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Title:
Effects of percutaneous revascularization for chronic total coronary occlusions
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Subject:
chronic total coronary occlusion ; coronary artery disease ; percutaneous revascularization
Abstract:
The study aimed to evaluate the effects of percutaneous revascularization for chronic total coronary occlusions (CTO). Material and methods: the study group consisted of 73 patients aged from 41 to 72 years (mean age 56.7 ±7.95) selected for PTCA of CTO, with the presence of viable myocardium in the occluded artery area. Analysis of clinical and angiographic factors affecting immediate procedural success of CTO recanalization was done. Long-term outcome after CTO recanalization was assessed in 47 patients with procedural success. Before and after procedureall patients underwent: clinical study, ECG recording, echocardiography, exercise test, myocardial scintigraphy GSPECT, multislice spiral computed tomography (MSCT) of coronary arteries. 30 patients underwent control coronary angiography. Results and conclusions: 1.Immediate success rate of percutaneous recanalization of CTO is 64.38%. 2.Factors that reduce success rate of procedure are duration of occlusion > 8 months, length of occlusion > 18.3 mm, no visualization of the vessel distal to the occlusion, scopy time> 20 min, presence of bridging collaterals, distance between the occlusion site and the nearest side branch <4.3 mm, tapered end of vessel stump and tortuous course of the artery. 3.Recanalization of CTO results in a significant clinical improvement, myocardial perfusion improvement as well as global and regional le ; ft ventricular contractility improvement. 4.Restenosis after percutaneous recanalization of CTO is 38,3 %. 5.MSCT is a helpful tool in the diagnosis of reocclusion after recanalization of CTO. 6.Factors predisposing to in-stent restenosis after recanalization of CTO are the length of implanted stents >26 mm, diameter of the stented vessel segment <2.8 mm, stent edge dissection, diabetes mellitus and nominalstent diameter < 2.5 mm.