ANGIOPLASTY OF CHRONIC TOTAL CORONARY OCCLUSIONS WITH THE USE OF 6 FRENCH GUIDING CATHETERS

The efficacy of 6 French guiding catheters for angioplasty of chronic total coronary occlusions was evaluated in 61 consecutive patients. Th e duration of the occlusion was determined angiographically, or estima ted from an index clinical event. Endpoints were procedural success, d efined as recanalization with less than 50% residual stenosis without major complications; and the need to change to larger-sized guiding ca theters, Recanalization was attempted in 62 chronic total occlusions; 35 were located in the left anterior descending coronary artery, 18 in the right coronary artery, and 9 in the left circumflex coronary arte ry. The mean duration of the occlusion was 6.0+/-6.6 months; the range was 2-39 months. Lesion morphology included abrupt or diffuse occlusi on (55%), a side branch originating at the occlusion (47%), and bridgi ng collaterals (23%). Death, urgent coronary bypass surgery, or myocar dial infarction did not occur. Recanalization was successful in 51 of the 62 total occlusions (82%); 49 were completed successfully with a 6 French guiding catheter, and 2 were successful after changing to a la rger-sized guiding catheter (which was required for peripheral vessel tortuosity in one patient, and to obtain better back-up support in ano ther). Three other attempts remained unsuccessful after a changing. A total of 12 Palmaz-Schatz stents were implanted in 11 patients for an unsatisfactory result or type C dissection, using the same 6 French gu iding catheters, These preliminary findings indicate that 6 French gui ding catheters are both effective and safe for angioplasty of chronic total occlusions. (C) 1997 Wiley-Liss, Inc.