PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY IN CHRONIC CORONARY-ARTERY OCCLUSION

Objectives. This study was conducted to determine the procedural succe ss rate, complication rate and long-term outcome of percutaneous trans luminal coronary angioplasty lin chronically occluded coronary arterie s. Background. Coronary angioplasty of chronically occluded vessels ha s a lower success rate than has angioplasty of nonoccluded vessels, bu t it is frequently considered safe because the target vessel is alread y occluded. The purpose of this study was to determine the reliability of these assumptions at our institution, with the objectives stated a bove. Methods. We identified from the angioplasty data base at our ins titution 100 consecutive coronary angioplasty procedures performed bet ween 1987 and 1991 for chronic total occlusion, defined as complete oc clusion (Thrombolysis in Myocardial Infarction [TIMI] grades 0 and 1 f low) for greater-than-or-equal-to 3 months. The records of the 95 pati ents who underwent these procedures were reviewed to determine procedu ral outcome and medium-term results. Results. Procedural success was o btained in 47 occluded vessels (47%). Significantly fewer successes we re obtained in the right coronary artery (26.8%) than in either the le ft anterior descending (57.1%) or the left circumflex (45%) coronary a rtery (p < 0.05). A procedural failure without serious adverse consequ ences Occurred in 45 procedures (45%), but in eight patients (right co ronary artery in five, left anterior descending artery in three) attem pted recanalization was complicated by extensive coronary dissection w ith acute myocardial ischemia, and one of these patients died. There w ere no emergency operations, but elective coronary artery bypass surge ry was undertaken in 26 patients (in 3 after extensive dissection, in 7 after an apparently good result and in 16 in whom the procedure fail ed). At 12 months after the procedure, 64.1% of those with a procedura l success were event free compared with 32.6% of those whose procedure was both unsuccessful and uncomplicated (p < 0.025) and 25% of those in whom it was unsuccessful and complicated by coronary dissection (p < 0.025).Conclusions. In this series of recanalization of chronically occluded coronary arteries, there was a low procedural success rate, p articularly for the right coronary artery. However, when procedural su ccess was obtained, the long-term outlook was good. The overall risk o f coronary dissection was comparable to the risk in nonoccluded vessel s but was particularly high in the right coronary artery (13%).