SAFETY AND EFFICACY OF PTCA IN THE TREATMENT OF CORONARY TOTAL OCCLUSION

Abstract

Background: In recent years several centers have published data suggesting that total coronary occlusion is
not a rare finding. Further exploration and improvement of percutaneous technique aimed at the treatment
of this potentially large group of patients therefore seems justifiable. A retrospective study was thus carried
out to analyze the short-term results of PTCA attempts on coronary total occlusion. Methods: St Thomas'
hospital London cardiac intervention database was used to retrieve 76 consecutive patients with total
coronary occlusion who had undergone PTCA (82 procedures) during Jan 1992 to Oct 1995. Either
conventional (20%), Kaltenbach (37%) or a Magnum (43%) wire was used to cross the total occlusions.
Results: Sixty-five (86%) of these patients were males with mean age of 57 + 6 . Of these procedures 47(57 %)
were successful (Group A) while in 35(43%) the PTCA wire did not cross the total occlusions (Group B). Risk
factors, prior myocardial infarction (MI), previous PTCA and anginal status were comparable in two groups.
Incidence of target location was 24(51%), 8(17%) and 14(30%) in Group A as compared to 9(26%), 7(23%)
and 16(46 %) in Group B for LAD, RCA and Cx respectively. The overall incidence of gross dissections was
4.8%. One patient from group B developed acute MI during the procedure and two died on the table. There
were, however, no major complications (including Ac MI or death) amongst group A patients during
hospitalization. None of the patients from either group required emergency CABG. Conclusions: PTCA is a
reasonably safe procedure for the treatment of coronary total occlusions. All the three types of wires used
were almost equally effective in crossing the occlusions. Treatment success was significantly related to the age
and site of occlusion.