Circulation, Vol 85, 1003-1011, Copyright © 1992 by American Heart Association
MR Bell, PB Berger, JF Bresnahan, GS Reeder, KR Bailey and DR Holmes Jr
BACKGROUND. Coronary balloon angioplasty of chronic total occlusions is
associated with relatively low success rates and a high incidence of
restenosis. Whether there is long-term benefit in performing angioplasty of
these lesions is unknown. The purpose of the present report was to analyze
the long-term outcome of a large series of patients undergoing this
procedure. METHODS AND RESULTS. A computerized database analysis of 354
consecutive patients (from 1979 to 1990) who underwent coronary angioplasty
of a chronic total coronary occlusion was performed (mean age, 62.3 years).
Initial technical success was achieved in 69%; in 66%, success was achieved
without procedural death or need for coronary artery surgery. During
hospitalization, six patients suffered myocardial infarction, nine required
emergency bypass surgery, and nine patients died. During a mean follow-up
period of 2.7 years, no difference was found in survival or freedom from
myocardial infarction among 234 successfully dilated patients compared with
120 patients with a failed attempt. However, the use of coronary artery
bypass surgery was significantly less after successful dilation (p less
than 0.0001 versus failed attempt). No significant difference in the
cumulative incidence of severe angina was observed between these two
patient populations, with the majority remaining asymptomatic. Restenosis
occurred in 59% of 69 patients who returned for follow-up angiography.
CONCLUSIONS. Successful recanalization is achieved in the majority of
patients undergoing angioplasty of chronic total occlusions and reduces the
need for coronary artery bypass surgery. However, no major impact on either
survival or incidence of myocardial infarction was noted after successful
recanalization when patients with surgery were included.
ARTICLES
Initial and long-term outcome of 354 patients after coronary balloon angioplasty of total coronary artery occlusions
Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, MN 55905.
This article has been cited by other articles:
 |
|
 |
|
  S. Rathore, H. Matsuo, M. Terashima, Y. Kinoshita, M. Kimura, E. Tsuchikane, K. Nasu, M. Ehara, Y. Asakura, O. Katoh, et al. Procedural and In-Hospital Outcomes After Percutaneous Coronary Intervention for Chronic Total Occlusions of Coronary Arteries 2002 to 2008: Impact of Novel Guidewire Techniques J. Am. Coll. Cardiol. Intv., June 1, 2009; 2(6): 489 - 497. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Rathore, O. Katoh, H. Matsuo, M. Terashima, N. Tanaka, Y. Kinoshita, M. Kimura, E. Tsuchikane, K. Nasu, M. Ehara, et al. Retrograde Percutaneous Recanalization of Chronic Total Occlusion of the Coronary Arteries: Procedural Outcomes and Predictors of Success in Contemporary Practice Circ Cardiovasc Interv, April 1, 2009; 2(2): 124 - 132. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Prasad, C. S. Rihal, R. J. Lennon, H. J. Wiste, M. Singh, and D. R. Holmes Jr Trends in Outcomes After Percutaneous Coronary Intervention for Chronic Total Occlusions: A 25-Year Experience From the Mayo Clinic J. Am. Coll. Cardiol., April 17, 2007; 49(15): 1611 - 1618. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D Perera, P Postema, R Rashid, S Patel, L Blows, M Marber, and S Redwood Does a well developed collateral circulation predispose to restenosis after percutaneous coronary intervention? An intravascular ultrasound study Heart, June 1, 2006; 92(6): 763 - 767. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. E. Abbas, S. D. Brewington, S. R. Dixon, J. A. Boura, C. L. Grines, and W. W. O'Neill Intracoronary Fibrin-Specific Thrombolytic Infusion Facilitates Percutaneous Recanalization of Chronic Total Occlusion J. Am. Coll. Cardiol., September 6, 2005; 46(5): 793 - 798. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C.-C. Fang, Y. T. F. N. Jao, Y. Chen, and S.-P. Wang Coronary Stenting or Balloon Angioplasty for Chronic Total Coronary Occlusions: The Taiwan Experience (A Single-Center Report) Angiology, September 1, 2005; 56(5): 525 - 537. [Abstract] [PDF]
|
|
|
|
 |
|
