Complete myocardial revascularization by single session triple vessel percutaneous coronary angioplasty and provisional stenting

Abstract

Background: Although availability of stents has made percutaneous transluminal coronary angioplasty (PTCA) safer, single vessel angiopIasty still represents 90% of procedures performed today. We report our initial experience with single session triple vessel angioplasty, using stents as needed to improve suboptimal balloon results. Patients: Fourteen patients (12 men, 85%), aged 67 ± 9 years were treated. All had triple vessel disease and angina. Mean left ventricular ejection fraction was 61% ± 8%. Results: PTCA was attempted in all three coronaries or one of their major branches during the same procedure. Seventeen target lesions were in the left anterior descending coronary artery, 2 in a diagonal branch, 11 in the left circumflex, 2 in a marginal branch, 13 in the right coronary artery, 3 in the posterior descending, and 1 a saphenous vein graft. PTCA of 3.5 ± 0.7 sites/procedure was attempted. The success rate was 13 (93%) of 14 patients and 47 (96%) of 49 lesions. Thirty-four (69%) lesions were treated by implantation of one or several stents, and 10 (71%) of 14 patients received at least one stent. Hospital stay duration was 4 ± 2 days. One patient required repeat PTCA to treat subacute stent thrombosis 2 days after the procedure (creatine kinase [CK] peak < 2 times upper limit of normal). There were no in-hospital deaths. Q-wave infarction, or need for coronary artery bypass grafting (CABG). After a median follow-up period of 24 months (range 3-102), one (7%) patient had died of a noncardiac cause, three (21%) had required repeat PTCA for restenosis in previously dilated lesions, and none had suffered a myocardial infarction. At follow-up, the median angina class was I (range I-II). Conclusion: For selected patients with three vessel disease, complete revascularization by single session PTCA and provisional stenting as needed is feasible, and is associated with a low rate of short- and long-term complications when successfully performed.