Coronary angioplasty in patients who undergo multiple vessel angioplasties, and in patients who have multivessel coronary disease.

ABSTRACT

Percutaneous transluminal coronary angioplasty (PTCA) was performed in patients who underwent multiple vessel angioplasties (MVA) and in patients with multivessel coronary disease (MCD). There were 235 MVA patients who underwent 255 procedures during which 600 lesions were dilated. Two lesions were dilated in 75% of cases, and three lesions in 16% of cases. 93% of the lesions were successfully dilated and 91% of the patients were clinically improved. Complications encountered included a 1.6% mortality, a 3.5% incidence of transmural infarction, and a 2.4% emergency surgery rate. Significant complications occurred in 13 patients (4.6%). A clinically apparent restenosis occurred in 51 patients (24%) with a repeat PTCA performed in 25/26 patients (96%), elective surgery in 14 patients, and the remainder were treated medically. 82% of patients remain clinically improved more than one year after a successful PTCA. There were 331 MCD patients who underwent 387 procedures during which 662 lesions were dilated. One lesion was dilated in 47% of cases, two lesions in 39% of cases, three lesions in 9% of cases, and four or more lesions in 5% of cases. 91% of the lesions were successfully dilated, and 90% of the patients were clinically improved. Complications encountered included a 1.6% mortality, a 3.1% incidence of transmural infarction, and a 3.9% emergency surgery rate. Significant complications were encountered in 35 patients (9%). A clinically apparent restenosis occurred in 46 patients (21%) with a repeat PTCA performed in 29/31 patients (94%), elective surgery in nine patients, and the remainder were treated medically. 86% of patients remain clinically improved more than one year after a successful PTCA. PTCA can be performed in carefully selected patients undergoing MVA, and in MCD patients with a good success rate, a low complication rate, and a satisfactory long term benefit. However, a large clinical trial would be most beneficial in establishing PTCA's role in the treatment of extensive coronary disease.