[Should a main coronary artery be dilated when the controlateral vessel is occluded?].

Angioplasty of the dominant left anterior descending or right coronary arteries when the controlateral artery is occluded may lead to major left ventricular dysfunction or cardiogenic shock. The authors assessed the results of angioplasty of a right coronary (n = 52) or left anterior descending (n = 141) artery stenosis when the controlateral artery was occluded and the left circumflex had no significant stenosis in 193 patients. The immediate and late (33 +/- 18 months) results were compared in 3 groups: the study group, a reference surgical group in which patients with comparable coronary lesions underwent double coronary artery bypass and a reference angioplasty group (n = 194) in which patients were treated by angioplasty of the right coronary and left anterior descending arteries. The left ventricular function of the study group was normal or midly abnormal in 72% of cases and moderately to severely abnormal in 28% of cases. During the hospital period, for the study group, there were 5.7% emergency coronary bypass procedures and 2.6% non-emergency bypass procedures, 1.6% of myocardial infarction and 0.5% deaths. After hospital discharge, the study group had 13.1% of coronary bypass procedures, 3.7% of myocardial infarcts and 4.7% deaths. The death and infarction rates were comparable in the 3 groups. The study group had a higher incidence of coronary bypass surgery in and after the hospital period than the control surgical group (p = 0.0.002). The authors conclude that dilatation of a main coronary artery when the controlateral artery is occluded is as safe as double coronary artery bypass surgery and angioplasty of the two vessels. Incomplete revascularisation in the study group did not affect survival rate without myocardial infarction compared with the angioplasty and surgical reference groups.