CORONARY ANGIOPLASTY - A PARTICULARLY SUI TABLE METHOD FOR MYOCARDIALREVASCULARIZATION IN THE ELDERLY

Coronary angioplasty is a myocardial revascularisation technique of ch oice in the elderly, avoiding the need for general anesthesia as well as the complications of thoracotomy and extracorporeal circulation. Us ed in a continuous series of 62 patients, it provided a 79% primary su ccess rate in this situation, where reaching the coronary artery and p enetrating the stenosis may be difficult. Femoral complications (hemat oma, false aneurysm) are commoner in this age group, but appear to be beneficially influenced by the replacement of heparin by ticlopidine p eri-operatively. With 24 months follow-up, the proportion of patients free of any major cardiac event and NYHA classes I and II is 66%, actu arial survival rate without infarction is 76%. These results would ten d to restrict the indications for bypass after the age of 75 to cases of stenosis of the left main coronary artery, failure of angioplasty o r multi-vessel atheroma with a <<culprit lesion>> inaccessible to dila tation.