Tibioperoneal (outflow lesion) angioplasty can be used as primary treatment in 235 patients with critical limb ischemia: five-year follow-up.

BACKGROUND: In a prospective, nonrandomized, consecutive series of tibioperoneal vessel angioplasty (TPVA), critical limb ischemia (CLI) patients' data were analyzed with regard to immediate and follow-up success. METHODS AND RESULTS: TPVA was successful in 270 of 284 critically ischemic limbs (95%), with 167 limbs (59%) requiring dilatation of 333 ipsilateral inflow obstructions to access and successfully dilate 486 of 529 (92%) tibioperoneal lesions. A clinical success (relief of rest pain or improvement of lower-extremity blood flow) was attained in 270 limbs at risk (95%). Clinical 5-year follow-up of 215 of 221 successful CLI patients (97%) with 266 successfully revascularized limbs revealed that bypass surgery occurred in 8% and significant amputations in 9% of limbs; 91% of the limbs were salvaged. The cohort's probability of survival was 56%: 58% for Fontaine class III and 33% for class IV patients. Class III compared with class IV patients had significantly (P<0.05) fewer surgical bypasses (3% versus 16%) and amputations: above-knee, 1% versus 4%; below-knee, 3% versus 12%; and transmetatarsal, <1% versus 21%. CONCLUSIONS: TPVA, often in combination with inflow lesions, is an effective primary treatment for critical limb ischemia. The poor cumulative survival reflects the existence of severe comorbidities, which could potentially be affected by aggressive and effective cardiovascular diagnostic and therapeutic strategies.

The acute outcome of tibioperoneal vessel angioplasty in 417 cases with claudication and critical limb ischemia.

A non-randomized, consecutive series of 417 first procedure tibioperoneal vessel angioplasty (TPVA) cases were analyzed to determine if angioplasty were an alternative revascularization technique for critical limb ischemia (CLI) and claudicants patients. TPVA was performed on 312 patients (70% male; age 66 +/- 10 years) with success attained in 406/417 cases (96%) of 605/657 lesions (92%): [461/469 stenoses (98%) and 144/188 occlusions (77%) *(P < 0.05)]. Claudication and CLI patients had similar rates of success. In claudication patients clinical success was 130/133 (98%); lesion success was 197/208 (92%); stenosis was 148/151 (98%); and occlusion was 49/57 (86%). In CLI patients clinical success was 270/284 (95%); lesion success was 408/449 (91%); stenosis was 313/318 (98%); and occlusion was 95/131 (73%). We conclude that TPVA is an effective revascularization technique for obstructed tibioperoneal vessels, with excellent success in stenotic (98%) and reasonable results in occluded vessels (77%). These data demonstrate TPVA effectiveness in CLI patients and in carefully selected claudicants with appropriate indications (severe, lifestyle limiting claudication) and readily amenable anatomy, and TPVA for CLI patients appears to be an effective revascularization technique.

Four-year follow-up of Palmaz-Schatz stent revascularization as treatment for atherosclerotic renal artery stenosis.

BACKGROUND: Stent revascularization is perceived as superior to balloon angioplasty and surgical revascularization, but the paucity of stent publications precludes even historical comparison with surgical data. METHODS AND RESULTS: Palmaz-Schatz stent revascularization of renal artery stenosis was successfully performed on 163 consecutive patients for poorly controlled hypertension or preservation of renal function. Of these, 145 were eligible for > or =6-month clinical follow-up of the effect of the procedure on renal function, blood pressure control, number of antihypertensive medications, and survival. At 4 years, systolic and diastolic blood pressures significantly decreased (from 166+/-26 to 148+/-22 mm Hg and from 86+/-14 to 80+/-11 mm Hg, respectively; P<0.05), and blood pressure control was more facile in approximately half of the patients. Creatinine decreased or remained stable in approximately two thirds of the patients. The cumulative probability of survival was 74+/-4% at 3 years, with few deaths related to end-stage renal disease. Survival was good in patients with normal (92+/-4%) baseline renal function, fair (74+/-7%) in those with mildly impaired renal function, and poor (52+/-7%) in patients with elevated baseline creatinine levels (> or =2.0 mg/dL). The combination of impaired renal function and bilateral disease adversely affected survival. CONCLUSIONS: Renal artery stent revascularization in the presence of normal or mildly impaired renal function had a beneficial effect on blood pressure control and a nondeleterious effect on renal function. Survival was adversely affected by renal dysfunction despite adequate revascularization. Early diagnosis and adequate revascularization before the onset of renal dysfunction could beneficially affect blood pressure control, preserve or prevent deterioration of renal function, and improve patient survival.

