[Some comments apropos of 120 cases of transluminal coronary angioplasty].

UNLABELLED

Between April 1980 and November 1982, 120 patients underwent transluminal coronary angioplasty (TCA) by Gruntzig's technique (128 attempts on 132 vessels). Immediate results were evaluated by: the transstenotic pressure gradient (disappearance of a systolic gradient, mean residual gradient less than 15 mmHg); angiographic improvement (at least 25 p. 100) with less than 50 p. 100 residual stenosis. Success was confirmed by symptomatic and electrocardiographic improvement, the comparison of radio-isotopic studies (Thallium myocardial scintigraphy or tomography; global and regional left ventricular contractility by Technetium radioangiography) at rest and if possible during exercise before TCA and 2 and 6 months after TCA. The incidence of primary success was 72 p. 100 (stable angina: 67,2 p. 100, unstable angina 79,4 p. 100 NS); recurrence was observed in 16/69 of controlled patients (23,1 p. 100); 7 secondary TCA were performed with 5 successful results, leaving 16 p. 100 "permanent" recurrences in this series. There were 2 deaths (1 electromechanical dissociation, 1 rupture of the balloon with dissection due to dysfunction of a new manometer), 5 rudimentary infarcts (transient Q waves and/or slight enzymatic elevation), 6 infarcts (5 anterior, 1 posterior), 4 acute coronary insufficiencies (total regression after surgery). There were 11 immediate (9 as an emergency) and 9 secondary aorto-coronary bypass operations. There were 2 femoral artery repair procedures.

IN CONCLUSION

certain technical procedures are relatively easy; successive utilisation of a 2 then a 3,7 mm balloon in severe or excentric stenoses for instance. Nine stenoses became occluded without infarction between coronary angiography and the TCA procedures: 2 were recanalised by the guide wire (and then dilated). Therefore, in very severe stenoses TCA should be performed rapidly, even straight away. TCA is associated with some risk to the patient: experienced operators and immediate surgical cover are essential. Initial evaluation of results should be careful: measurement of the pressure gradient is often erroneous (damping of pressure wave, transmission of ventricular pressure); automatic measurements show an overestimation of the degree of stenosis of more than 60 p. 100. Stress radioisotopic studies seem to be the most satisfactory way of assessing the outcome. Medium term results are encouraging: the majority of patients return to work, but this took too long. The ideal theoretical indication remains rare.(ABSTRACT TRUNCATED AT 400 WORDS)