Elective PTCA of totally occluded coronary arteries not associated with acute XXXX ; short-term and long-term results.

@entity1 @entity583 @entity432 @entity158
Of 652 consecutive @entity1 referred for coronary angioplasty between September 1980 and March 1984, 49 @entity1 presented with total or functional 'occlusion' of the involved vessel. @entity432 was defined as absent anterograde filling beyond the lesion. Functional occlusion was defined as faint, late anterograde opacification of the distal segment in the absence of a discernible luminal continuity. In 39 @entity1 , the @entity432 represented a progression, without acute @entity583 , of a previously diagnosed stenotic lesion. The maximal potential duration of occlusion was estimated to be 4 weeks or less in 21 @entity1 , more than 4 to 8 weeks in 12, and more than 8 weeks in 16. Dilation of the occluded artery was attempted in the left anterior descending coronary artery in 30 @entity1 , in the right coronary artery in 8, in the circumflex coronary in 7 and in 4 jumpgrafts. For the whole group, angioplasty was successful in 28 @entity1 (57%). The primary success rate with the functionally occluded vessel (81%) was significantly higher than with the total occlusion (45%). In 33 @entity1 with an occlusion estimated to be of 8 weeks or less, angioplasty was successful in 65%. In the 16 @entity1 with an occlusion estimated to be of 8 weeks or less, angioplasty was successful in 65%. In the 16 @entity1 with an occlusion estimated to be of more than 8 weeks duration, dilation was successful in 44%. Of the 21 @entity1 in whom angioplasty was unsuccessful, 11 required surgery (1 urgent with persistent @entity158 and ST elevation and 10 elective). Ten @entity1 were maintained on medical treatment. Of the 28 @entity1 in whom angioplasty was successful, 10 @entity1 had recurrence of symptoms during follow-up (1-42 months). Four were kept on medical therapy, three required bypass surgery and three underwent repeat percutaneous transluminal coronary angioplasty (PTCA). After primary success, late angiographic studies obtained in 20 out of 28 @entity1 showed reocclusion in 8. In conclusion, elective PTCA of totally occluded coronary arteries is feasible but the primary success rate is lower (57%) than that associated with conventional lesions. The long-term clinical results following successful angioplasty are satisfactory (64%), but the incidence of reocclusion is higher (40%).