Stent revascularization for atherosclerotic renal artery stenosis. 1-year clinical follow-up.

Patients who had undergone stent revascularization of renal artery stenosis for poorly controlled hypertension, preservation of renal function, or both were monitored to assess the procedure's effect upon subsequent renal function and blood pressure control. At 1-year follow-up, systolic and diastolic blood pressures had significantly decreased (166 +/- 26 to 156 +/- 25 mmHg and 86 +/- 14 to 80 +/- 13 mmHg, respectively; P < 0.05), and creatinine levels decreased or remained stable in approximately two thirds of the patients. Renal artery stent revascularization appears to have a beneficial effect upon blood pressure control and a nondeleterious effect upon renal function in the majority of patients.

Coronary blood flow velocities during rotational atherectomy.

This study was designed to evaluate the alterations in doppler derived coronary blood flow velocities and flow reserve following rotational ablation. Changes in doppler derived coronary blood flow velocity variables have been valuable in assessing the physiological outcome following coronary balloon angioplasty. Rotational ablation's mechanism of plaque removal could alter distal vascular bed characteristics, and, as a result, intracoronary blood flow velocities and the coronary flow reserve. A 12-MHz doppler guidewire recorded intracoronary phasic velocities and coronary flow reserve (as assessed by the hyperemic response to adenosine [12-18 mcg intracoronary]) in 28 patients, before and after rotational ablation of 30 lesions. Adjunctive balloon angioplasty was performed in 27 of 28 patients (96%). Rotational ablation and adjunctive balloon angioplasty successfully reduced the lesion diameter (87 +/- 9% to 14 +/- 11%; P < 0.001). A significant increase in the mean distal average peak velocity (25 +/- 13 cm/sec, before; 47 +/- 22 cm/sec, after; P < 0.001), and decrease in the proximal to distal average peak velocity ratio, (2.1 +/- 1.3; to 1.2 +/- 0.4; P = 0.002) was recorded. The mean distal diastolic to systolic velocity ratio (before, 1.4 +/- 0.7; after, 1.6 +/- 0.8; P = 0.44) and the coronary flow reserve (before, 1.6 +/- 0.6; after, 1.5 +/- 0.5; P = 0.34) did not increase despite increases in distal velocities, following successful intervention. Doppler derived distal coronary blood flow velocities increased following rotational ablation and adjunctive balloon angioplasty, with resolution of transstenotic velocity gradient. Changes in distal phasic velocity pattern and coronary flow reserve, immediately after the intervention, were not useful in the assessment of the functional outcome and may be related to abnormalities in distal vascular bed vasoreactivity produced by rotational ablation.

Follow-up of primary Palmaz-Schatz stent placement for atherosclerotic renal artery stenosis.

A Palmaz-Schatz stent was successfully placed in 92 stenotic renal arteries (76 patients) for (1) hypertension in 62 (82%), and/or (2) chronic renal failure (serum creatinine > or = 1.5 mg/dl) and preservation of renal function in 39 (51%). Patients were followed to assess clinical and angiographic 6-month outcome. Angiography, performed in 45 of 62 eligible patients (73%) and in 56 of 74 treated arteries (76%), showed restenosis occurring in 14 renal arteries (25%). Serum creatinine improved or remained stable in 78% of patients. In patients with chronic renal failure, improvement or stability was observed in 55%. Blood pressure recordings significantly decreased for the entire cohort (systolic: 168 +/- 25 to 156 +/- 22 mm Hg, p < 0.0001; diastolic: 87 +/- 11 to 81 +/- 11 mm Hg, p < 0.005), and for hypertensive patients with normal creatinine (systolic: 179 +/- 20 to 155 +/- 23 mm Hg, p < 0.0001; diastolic: 92 +/- 9 to 83 +/- 12 mm Hg, p < 0.002). These follow-up data of a prospective, nonrandomized, observational study showed that stent recanalization of atherosclerotic renal artery stenoses was beneficial with regard to renal function and blood pressure response, and had a restenosis incidence of 25%.

Primary stent deployment in occlusive subclavian artery disease.

