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Objective: The prognostic significance of recanalisation of a chronically occluded infarct vessel in single-vessel coronary disease remains controversial, in contrast to early re-opening of the infarct vessel in the acute state of infarction. It was the purpose of this prospective study to discover whether successful recanalisation in the former influences the incidence of cardiac events (death, infarction, by-pass operation) and clinical symptoms in the long term., Patients and Method: Recanalisation procedures were successful in 58, unsuccessful in 41 of 99 patients (81 men, 18 women; mean age 55 [28-79] years) with anterior wall (n = 53) or posterior wall (n = 46) myocardial infarction (AMI and PMI, respectively). The two groups were similar with respect to age, sex, left-ventricular function, indication, exercise capacity and premedication. But the interval between infarction and recanalisation was shorter in the patients who had successful recanalisation (5.1 +/- 5.3 vs 7.8 +/- 7.6 months; P < 0.05). Mean follow-up period for all patients was 55.8 +/- 8.9 months after the recanalisation procedure., Results: There were significantly fewer cardiac events after successful than failed recanalisation, both for the total group of patients (5% vs 23%; P < 0.01) and those with AMI (9 vs 36%; P = 0.012). In the patients with PMI there was only a trend in favour of those with successful recanalisation (0% vs 14%; P = 0.058). Symptomatic improvement was reported by 73% of patients after successful but only 40% after failed recanalisation (P < 0.01)., Conclusion: The results provide pointers towards prognostic indications of recanalisation even after chronic occlusion of the infarct vessel. The procedure should therefore be attempted if the occlusion is morphologically suitable.

Cardiac tamponade following coronary perforation is a rare complication in conventional balloon angioplasty. In a series of 8000 dilatations we observed this complication after PTCA in 2 female patients (0.25/1000). In both cases cardiac tamponade occurred 2 h after PTCA of small, in 1 case calcified, coronary arteries during monitoring on the coronary care unit. By immediate percutaneous pericardiocentesis and subsequent drainage by a pigtail catheter we could manage the complication. One patient suffered an acute myocardial infarction 3 days after PTCA because of a subacute occlusion of the perforated vessel.

In this prospective nonrandomized study, we analyzed the influence of the degree of revascularization--determined by anatomic, morphologic, and functional criterias--on clinical follow-up after PTCA in patients with multivessel disease. 283 patients (74% with double vessel disease, 26% with triple vessel disease; mean age 59.2 +/- 8.2 years; 250 (88%) men) were treated. Clinical successful PTCA was achieved in 247 patients (87.2%): in 239 patients (84.4%) all attempted lesions and in 8 patients (2.8%) at least the culprit lesions were successfully dilated. Complications were seen in 15 patients (5.3%): seven patients underwent emergency bypass surgery, one patient had bypass surgery 8h after PTCA because of an early re-occlusion, five patients suffered an acute myocardial infarction during PTCA, and two patients, who had PTCA because of cardiogenic shock, died during PTCA. Post PTCA, 39 patients (13.8%) had anatomic complete (AK), 35 patients (12.4%) anatomic incomplete but functional complete (FK), 148 patients (52.3%) anatomic incomplete but functional adequate (FA), and 46 patients (16.2%) anatomic and functional incomplete (IR) revascularization. All patients had follow-up after 30.5 +/- 5.5 months. Fifteen patients (5.3%) died, 15 patients (5.3%) suffered a myocardial infarction, and 39 patients (13.8%) underwent an elective bypass operation during follow-up. Cumulative 2-year survival and cumulative 2-year infarct-free survival were not influenced by the degree of revascularization. In contrast to that, the cumulative 2-year bypass-free survival was significant lower in patients with IR (71.0%) compared to patients with AK (92.5%; p < 0.01), FK (89.3%; p < 0.05), and FA (92.7%; p < 0.001). Patients with IR were more likely to have PTCA of previous untreated lesions and were often less likely to have clinical improvement compared to the other subgroups. Thus, in patients with multivessel disease PTCA is a therapeutic option if AK, FK, and FA revascularization can be achieved. Provided that just an IR revascularization can be achieved by PTCA, angioplasty should be performed only for treatment of acute ischemic syndromes in order to improve clinical symptoms. Otherwise, an increased incidence of further revascularization procedures and a reduced clinical improvement can be expected.

Recanalization procedures with the "Magnum" system were undertaken in 137 patients (113 men, 24 women; mean age 57.1 +/- 8.1 years) with complete occlusion of a coronary artery. The system consists of a 0.021 inch guidewire with a flexible 1 mm diameter olive tip, a double-lumen probing catheter and a Magnarail balloon catheter. Chronic coronary artery occlusion of maximally 3 months was present in 51 patients (37%), for over 3 months in 52 (38%), while the duration of occlusion was unknown in 18 (13%). An acute coronary occlusion was successfully recanalized in 7 patients (5%), while in 9 (7%) it was accomplished when it had occurred during or shortly after a percutaneous coronary artery angioplasty (PCTA). The occlusion was successfully passed in 87 patients (64%); in 15 of them recanalization with another system had failed. The highest success rates were obtained with an acute occlusion (5 of 7; 71%), occlusion of 3 months' duration or less (39 of 51; 76%), and occlusion during PTCA (8 of 9; 89%). The success rates were lower for occlusions over 3 months' duration (25 of 52; 48%; P < 0.05) and of unknown duration (10 of 18; 56%; n.s.). Recanalization after failed recanalization was successfully accomplished by rotation-angioplasty (n = 2) or a standard system (n = 4).--These results indicate that the Magnum system is suitable for recanalizing chronic or acute coronary occlusion. But cardiologists should be capable of using several systems to increase the chances of successful recanalization.

In this study we examine the influence of the initial grade of revascularisation on clinical follow-up in patients with multivessel PTCA instead of CABG. Between I/85 and VII/89 multivessel PTCA was performed in 231 patients (202 m, 29 w; age 57 +/- 9 years). 71% of the patients had 2-vessel disease (VD), 14% 3-VD. 15% had angioplasty of one major and at least one important side branch. Clinical follow-up was achieved by a questionnaire 19.8 +/- 10.1 months after PTCA. 473 of 508 (93.1%) treated stenoses were successfully (residual stenosis less than 50%). 198 patients (86%) had successful angioplasty of all treated lesions. 31 patients (13%) had failed PTCA of one stenosis, 1 patient of both treated lesions. 1 patient underwent emergency CABG. A complete revascularisation (group A) - no residual stenosis greater than 50% in any coronary artery - was achieved in 164 patients (71%). 65 patients (28%) had incomplete revascularisation [group B]. 206 patients (89.1%) had clinical follow-up by questionnaire, 144 patients in group A (87.8%) and 60 patients in group B (92.3%) [n.s.]. 3 patients had died by noncardiac reasons (two in group A and one in group B), 1 patient of group A by cardiac reason. 70% in group A and 68% in group B had continuous clinical improvement (n.s.). Total amount of cardiac events (PTCA, CABG, cardiac death, MI) showed no significance between both groups - 35 (24%) vs 23 (38%). Patients in group B had more CABG (12% vs 3%) and angioplasty of further lesions (7% vs 1%) [p less than 0.05] during follow-up. We conclude multivessel PTCA shows good primary results with low risk.(ABSTRACT TRUNCATED AT 250 WORDS)