Coronary transluminal angioplasty. Current indications, criteria of success and a 2d angioplasty
Sousa, J.E.; Pimentel, W.A.; Büchler, J.R.; de Moraes, A.G.; de Assis, S.F.; Fontes, V.F.; Cano, M.; Esteves, C.A.; Inciarte, D.J.; Arnoni, A.S.
Arquivos Brasileiros de Cardiologia 45(1): 17-25
1985
ISSN/ISBN: 0066-782X PMID: 2938560 Document Number: 246241
From December 1979 to December 1984 we performed 715 transluminal coronary angioplasties (TCA) in 643 patients (P), age 25 to 80 years (average 53.5 years, 501 males). Sixty-eight P (10.4%) were above 65 years old. Elective TCA was carried out in 604 cases, and the remaining 39 were acute coronary syndromes (unstable angina (29.7%), angina post myocardial infarction (MI) (17.1%), acute MI with streptokinase (SK) (18.2%) or without SK (35.2%). The following complications were observed immediately after TCA: coronary occlusion 3.7%, coronary artery dissection 1.2%, emergency bypass surgery 3.9%, death 0.27%. There was a reduction in emergency surgery as experience increased with the method (8% in 1981 to 2.6% in 1984). Three-hundred and fifty-four cases were followed up to 5 years post-TCA either clinically or through invasive or non-invasive methods (cinecoronaryangiography in 299P, bicycle exercise test associated or not with thallium 201 scintigraphy 42P, clinical follow-up 5P). Restenosis occurred in 90P in a period ranging from 1 to 12 months (media 3.6m); 90% of these P had angina and the remaining 10% had a positive thallium 201 or stress test. Repeated TCA success rate was 84.6% (33/39P). Seven out of the 33P developed late restenosis (25%). Two patients underwent successful TCA (third dilatation), and one of them presented restenosis and underwent bypass surgery. The authors conclude that TCA is an established therapeutic method in atherosclerotic coronary artery disease (with an increasing spectrum of indications). Complications progressively diminish as experience increases. Restenosis should be treated by a second TCA, which is associated with a similar immediate and late success rate (cummulative success 85%).