Primary (without antecedent balloon dilation) Palmaz stent implantation was successfully performed in 27 consecutive patients entering with 31 obstructed subclavian arteries. Stents (n = 50) were successfully deployed, using the brachial (n = 7), femoral (n = 16), or combined (n = 8) approach, to revascularize 31 subclavian vessels [8 occluded (26%); 23 stenotic (74%)], using a 6 or 7.5 French delivery system. The indications for intervention were arm claudication in 8 patients (30%), subclavian steal syndrome in 11 patients (41%), angina pectoris secondary to impaired blood flow to the left internal mammary artery coronary bypass in 6 patients (22%), and recanalization of a left subclavian occlusion to permit central arterial access and performance of a second interventional procedure 2 patients (7%). The percent diameter stenosis improved from 85 +/- 12% to 6 +/- 7% (P < 0.001); and, the peak and mean translesion gradients decreased, respectively, from 56 +/- 35 mm Hg to 3 +/- 4 mm Hg (P < 0.01), and 29 +/- 18 mm Hg to 2 +/- 2 mm Hg (P < 0.01). Procedural complications encountered were one stent dislodgement with migration into and uneventful deployment within the right external iliac artery, and two brachial artery repairs. No acute vessel closures, deaths, myocardial infarctions, cerebrovascular accidents, transient ischemic attacks, or need for transfusions occurred. Therefore, primary subclavian artery stent deployment can be performed using low-profile sheath systems with excellent success (100%), resulting in immediate restoration of pulsatile flow, and few complications. The incidence of lesion recurrence remains for follow-up studies.

The use of Gianturco-Roubin flexible metallic coronary stents in old saphenous vein grafts: in-hospital outcome and 7 day angiographic patency.

After placement of a Gianturco-Roubin metallic, coiled coronary stent(s) following balloon angioplasty (PTCA), a pre-discharge (7 day) angiogram determined the patency of the old coronary bypass vein graft(s) (SVG) (> or = 5 years remote from their last surgery, mean age: 8.5 +/- 1.8 years). Metallic, coiled stents were successfully deployed in 95/96 (99%) patients within 100/101 (99%) SVGs. The indications for deployment were threatened [81 patients (84%)] or acute [15 patients (16%)] vein graft closure following PTCA. Intragraft urokinase infusion was performed in 17 patients (17%) [6 patients with baseline occlusions; 11 with abrupt closure post PTCA]. Complications encountered included three (3%) in-hospital deaths (two procedure related) two (2%) Q wave myocardial infarctions, six (6%) non-Q wave myocardial infarctions, and 22 (22%) bleeding problems. These included, not mutually exclusively, 21 (22%) requiring transfusions, six (6%) cases of gastrointestinal bleeding, six (6%) pseudoaneurysms, five (5%) retroperitoneal haemorrhages and two (2%) cerebrovascular accidents. All patients received dipyridamole, aspirin, dextran, and anticoagulation (heparin 10-20,000 U intra-procedurally); a heparin infusion was continued for 5 +/- 1 days, despite warfarin administration which attained a therapeutic prothrombin time (PT) (1.5-2 times control) by 3 +/- 1 days. Out of the 95 successfully treated patients, six with eight stented grafts were ineligible for pre-discharge angiography. Of the six, three died in hospital (four SVGs), one had an intracerebral haemorrhage (one SVG), and two were asymptomatic patients with chronic renal failure (three SVGs).(ABSTRACT TRUNCATED AT 250 WORDS)

The impact of balloon angioplasty of coronary artery and/or vein bypass graft lesion(s) upon the survival of patients > or = 5 years after their last bypass surgery.

Data analyses of angioplasty patients, whose operative and angioplasty (PTCA) interval was > or = 5 years, were performed to determine if the site of PTCA (coronary artery (CA) and/or vein bypass graft (VG)) influenced longevity. PTCA was successful in 677/768 lesions (88%) (377/432 CA (87%), and 294/327 VGs (90%)) and resulted in clinical improvement in 280/322 patients (87%). Patients were stratified into those who underwent PTCA of a lesion(s) in a coronary artery only, a vein graft only, or in both a coronary artery and a vein graft. Survival, at 60 months, was adversely affected (P < 0.05) for VG (59%) in comparison to CA (86%) or CA + VG (86%) cohorts, which was reaffirmed by a Cox proportional hazard model. PTCA was effective in opening lesions in coronary arteries or vein grafts in patients whose last bypass surgery had occurred over 5 years previously; however, PTCA patients who only had a vein graft had a significantly diminished 5-year survival in comparison to the cohorts, who had a coronary artery lesion dilated, with or without an accompanying vein graft PTCA. Therefore, PTCA of isolated vein graft lesions may not be the best long-term therapeutic option for these patients; however, it may best serve patients, acutely and long-term, who have an amenable significant arterial lesion, whether or not an accompanying vein graft lesion is dilated.

