyping showed success in 91% and 86%, untoward events in 1.3% and 6% and an unsuccessful uncomplicated outcome in 7.5% and 8.5%, respectively. Among the 764 vessels, success was obtained in 89.5% and untoward events occurred in 2.5% and an unsuccessful uncomplicated outcome in 8%. Assessment of lesion-vessel combinations showed a less favorable outcome with type C lesions and combinations of A-B, B-C and multiple (more than three lesions) type B and C vessels. Statistical analysis of morphologic factors associated with angioplasty success included absence of (old) occlusion (p less than 0.0001) and unprotected bifurcation lesion (p less than 0.001), decreasing lesion length (p less than 0.003) and no thrombus (p less than 0.03). The only significant factor associated with untoward events was the presence of thrombus (p less than 0.003). Predictors of an unsuccessful uncomplicated outcome included old occlusion (p less than 0.0001) and increasing lesion length (greater than 20 mm) (p less than 0.001), unprotected bifurcation lesion (p less than 0.05) and thrombus (p less than 0.03).

Continuing evolution of therapy for coronary artery disease. Initial results from the era of coronary angioplasty.

“…Certainly, the relation between specific morphological characteristics and acute success and complication rates have been well described. 41,42 However, unless such factors are strongly associated with subsequent mortality, no long-term prognostic effects may be evident. In a preliminary analysis of this issue, we found no relation between lesion morphology and long-term survival in our PTCA cohort,43 so we do not feel that variations in lesionspecific characteristics in the PTCA cohort affected our results.…”

Short Term and Long Term Complications after Percutaneous Transluminal Coronary Angioplasty (PTCA)

“…Although PTCA is genrerally safer, complication occasionally occurs including myocardial infarction in 3 to 5 percent [5,6], Yet it is need for emergency bypass surgery in 3 to 7 percents [7,8] and death in 0 to 2 percent [9,10]. These event usually caused by extensive coronary arterial dissection, intracoronary thrombosis, or both, with resultant vessel occlusion.…”

Dedicated bifurcation stents

“…In order to clarify the best bifurcation PCI approach between 'provisional' T-stenting of implanting only one-DES (1 DES) in the main-branch (MB) vs a two-DES approach with routine stenting of both bifurcation branches (MB and SB), a number of studies and randomised controlled trials (RCT) have been performed. [1][2][3] The 'Randomised Study of the Crush Technique Versus Provisional Side-Branch Stenting in True Coronary Bifurcations (CACTUS Study)' was a prospective, randomised, multicentre study enrolling 350 patients was designed to assess whether elective stenting of both branches (by the use of Crush technique), which can be more technically demanding, provides greater benefits than the simple approach of stenting only the MB (provisional T-stenting) with additional stenting on the SB only in the case of unsatisfactory result at that site. Of the 350 patients, 177 were enrolled in the Crush arm while 173 in the provisional group.…”