[Angioplasty in total occlusion of the coronary arteries: the importance of the angiographic variables].
Total coronary occlusions can be treated by coronary angioplasty with a lower success rate when compared to the angioplasty success rate of stenoses. To evaluate factors associated with successful re-opening of total coronary occlusion we evaluated 128 occlusions attempted in 120 patients. We analyzed clinical and angiographic variables. Successful re-opening was obtained in 65% of total occlusions attempted; 1 patient (0.8%) had to undergo emergency coronary artery bypass surgery. Only the morphological characteristics of the occlusions were predictive of success. When total occlusions had a tapered morphology, success was achieved in 87% of the attempts versus 50% of success without tapered morphology (p < 0.001). The success, when the occlusion was associated with the presence of bridging collaterals, was very low (present: 30% success; absent: 71% success, p < 0.005). Success for occlusions longer than 1.5 cm was lower when compared to shorter occlusions (61% vs 78%; p < 0.005). The type of occlusion (absolute, functional), the presence of a branch originating at the level of the occlusion, the duration of the occlusion, the artery and its segment were not predictive of success. Multivariate analysis showed that tapered morphology was the only variable associated with successful re-opening of a total occlusion (87% probability of success when present). We conclude that it is possible to re-open a total coronary occlusion with low complication rate and high primary success rate when careful care is applied with particular attention paid to the morphology of the occlusion.
Maiello
L
L
Centro Cuore Columbus, Sezione Emodinamica, Milano.
Colombo
A
A
Gianrossi
R
R
Martini
G
G
Finci
L
L
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000379:methods / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012074:Remission Induction