CORONARY ANGIOPLASTY OF CHRONIC TOTAL OCCLUSIONS WITH BRIDGING COLLATERAL VESSELS - IMMEDIATE AND FOLLOW-UP OUTCOME FROM A LARGE SINGLE-CENTER EXPERIENCE

Objectives. The purpose of the present study,vas to assess the effect of bridging collateral vessels on the success of coronary angioplasty of chronic total occlusions in the context of state of the art technol ogy and operator skill. Background. Coronary angioplasty of chronic to tal occlusions has been associated with relatively low success rates. Because the presence of bridging collateral vessels in chronic total o cclusion has been reported to be the major predictive factor in proced ural failure, angioplasty is often not recommended in patients with su ch vessels. Methods. Three hundred ninety-seven consecutive patients u ndergoing coronary angioplasty for chronic total occlusion were classi fied into two groups. Patients in group I had chronic total occlusion with bridging collateral vessels (97 patients, 109 total occlusions), and patients in group II had chronic total occlusion without such vess els (300 patients, 324 total occlusions). Results. The mean +/- SD dur ation of occlusion was 46 +/- 66 months (range 2 to 170) in group I an d 27 +/- 39 months (range 2 to 112) in group II (p < 0.05, high power value 0.83, group I vs. group II). Angioplasty for single-vessel disea se was performed in a smaller proportion of patients in group I than i n group II (22% vs. 36%, p < 0.05; power value 0.77). Procedural succe ss was achieved in 82 chronic total occlusions in group I and 270 chro nic total occlusions in group II (75% vs. 83%, p = 0.07; power value 0 .53). The rates of restenosis and reocclusion were 54% and 16%, respec tively, for group I and 56% and 13%, respectively, for group II (p = 0 .76, 0.46; power value 0.51, 0.47). Complications were minor with no Q wave infarction or requirement for urgent bypass surgery in either gr oup. Of 81 patients with unsuccessful coronary angioplasty, 1 patient from group I (1%) and 3 patients from group II (1%) required pericardi ocentesis because of cardiac tamponade. Guide wire manipulation did no t impair the flow of bridging collateral channels in group I. Conclusi ons. Coronary angioplasty can open chronic total occlusions, with or w ithout bridging collateral channels, for safe and effective recanaliza tion without major complications.