PTCA--clinical aspects.
At Emory University Hospital, 7,000 coronary angioplasty procedures have been performed since 1980. The overall success rate remains around 90% despite extensive broadening of the indications. Complications include emergency surgery in 2.5%, acute infarction in 2.5%, and a mortality of 0.2%. Major problems are acute closure and recurrence of stenosis. Factors predisposing to acute closure include lesion length, female gender, bend in the artery at the area of stenosis, branch point location, thrombus in the artery and other lesions in the same vessel. Therapy for acute closure includes prolonged balloon inflations, the use of the bail-out catheter, and for the future, intracoronary stenting devices. Restenosis occurs in approximately 25% of the patients and is influenced by male gender, unstable angina, total occlusion, location of the lesions, and incomplete results of angioplasty. Attempts at modifying restenosis included anti-platelet therapy, anticoagulation and calcium antagonists. At the present it is felt that more potent antiplatelet agents will be required to make additional improvements in the restenosis rate. Long-term follow-up of the Emory cohort reveals a 4 1/2 year survival of over 96% with 89% free from death, myocardial infarction or the need for coronary bypass surgery. In order to identify the proper role of angioplasty in multivessel disease, a prospective randomized trial is now being instituted at Emory to evaluate the relative merits of angioplasty and coronary bypass surgery.
D000800:Angioplasty, Balloon / Q000009:adverse effects; D003327:Coronary Disease / Q000628:therapy*; D005500:Follow-Up Studies; D006801:Humans; D012008:Recurrence