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Potential and Limitations of PTCA in Severe Coronary Artery Disease

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Abstract

In the late seventies coronary angioplasty was limited to the treatment of simple lesions only (i.e. type A or type B1 according to the classification of the American Heart Association). The method was also restricted to patients with single-vessel-disease. The success-rate in these short, non calcified, non thrombotic lesions of rather straight segments was about 70%. Severe complications (Q-infarction, emergency CABG, death) happened in 5 to 10% of the patients, and restenosis occured in 20 to 40%. Today, more complex lesions (type B2 and C following the AHA-classification) are treated and patients with multi-vessel-disease are the majority. Operator experience and an incredibly rapid development of technology resulted in a success rate of 99% in type A and B1 lesions and 90% with more complex stenoses. Chronic old occlusions can now be recanalized in about 70% of the patients. Severe complications (Q-wave myocardial infarction, emergency coronary bypass operation, or death) happen in no more than 1% of the patients treated today.

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References

  1. RITA (1993) Trial Participants. Coronary angioplasty versus coronary artery bypass surgery: the Randomized Intervention Treatment of Angina (RITA) trial. Lancet 341:573–580

    Article  Google Scholar 

  2. Goy JJ, Eckhout E, Burnand B et al. (1994) Coronary angioplasty versus left internal mammary artery grafting for isolated proximal left anterior descending artery stenosis. Lancet 343:1449–1453

    Article  PubMed  CAS  Google Scholar 

  3. Hamm CW, Reimers J, Ischinger T, Rupprecht H-J, Berger J, Bleifeld W (1994) A randomuized study of coronary angioplasty compared with bypass surgery in patients with symptomatic multivessel coronara disease. N Engl J Med 331:1037–1041

    Article  PubMed  CAS  Google Scholar 

  4. King SB III, Lembo NJ, Weintraub WS et al. (1994) A randomized trial comparing coronary angioplasty with coronary bypass surgery. N Engl J Med 331:1044–1050

    Article  PubMed  Google Scholar 

  5. CABRI Trial Participants. First-year results of CABRI (coronary Angioplasty versus Bypass Revascularisation Investigation). Lancet 346:1179–1184

    Google Scholar 

  6. The Bypass Angioplasty Revascularization Investigation (BARI) Investigators (1996) Comparison of coronary bypass surgery with angioplasty in patients with multivessel disease. N Engl J Med 335:217–225

    Article  Google Scholar 

  7. Pocock SJ, Henderson RA, Rickards AF et al. (1995) Meta-analysis of randomized trials comparing coronary angioplasty with bypass surgery. Lancet 346:1184–1189

    Article  PubMed  CAS  Google Scholar 

  8. Sim I, Gupta M, McDonald K, Bpourassa MG, Hlatky MA (1995) A meta-analysis of randomized trials comparing coronary artery bypass grafting with percutaneous transluminal coronary angioplasty in multivessel coronary artery disease. Am J Cardiol 76:1025–1029

    Article  PubMed  CAS  Google Scholar 

  9. Holmes DR Jr, Bates ER, Kleiman NS, Sadowski Z, Horgan JH, Morris DC, Califf RM, Berger PB, Topol EJ (1995) Contemporary reperfusion therapy for cardiogenic shock: the GUSTO-I trial experience. The GUSTO-I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. J Am Coll Cardiol 26:668–674

    Article  PubMed  Google Scholar 

  10. O’Keefe JH Jr, Bailey WL, Rutherford BD, Hartzler GO (1993) Primary angioplasty for acute myocardial infarction in 1,000 consecutive patients. Results in an unselected population and high-risk subgroups. Am J Cardiol 72:107G–115G

    Article  PubMed  Google Scholar 

  11. Lee L, Erbel R, Brown TM, Laufer N, Meyer J, O’Neill WW (1991) Multicenter registry of angioplasty therapy of cardiogenic shock: initial and long-term survival. J Am Coll Cardiol 17:599–603

    Article  PubMed  CAS  Google Scholar 

  12. Stevens T, Kahn JK, McCallister BD, Ligon RW, Spaude S, Rutherford BD, McConahay DR, Johnson WL, Giorgi LV, Shimshak TM et al. (1991) Safety and efficacy of percutaneous transluminal coronary angioplasty in patients with left ventricular dysfunction. Am J Cardiol 68:313–319

    Article  PubMed  CAS  Google Scholar 

  13. Eltchaninoff H, Franco I, Whitlow PL (1994) Late results of coronary angioplasty in patients with left ventricular ejection fraction<or = 40%. Am J Cardiol 73:1047–1052

    Article  PubMed  CAS  Google Scholar 

  14. Reifart N, Vandormael M, Krajcar M, Göhring S, Preusler W, Schwarz F, Störger H, Hofmann M, Klöpper J, Müller S, Haase J (1997) Randomized comparison of angioplasty of complex coronary lesions at a single center. Excimer laser, Rotational atherectomy, and Ballon Angioplasty Comparison (ERBAC) study. Circulation 96:91–98

    PubMed  CAS  Google Scholar 

  15. Bittl JA (1996) Advances in coronary angioplasty. N Engl J Med 335:1282–1289

    Article  Google Scholar 

  16. Fischman DL, Leon MB, Baim DS, Schatz RA, Savage MP, Penn I, Detre K, Veltri L, Ricci D, Nobuyoshi M, Cleman M, Heuser R, Almond D, Teirstein PS, Fish RD, Colombo A, Brinker J, Moses J, Shaknovich A, Hirshfeld J, Bailey S, Ellis S, Rake R, Goldberg S (1994) A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease: Stent Restenosis Study Investigators. N Engl J Med 331:496–501

    Article  PubMed  CAS  Google Scholar 

  17. Topaz O, Vetrovec GW (1996) The stenotic stent: mechanisms and revascularization options. Cathet Cardiovasc Diagn 37:293–299

    Article  PubMed  CAS  Google Scholar 

  18. Hoffmann R, Mintz GS, Dussaillant GR, Popma JJ, Pichard AD, Satler LF, Kent KM, Griffin J, Leon MB (1996) Patterns and mechanisms of in-stent-restenosis. A serial intravascular ultrasound study. Circulation 94:1247–1254

    PubMed  CAS  Google Scholar 

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© 1998 Springer-Verlag Berlin Heidelberg

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Reifart, N., Göhring, S. (1998). Potential and Limitations of PTCA in Severe Coronary Artery Disease. In: Klein, M., Schulte, H.D., Gams, E. (eds) TMLR Management of Coronary Artery Diseases. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-72134-2_6

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  • DOI: https://doi.org/10.1007/978-3-642-72134-2_6

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-72136-6

  • Online ISBN: 978-3-642-72134-2

  • eBook Packages: Springer Book Archive

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