Chronic Coronary Occlusion Ñ Treatment Options and Results.
Indications for chronic coronary occlusion angioplasty are based on the projected benefit and technical difficulties. With current indications, primary success is around 60% and complications are rare. In successful cases, the main benefits are improvement of symptoms and obviation of the need for bypass surgery. Late improvement of left ventricular function can also occur. Recurrences are frequent, but reocclusions occur only in about 20% of cases. Several techniques have been advocated to improve the success rate. It is obvious that the stiffer the instrument used the higher the crossing rate, but also the risk for perforation. While the laser wire aims at high crossing success, the Magnum wire aims at high safety. In about 800 cases using the Magnum wire, the success rate was 64% before, and 66% after crossover to another technique. Complications were comparable to those of routine coronary angioplasty. Chronic total occlusions are a major reason for selecting bypass surgery over angioplasty. The technical success with angioplasty leaves room for improvement. However, safety should not be compromised and there are limits to the investment in terms of time and material because the clinical yield is relatively small, albeit uncontested.
Meier
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Professor and Head of Cardiology, 3010, Bern, Switzerland.