Tan, Kim Heung; (1995) A study of the clinical outcome of complex coronary balloon angioplasty. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

Percutaneous transluminal coronary angioplasty has gained wide acceptance as a non-surgical form of revascularisation. However, its application in certain complex patient or lesion subsets has been the subject of considerable debate. This thesis examines some of these controversial issues. Coronary angioplasty of chronic total occlusions was shown to be associated with a low success rate, but also a low risk of complication. Successful recanalisation was adversely influenced by easily identifiable clinical and angiographic parameters, and reduced the use of subsequent bypass surgery. Although angioplasty of ostial stenoses was found to be associated with a higher complication rate than angioplasty of non-ostial lesions, there was no difference in the success rate. Distinctive procedural features included higher inflation pressures and inflation frequency for aorta ostial lesions. A third angioplasty for a second restenosis was shown to be safe and effective. Furthermore, the likelihood of a third restenosis could be predicted from the time interval between previous procedures. The restenosis pattern after 'tandem lesion' angioplasty, suggested that local factors were more important than systemic factors in influencing restenosis. Coronary angioplasty was found to be safe and effective in patients with previous bypass surgery. In patients aged [greater-than] 70 years of age, complete revascularisation was unnecessary to achieve symptomatic relief, but incomplete revascularisation meant poorer long-term survival. Evaluating angioplasty outcome using a lesion-specific morphological approach, was shown to allow better patient stratification than the ABC lesion classification scheme proposed by the American College of Cardiology/American Heart Association Task Force. When chest pain recurred after successful angioplasty, the mechanisms found to be responsible included restenosis, incomplete revascularisation, progression of coronary atherosclerosis, and non-cardiac pain. The time from successful angioplasty to onset of recurrent chest pain was the strongest predictor of angiographic outcome. The incidence of new lesion development was also shown to be higher in the vessels that had instrumented angioplasty.

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