Coronary angioplasty of 'complex lesions' in patients with unstable angina.

Out of 55 patients subjected to coronary angioplasty over the past 12 months, there were 33 (60%) who had unstable angina. Amongst these, 22 patients had coronary lesions classified as 'complex' on coronary angiography. These included tandem lesions, branch stenoses, distal lesions, total occlusions, vein graft stenoses, lesions with ulceration and intraluminal clot and associated with valvular lesions. We describe our experience of coronary angioplasty in these 22 patients of unstable angina having 'complex lesions'. All were males with a mean age of 48.7 +/- 13 years. Fourteen patients had single vessel and 8 multivessel disease. A total of 35 lesions were subjected to dilatation. The angiographic primary success was achieved in 85.7% of the lesions attempted. Except total occlusions and very distal lesions, all other types of 'complex lesions' could be dilated with a success rate of greater than 75%. There were 4 (11.4%) failures because of inability to cross the lesion with the guidewire or balloon catheter. One patient developed non-Q wave inferior wall infarction. There were no deaths. We conclude that coronary angioplasty of various types of 'complex lesions' can be performed with a good primary success and negligible complications in our setting.