Stenting of a renal artery stenosis achieves better relief of the obstructive lesion than balloon angioplasty.

A balloon-expandable (Palmaz-Schatz) stainless steel stent was utilized following balloon angioplasty (PTRA) to determine if the obstructive lesion, using quantitative methods (automated measuring the diameter stenosis, and transstenotic peak systolic and mean pressure gradients), was significantly further reduced or abolished. Hemodynamic transstenotic gradient and stenoses measurements were made during 21 renal artery stenting procedures; prior and following PTRA, and subsequent to stent deployment. The stent sizes placed in the renal arteries were 5 mm (19%), 6 mm (67%), and 7 mm (14%). The results were as follows: [table: see text] The balloon-expandable (Palmaz-Schatz) stent significantly further reduced, and in fact effectively abolished, the obstructive renal artery lesion in comparison to balloon angioplasty (PTRA). The stent's effectiveness with regard lesion recurrence, maintenance, and preservation of renal function; cure or improved management of hypertension; and survival will be determined by careful clinic follow-up.

Direct deployment of the iliofemoral balloon expandable (Palmaz) stent utilizing a small (7.5 French) arterial puncture.

A new, smaller (7.5F) stent delivery sheath system is described for deployment of the iliofemoral large balloon expandable (Palmaz) stainless steel stent which allows a brachial or ipsilateral retrograde femoral or popliteal approach. The procedure described does not require predilatation of the lesion prior to stent deployment.

Angiographic follow-up and clinical outcome of 126 patients after percutaneous directional atherectomy (Simpson AtheroCath) for occlusive peripheral vascular disease.

Angiographic and clinical follow-up data were obtained in 115/126 patients who underwent directional atherectomy for peripheral vascular disease; of the 126, ten were excluded for appropriate reasons and one was lost to follow-up. Thus, 115/116 successful atherectomy patients (99%) had follow-up of 182/213 lesions (86%): 74 patients (64%) with angiography (mean time 5.4 mon), and 41 patients (36%) clinically. One hundred twenty-eight of 183 lesions (70%) had angiographic follow-up; the lesion recurrence as a stenosis or as an occlusion was 53%. Lesion distribution did not differ between angiography and clinical follow-up groups: nearly 85% were within the superficial femoral or popliteal arteries. Despite data stratification, angiographic follow-up indicated that patients after successful directional atherectomy, at a mean follow-up time of 5 mos, have more than a 50% lesion recurrence rate. Although directional atherectomy (Simpson AtheroCath) utilizing present techniques has excellent primary success and acceptable complication rates, angiographic follow-up statistics are bothersome.

Percutaneous coronary angioplasty in 1,001 multivessel coronary disease patients: an analysis of different patient subsets.

The prospectively collected data of 1,001 multivessel coronary disease patients who underwent percutaneous transluminal angioplasty (PTCA) was analyzed after categorization into single vessel angioplasty (SVA; group I) and multiple vessel angioplasty (MVA; group II) PTCA groups, which were each compartmentalized into "simple" (group A) and "complex" (group B) cohorts. Patients were assigned to the SVA or MVA group according to the physician's pre-PTCA assessment of how many lesions would be attempted (intention to treat) and not the number of lesions actually attempted. A "simple" patient was more likely than a "complex" patient to be clinically improved after PTCA whether or not the patient had a single dilatation (90% vs 78%; P less than 0.05) or multiple dilatations (97% vs 94%; P<0.05). Similarly, a lesion(s) was more likely to be successfully dilated in the "simple" than in the "complex" group (SVA: 90% vs 82%, P less than 0.05; MVA: 97% vs 91%, P<0.05). In addition, occluded vessels in the MVA group were more likely to be recanalized than in the SVA group (73% vs 44%, P less than 0.05). Group I-A patients had a significantly increased (10%) incidence of emergency bypass surgery. Follow-up, at 84 months, showed that "simple" cohorts had a better survival than the "complex" cohorts (MVA: 95% vs 71%, P less than 0.05; SVA: 90% vs 72%, P less than 0.05); and, nearly two thirds of all successful PTCA patients were angina free.(ABSTRACT TRUNCATED AT 250 WORDS)

Percutaneous transluminal angioplasty in patients greater than or equal to 5 years after their last coronary bypass graft surgery.

