Procedural outcome of angioplasty for total coronary artery occlussion: An analysis of 971 lesions in 905 patients

Abstract

This study analyzes the results of angioplasty in 905 consecutive patients with 971 total occlusions. The procedures were performed by five cardiologists from January 1980 to January 1989 at one institution. The overall success rate per lesion was 72%. Even the most experienced operator (524 occlusions attempted) has continued to improve on a learning curve, with 83% of his most recent 100 occlusions successfully dilated. Procedural death occurred in seven patients (0.8%), five patients (0.6%) sustained a myocardial infarction and seven patients (0.8%) required urgent coronary bypass surgery. Complications were significantly more likely to occur in the elderly, in women and in patients with triple vessel disease and depressed left ventricular function. Compared with angioplasty in 6,950 patients with nonoccluded stenoses, angioplasty of total occlusions had a lower success rate (72% versus 96%, p = 0.001), although the complication rate was also lower (1.9% versus 3.5%, p = 0.01). Multivariate analysis of 20 clinical and angiographic variables in 100 consecutive patients undergoing angioplasty of 104 total occlusions in 1988 identified only bridging collateral vessels (85% success rate if absent versus 18% if present, p less than 0.001) and a tapered occlusion morphology (88% success rate if present versus 59% if absent, p = 0.01) as independent correlates of procedural outcome. Other variables, including the estimated duration of occlusion, lesion length and location, and extent of disease were unrelated to technical success. With present techniques and sufficient operator experience, 70% to 80% of total occlusions can be successfully recanalized by coronary angioplasty with a complication rate of less than 2%.(ABSTRACT TRUNCATED AT 250 WORDS)

Total occlusion trial with angioplasty by using laser guidewire. The TOTAL trial

“…Typically, the success rates in most reports were less than favourable, the most common reason for failure being the inability to pass a guidewire through the occlusion into the distal true lumen [1,2] . As several reports have demonstrated the clinical relevance of successful recanalization of occluded coronary arteries [3][4][5][6][7][8] , further exploration and improvement of percutaneous techniques seemed justifiable. As a result, a laser wire (laser guidewire), the Spectranetics Prima Coronary Total Occlusion System Model 018-003 (Spectranetics, Colorado Springs, CO, U.S.A.) was developed.…”

Percutaneous Revascularization of Lesions With Saphenous Vein Graft Failure

“…The initial success rate of PTCA targeting CTO lesions of the NCA has been reported to be 66 -81%. [16][17][18] In our series, initial success was obtained in 67%. Although the re-stenosis rate of CTO was unfavorable compared with non-CTO lesions, it could be acceptable.…”

“…It has been, however, reported that the proportion of CTO among all target lesions is approximately 20%. 15,16 In patients with graft failure-related angina pectoris following CABG, the coronary artery responsible for the ischemic region, as well as the corresponding graft, may exhibit CTO to a relatively high degree.…”

A Case in Which Stent Insertion is Considered to Have Triggered Contrast Medium-Induced Coronary Vasospasm

“…However, the RCA was chronically and completely occluded, and restenosis occurred even after stent insertion. 7,8 Angiography was performed using Iomeprol, but no spasm was observed in the RCA until after stent insertion. The spasm was first noted during angiography 10 months after insertion of a GR-II stent, and the contrast medium was suspected to be the cause.…”