 B. D. Powell, C. S. Rihal, M. R. Bell, K. J. Zehr, and D. R. Holmes Jr Anticipated Impact of Drug-Eluting Stents on Referral Patterns for Coronary Artery Bypass Graft Surgery: A Population-Based Angiographic Analysis Mayo Clin. Proc., June 1, 2004; 79(6): 769 - 772. [Abstract] [PDF]
|
|
|
|
|
|
Z. Olivari, P. Rubartelli, F. Piscione, F. Ettori, A. Fontanelli, L. Salemme, C. Giachero, C. Di Mario, G. Gabrielli, L. Spedicato, et al. Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE) J. Am. Coll. Cardiol., May 21, 2003; 41(10): 1672 - 1678. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. W. Stone, P. S. Teirstein, R. Rubenstein, D. Schmidt, P. L. Whitlow, E. J. Kosinski, G. Mishkel, and J. A. Power A prospective, multicenter, randomized trial of percutaneous transmyocardial laser revascularization in patients with nonrecanalizable chronic total occlusions J. Am. Coll. Cardiol., May 15, 2002; 39(10): 1581 - 1587. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Watanabe, T. Akasaka, Y. Yamaura, M. Akiyama, Y. Koyama, N. Kamiyama, Y. Neishi, S. Kaji, Y. Saito, and K. Yoshida Noninvasive detection of total occlusion of the left anterior descending coronary artery with transthoracic Doppler echocardiography J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1328 - 1332. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. A. Suero, S. P. Marso, P. G. Jones, S. B. Laster, K. C. Huber, L. V. Giorgi, W. L. Johnson, and B. D. Rutherford Procedural outcomes and long-term survival among patients undergoing percutaneous coronary intervention of a chronic total occlusion in native coronary arteries: a 20-year experience J. Am. Coll. Cardiol., August 1, 2001; 38(2): 409 - 414. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 C Lotan, Y Rozenman, A Hendler, Y Turgeman, O Ayzenberg, R Beyar, R Krakover, T Rosenfeld, and M.S Gotsman Stents in Total Occlusion for restenosis Prevention. The multicentre randomized STOP study Eur. Heart J., December 1, 2000; 21(23): 1960 - 1966. [Abstract] [PDF]
|
|
|
|
|
|
A Wahl, M Billinger, M Fleisch, B Meier, and C Seiler Quantitatively assessed coronary collateral circulation and restenosis following percutaneous revascularization Eur. Heart J., November 1, 2000; 21(21): 1776 - 1784. [Abstract] [PDF]
|
|
|
|
 |
|
 W. G. Hundley, L. D. Hillis, C. A. Hamilton, R. J. Applegate, D. M. Herrington, G. D. Clarke, G. A. Braden, M. S. Thomas, R. A. Lange, R. M. Peshock, et al. Assessment of Coronary Arterial Restenosis With Phase-Contrast Magnetic Resonance Imaging Measurements of Coronary Flow Reserve Circulation, May 23, 2000; 101(20): 2375 - 2381. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Gruberg, R. Mehran, G. Dangas, M. K. Hong, G. S. Mintz, R. Kornowski, A. J. Lansky, K. M. Kent, A. D. Pichard, L. F. Satler, et al. Effect of plaque debulking and stenting on short- and long-term outcomes after revascularization of chronic total occlusions J. Am. Coll. Cardiol., January 1, 2000; 35(1): 151 - 156. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Hoher, J. Wohrle, O. C. Grebe, M. Kochs, H.-H. Osterhues, V. Hombach, and A. B. Buchwald A randomized trial of elective stenting after balloon recanalization of chronic total occlusions J. Am. Coll. Cardiol., September 1, 1999; 34(3): 722 - 729. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Schofer, T. Rau, M. Schluter, and D.G. Mathey Restenosis after stenting of matched occluded and non-occluded coronary arteries. Should there be a difference? Eur. Heart J., August 2, 1999; 20(16): 1175 - 1181. [Abstract] [PDF]
|
|
|
|
|
|
J Hancock, M R Thomas, S Holmberg, R J Wainwright, and D E Jewitt Randomised trial of elective stenting after successful percutaneous transluminal coronary angioplasty of occluded coronary arteries Heart, January 1, 1998; 79(1): 18 - 23. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. B. King III Total Occlusions : The View of an Optimist Circulation, April 15, 1995; 91(8): 2113 - 2114. [Full Text]
|
|
|
|
|
|
A. G. Violaris, R. Melkert, and P. W. Serruys Long-term Luminal Renarrowing After Successful Elective Coronary Angioplasty of Total Occlusions : A Quantitative Angiographic Analysis Circulation, April 15, 1995; 91(8): 2140 - 2150. [Abstract] [Full Text]
|
|
|
|
 |
|
 C. Landau, R. A. Lange, and L. D. Hillis Percutaneous Transluminal Coronary Angioplasty N. Engl. J. Med., April 7, 1994; 330(14): 981 - 993. [Full Text]
|
|