RECANALIZATION OF CHRONIC CORONARY-ARTERY OCCLUSIONS - WHAT FACTORS INFLUENCE RESULTS

Between January 1986 and June 1990, recanalization with guide-wire and balloon angioplasty (PTCA) was attempted in 509 patients (416 men, 93 women; mean age 57.5 +/- 9 years) with chronic coronary artery occlus ions. The data recorded were analysed to determine the factors which i nfluenced the outcome. The intervention was initially successful in 28 4 patients (55.8%; circumflex branch: 50%; right coronary artery: 52%; venous bypass graft: 50%; anterior interventricular branch: 64%). The success rate was markedly reduced if (1) the occlusion had persisted for more than 6 months (9.5%; P < 0.001); (2) occlusion had occurred a t or after a vessel kink (28.5%; P < 0.001); (3) there had been no ves sel >>stump<< (36%; P < 0.01) and (4) the occlusion was. longer than 1 0 mm (40.7%; P < 0.05). The success-rate was higher if (1) intracorona ry anastomoses were absent (61,2%); (2) occlusion had occurred in a st raight vessel (62,6%); (3) there had been a vessel stump (64%); (4) th e occlusion had persisted for less than 4 weeks (68,5%) and (5) the le ngth of occlusion was less than or equal to 10 mm (75,8%). - These dat a, indicate that the success of PTCA after chronic coronary artery occ lusion depended on the site of occlusion, its duration and length, abs ence of orthograde collaterals and the presence of a vessel stump. Kno wing the extent of these factors helps in delineating the indications.