Angioplasty (PTCA) was successfully performed in 257 of 304 patients (85%) greater than or equal to 5 years after their last bypass surgery. A lesion was successfully dilated in 496 of 566 vessels attempted (88%): 332/386 coronary arteries (86%) and 164/180 vein grafts (91%). Significant complications included: 8 (2.6%) mortalities, 4 (1.3%) emergency surgeries, 13 (4.3%) Q-wave myocardial infarctions, and 14 (4.6%) distal embolizations. Distal embolization occurred in 13/180 (7%) vein graft lesions dilated and usually resulted in a non-Q-wave infarction (4/13 distal embolizations). A second PTCA was performed on 89 (35%) patients: 44% of them had lesion recurrence; 20% a new lesion requiring dilatation; and 30% both recurrence and new lesion. Follow-up (mean 3.7 years) revealed 78% of patients having an improved anginal status, and 58% no angina. The cumulative probability of survival at 60 months was 88 +/- 3%. Angioplasty can be effectively employed in patients greater than or equal to 5 years remote from their last bypass surgery in native arteries or saphenous vein grafts with good procedural and long-term success. Vein graft age inherently does not appear to be a contraindication to angioplasty.

Percutaneous transluminal aortic valvuloplasty--the acute outcome and follow-up of 149 patients who underwent the double balloon technique.

Double balloon percutaneous transluminal aortic valvuloplasty (PTAV) was performed on 149 patients (76 male (51%), mean age 76 +/- 11 years) whose symptoms included severe congestive heart failure in 127 cases (82%), syncope in 21 (14%) and angina in six (4%). Significant changes (P less than 0.05) in peak systolic (83 +/- 36 to 38 +/- 30 mmHg) and mean gradient (68 +/- 25 to 36 +/- 21 mmHg), and aortic valve area (0.6 +/- 0.2 to 1.0 +/- 0.4 cm2) were achieved in 130/149 patients (87%). Complications included an overall in-hospital mortality of 13%, (10.0% excluding the six deaths occurring in 18 moribund patients), a neurologic deficit incidence of 3%, and surgical arterial entry site repair 3.0% (14/47) of patients. Multivariate analysis identified congestive heart failure (NYHA Class IV), left ventricular ejection fraction, cardiac output and coronary artery disease as independent variables significantly affecting in-hospital mortality. Predictors of poor long-term survival were degree of heart failure, and coronary artery disease. The cumulative probability of survival at 24 months was 52 +/- 5% (excluding non-cardiac deaths, was 66 +/- 3%). Follow-up (mean time: 16 +/- 7 months) of 130 patients discharged alive revealed 41 late deaths (26 cardiac related). Sixty-two patients (70%) were symptomatically improved; 17 patients had symptom recurrence and underwent repeat valvuloplasty, and 10 patients valve replacement. Follow-up catheterization of 18 asymptomatic patients revealed that 11 patients had silently restenosed. These data indicate that aortic valvuloplasty is a palliative therapy for elderly patients, who are poor surgical candidates, with symptomatic calcific aortic stenosis with reasonable clinical success and long-term survival when considering their clinical status, but with a significant restenosis rate.

Below-the-knee angioplasty: tibioperoneal vessels, the acute outcome.

Conventional balloon angioplasty (PTA) was attempted in 111 patients (60% male; mean age 67 +/- 9 years) with 168 below-the-knee, tibioperoneal vessels (TPV) lesions. The presenting predominant symptoms were claudication in 52 (47%), non-healing ulcer/gangrene in 30 (27%), and rest pain in 29 (26%) of patients. An above-the-knee vessel was dilated before TPV angioplasty in 62 patients (56%). A successful PTA was achieved in 152/168 (90%) TPV: stenoses, 124/125 (99%); occlusions, 28/43 (65%). Complications encountered included contrast-induced renal failure (4%), distal embolization (4%), entry site arterial repair or embolectomy (2%), dissection or occlusion (2%), and groin hematoma (2%). A significant complication (death, emergency bypass surgery, or distal embolization) occurred in only 3 patients (3%); no complications whatsoever were found in 100 patients (90%). At discharge, 106 patients (95%) were clinically improved. A restenosis and/or second PTA procedure occurred in 44/108 patients (40%) (mean time: 9 +/- 6 months) with the presenting predominant symptom being claudication in 38 patients (86%). However, only 36% of patients had lesion recurrence with or without new disease, and 64% showed evidence of disease progression with symptoms. Angiographic and clinical success was achieved in 42 patients undergoing second PTA (96%). These data indicate that balloon angioplasty can be successfully utilized in patients with symptomatic obliterative disease of the tibioperoneal vessels with excellent success, a low risk of complications, and good clinical improvement. PTA of the below-knee vessels should not be restricted to patients in limb salvage situations.

