Percutaneous revascularization of chronic coronary occlusions: An overview

• Published in: Journal of the American College of Cardiology 1995-07, Vol.26 (1), p.1-11
• Main Authors: Puma, Joseph A., Sketch, Michael H., Tcheng, James E., Harrington, Robert A., Phillips, Harry R., Stack, Richard S., Califf, Robert M.
• Format: Article
• Language: English
• Subjects: Angioplasty, Balloon, Coronary - adverse effects; Biological and medical sciences; Chronic Disease; Combined Modality Therapy; Coronary Artery Bypass; Coronary Disease - drug therapy; Coronary Disease - mortality; Coronary Disease - therapy; Diseases of the cardiovascular system; Fibrinolytic Agents - therapeutic use; Humans; Medical sciences; Prognosis; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Treatment Failure
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(95)00156-T

Patients with a chronic coronary occlusion often undergo coronary angiography after weeks to months of occlusion. The published reports underestimate the extent of this problem because such patients are often arbitrarily assigned to receive medical therapy or undergo bypass surgery as a result of poor success with percutaneous revascularization and substantial restenosis. Thus, there is controversy about the role of angioplasty in this patient cohort. The goal of this overview was to evaluate the available information about angioplasty in chronic coronary occlusions. The primary indication for attempted recanalization of a chronic coronary occlusion has been symptomatic angina pectoris. Anginal status often improves after successful procedures (70% vs. 31% with a failed procedure); left ventricular function may improve; and subsequent referral for coronary artery bypass graft surgery is uncommon (3% vs. 28% in unsuccessful cases). Successful recanalization is achieved in ∼65% of attempted procedures. Inability to cross the stenosis with a guide wire is the most common cause of procedural failure. Statistically significant predictors of procedural success include older occlusions (75% 15 mm. Procedural complications occur at a slightly lower incidence than in angioplasty of high grade subtotal stenoses. Long-term success is limited, and restenosis can be expected in >50% of the patients. The experience with chronic total occlusions of saphenous vein bypass grafts is small, but there appear to be limited procedural success and significant procedural complications, particularly associated with distal emboli. The role of new pharmacologic agents has yet to be defined and that of new devices has been disappointing so far, but further technologic advances are on the horizon.