INITIAL AND LONG-TERM RESULTS OF PERCUTANEOUS TRANSLUMINAL BALLOON ANGIOPLASTY FOR CHRONIC TOTAL OCCLUSIONS - AN ANALYSIS OF 184 PROCEDURES

Background: Coronary angioplasty, although of proven use in partial oc clusion, has not been shown to be of similar benefit in chronic total occlusion. Aims: To assess the utility of coronary angioplasty in chro nically totally occluded vessels in patients undergoing angioplasty an d to determine the success of TIMI-I flow before angioplasty compared to those patients with TIMI-O flow.Methods: A group of 178 consecutive patients (from 1984 to 1992), who underwent angioplasty of a chronic occlusion, were analysed. There were 136 males and 42 females with a m ean age of 56.9 years. Results: Initial technical success was achieved in 65%. Patients with TIMI-I flow before angioplasty had a higher cha nce of success (70%) compared to those with TIMI-O flow (53%), p < 0.0 4. During hospitalisation six patients suffered myocardial infarction (MI), two required surgery and one patient died. During a mean follow- up of 2.8 years the overall survival rate was 95% for the group as a w hole. Freedom from coronary surgery was significantly greater in patie nts with successful angioplasty (93%) than those without (66%, p < 0.0 02). The above two populations also showed a significant difference in the incidence of angina (35% vs 56%, P < 0.0003). However, the incide nce of MI (6% vs 5%, p > 0.5) and cardiac survival (98% vs 94%, p > 0. 1) did not differ significantly in the two groups. Restenosis occurred in 63% of the 95 patients (82%) who returned for follow-up angiograph y. Eighteen of the 59 patients (28%) with restenosis had a reocclusion . Conclusion: The success rate for angioplasty of chronic total occlus ions is acceptable. Long-term clinical benefit in patients with succes sful angioplasty is suggested by the high freedom from angina and the lesser need for coronary surgery. No major impact on either the incide nce of MI or cardiac survival was noted when patients who had coronary surgery were included, although it must be emphasised that the sample size in this study was insufficient to detect a difference in these o utcome variables.