Peripheral transluminal angioplasty of the subclavian and innominate arteries utilizing the brachial approach: acute outcome and follow-up.

Percutaneous transluminal angioplasty (PTA) of the subclavian and innominate arteries was performed in 27 patients at 33 sites (30 subclavian, 3 innominate). All procedures were successful angiographically and clinically and were without complication. The ipsilateral arm was utilized in all cases. Indications for the procedure included claudication (ten patients), neurological symptoms (seven patients), to gain vascular access for other interventions (eight patients), and scheduled coronary bypass surgery with internal mammary utilization (two patients). There were 22 stenoses and 11 occlusions. Thrombi was retrogradely recovered through the arteriotomy site in three patients with vessel occlusions. No early or late episode of neurological deficit was seen. Follow-up was obtained in 22 patients (82%) at a mean time of 28 months (range, 2-73 months). The cumulative patency rate was 95%. The three restenosed sites were treated with successful repeat PTA. Angioplasty of stenotic or occluded subclavian or innominate arteries should be the procedure of choice in symptomatic patients.

Percutaneous transluminal aortic valvuloplasty: acute outcome and follow-up of 125 patients.

Percutaneous transluminal aortic valvuloplasty was performed on 125 patients (59 men [47%], mean age 76 +/- 13 years) between July 1986 and May 1988, with presenting symptoms of severe congestive heart failure in 88 (70%), moribund state in 15 (12%) and syncope in 17 (14%). Surgical valve replacement was considered unsuitable in 79% of cases. A multiple balloon technique was utilized in 119 patients (95%). Valvuloplasty produced significant changes in peak pressure gradient (87 +/- 38 to 32 +/- 17 mm Hg), mean pressure gradient (70 +/- 26 to 30 +/- 13 mm Hg) and valve area (0.6 +/- 0.2 to 1.0 +/- 0.3 cm2). Complications included: in-hospital mortality in 10% (6 of 13 deaths in moribund patients), neurologic deficit in 3% and myocardial infarction in 2%. Arterial repair was required at 12 (4%) of 325 entry sites. Multivariate analysis identified severe congestive heart failure, preprocedure left ventricular ejection fraction and cardiac output as the only independent variables significantly affecting mortality. The cumulative probability of survival at 12 months was 62 +/- 6% and, excluding non-cardiac deaths, was 77 +/- 5%. At a mean of 12 +/- 4 months' follow-up, 55 of 72 patients were symptomatically improved; 10 patients with symptom recurrence underwent repeat valvuloplasty and 5 had valve replacement. Cardiac catheterization was repeated in 12 symptomatically improved patients, 9 of whom had valve restenosis. These data indicate that aortic valvuloplasty should be considered a palliative therapy for elderly patients with symptomatic calcific aortic stenosis who are poor surgical candidates.

Percutaneous transluminal coronary angioplasty in patients over the age of 70 years.

Percutaneous transluminal coronary angioplasty was successfully performed in 207 of 242 patients over the age of 70 years. Multivessel disease was present in 71 per cent of patients; 93.0 per cent of patients had good left ventricular ejection fractions (greater than or equal to 35 per cent). Angioplasty was successful in 348 of 385 lesions dilated (90 per cent), with the desired degree of revascularization achieved in 90 per cent of patients with the dilatation of one or two lesions. The complications encountered included five Q wave infarctions (2.1 per cent), seven angioplasty-related deaths (2.9 per cent), and three emergency bypass surgeries (1.2 per cent). The cumulative probability of survival was 92 +/- 3 per cent at 63 months, and at a mean of 2.9 years 66 per cent of patients were angina-free. These data indicate that selected symptomatic coronary disease patients over the age of 70 years unsatisfactorily managed with medication have been successfully managed with coronary angioplasty. The results of coronary angioplasty compare favorably to those of coronary artery bypass surgery.

Complex angioplasty: single versus multiple dilatations in multivessel coronary disease patients.

Percutaneous transluminal coronary angioplasty (PTCA) has become an accepted therapy in the management of selected patients with obstructive coronary disease, including selected patients with multivessel disease. This article reports the authors' experience with PTCA in patients who underwent single or multiple dilatation angioplasty, their outcome, and follow-up. It also provides an additional perspective to the multivessel coronary disease patient.