Transluminal angioplasty of occluded coronary arteries: use of a movable guide wire system.

Publisher Website
Google Scholar
Abstract
Of 47 consecutive patients referred for coronary angioplasty, the procedure was attempted in 13 patients despite occlusion of the involved vessel. This included 4 patients with total coronary occlusion and 9 with functional coronary occlusion (faint, late antegrade opacification in the absence of a discernible luminal continuity). All procedures were performed with an angioplasty system in which the leading guide wire could be moved independently of the dilatation catheter. Primary success was obtained in 54% (7/13) of patients with coronary occlusion compared with 85% (29/34) in the remaining patients with conventional stenoses between 75 and 95% (91 .+-. 5%, mean .+-. SD; P < 0.02). In patients with coronary occlusion, the mean residual stenosis after angioplasty (41%). The abrupt reclosure rate (8%), and the incidence of angiographically evident dissection (29%) were similar to those seen in the 34 patients who underwent angioplasty of conventional stenoses, although restenosis tended to be more common (43 vs. 23%) in patients with coronary occlusion. No evidence of coronary perforation or distal embolization was found in either group, and no patient undergoing angioplasty of an occluded vessel required emergency surgery, despite 1 case of abrupt reclosure. All patients with coronary occlusion had prominent collateral flow to the occluded vessel, which could no longer be visualized after successful angioplasty. These collaterals were associated with a higher distal pressure (35 .+-. 10 mm Hg) in patients with coronary occlusion than that seen in patients with less severe stenoses and no visible collaterals (distal occluded pressure 20 .+-. 7 mm Hg; P < 0.001). Although the primary success rate is lower than that associated with conventional stenotic lesions, coronary angioplasty can be performed safely and successfully in the majority of patients with coronary occlusion.