Author + information
- Received October 22, 1986
- Revision received December 3, 1986
- Accepted January 7, 1987
- Published online June 1, 1987.
- Eric J. Topol, MD, FACC*,1,
- Stephen G. Ellis, MD*,
- Jodi Fishman, RN, MS‡,
- Pierre Leimgruber, MD†,
- Richard K. Myler, MD, FACC‡,
- Simon H. Stertzer, MD, FACC‡,
- William W. O’Neill, MD*,
- John S. Douglas, MD, FACC†,
- Gary S. Roubin, MD, FACC† and
- Spencer B. King III, MD, FACC†
- ↵1Address for reprints: Eric J. Topol, MD, University of Michigan Medical Center, UH Bl F245, 1500 E. Medical Center Drive, Ann Arbor, Michigan 48109-0022.
Over a 5 year period at three centers, 53 patients underwent percutaneous transluminal angioplasty of a right coronary artery ostial stenosis. The procedure was successful in 42 patients (79%) and unsuccessful in 11, of whom 5 (9.4%) required emergency coronary artery bypass grafting because of abrupt closure. The right coronary ostial lesion had distinctive technical requirements to achieve success, including high pressure balloon inflation (10 ± 4 atm) and the need for unconventional right coronary guide catheters.
Technical factors that account for increased difficulty in these patients include: 1) problems with guide catheter impaction and ostial trauma; 2) inability to inflate the balloon with adequate guide catheter support; and 3) need for increased intracoronary manipulation. The stenoses were quite discrete (4 ± 5 mm) and calcified in the majority (40) of the 53 patients. Long-term follow-up (mean 12.5 months, range 4 to 60) of these patients demonstrated clinical recurrence of angina in 20 patients (48%) and angiographically proved restenosis in 16 (38%). Repeat coronary angioplasty was successful in three of six patients for relief of symptoms for over 6 months.
In conclusion, angioplasty of the right coronary ostial lesion compared with nonostial dilation leads to 1) a subopto\nal early success rate; 2) an apparent high risk of emergency bypass surgery; and 3) a high restenosis rate. Careful assessment of the patient with this lesion and improved technology appear to be warranted.
- Received October 22, 1986.
- Revision received December 3, 1986.
- Accepted January 7, 1987.
- American College of Cardiology Foundation