Complete myocardial revascularization by single session triple vessel percutaneous coronary angioplasty and provisional stenting

Background: Although availability of stents has made percutaneous translumi nal coronary angioplasty (PTCA) safer, single vessel angioplasty still repr esents 90% of procedures performed today. We report our initial experience with single session triple vessel angioplasty, using stents as needed to im prove suboptimal balloon results. Patients: Fourteen patients (12 men, 85%) , aged 67 +/- 9 years were treated. All had triple vessel disease and angin a, Mean left ventricular ejection fraction was 61% +/- 8%. Results: PTCA wa s attempted in all three coronaries or one of their major branches during t he same procedure. Seventeen target lesions were in the left anterior desce nding coronary artery, 2 in a diagonal branch, II in the left circumflex, 2 in a marginal branch, 13 in the right coronary artery, 3 in the posterior descending, and I a saphenous vein graft. PTCA of 3.5 +/- 0.7 sites/procedu re was attempted. The success rate was 13 (93%) of 14 patients and 47 (96%) of 49 lesions. Thirty-four (69%) lesions were treated by implantation of o ne or several stents, and 10 (71%) of 14 patients received at least one ste nt. Hospital stay duration was 4 +/- 2 days. One patient required repeat PT CA to treat subacute stent thrombosis 2 days after the procedure (creatine kinase [CK] peak ( 2 times upper limit of normal). There were no in-hospita l deaths, e-wave infarction, or need for coronary artery bypass grafting (C ABG). After a median follow-up period of 24 months (range 3-102), one (7%) patient had died of a noncardiac cause, three (21%) had required repent PTC A for restenosis in previously dilated lesions, and none had suffered a myo cardial infarction. At follow-Lip, the median angina class was I (range I-I I). Conclusion: For selected patients with three vessel disease, complete r evascularization by single session PTCA and provisional stenting as needed is feasible, and is associated with a low rate of short- and long-term comp lications when successfully performed.