Transluminal coronary angioplasty of the right coronary artery brachial cutdown approach.

Transluminal coronary angioplasty (TCA) of the right coronary artery (RCA) was performed by brachial cut-down approach in 33 patients during a period of 16 months. Flexible-tip guiding catheters were used in all cases. TCA was successful in 27 of 33 patients (81%). The stenosis was reduced in successful cases from a mean of 89% predilatation to 26% postdilatation (P less than 0.001). The systolic pressure gradient across the lesion was reduced from a mean of 49 mm Hg to 4 mm Hg (P less than 0.001). Following successful TCA, patients experienced marked improvement in clinical status, functional capacity, and relief of angina. The complication rate in this study was low. There was no early or late mortality. The most common complication was dissection of the coronary artery occurring in four cases (12%). One patient sustained an acute inferior myocardial infarction. Only one patient required emergency coronary artery bypass surgery. The late follow-up (mean 6 months) angiography was obtained in 17 patients. The stenosis recurred in late follow-up in three cases (18%). Our initial experience revealed that the use of softer guiding catheters by brachial technique offers more selective approach for TCA of RCA lesions and provides better results than percutaneous femoral approach with fixed-tip catheters. Our success rate of 81% for dilatation of RCA is significantly higher than previously reported.