The role of percutaneous transluminal coronary angioplasty (PTCA) in unstable angina

Summary

Transluminal coronary angioplasty is successfully used in stable and unstable angina. Preferably the first angiography and PTCA are performed within the same cath-lab procedure. By this, the patient has not to be exposed to the cath-lab situation twice. The costs for personnel and material are reduced. In 145 patients the stenosis diameter was improved from 75.9 ±11.7% obstruction to 23.3 ± 17.1% (improvement 52.6 ± 17.9%) without significant differences between con-centric and eccentric, but with differences in right and left coronary artery stenoses. The absolute diameter was improved from 0.69 ± 0.29 mm to 2.07 ± 0.48mm (improvement 1.4 ± 0.55 mm), in the 1984 series from 0.58 ± 0.31mm to 1.94 ± 0.51mm (improvement 1.36 ± 0.48mm).

In 81 successfully treated patients a control angiography has been performed after six months. The recurrence rate was significantly higher than in stable angina (36% vs. 28%). The stenoses had deteriorated from 23.7 ±16.2% immediately after the dilatation to 40.8 ± 28.3% at the control study. There were no significant differences between the group with lasting success and that with a restenosis with respect to the degree of the initial stenosis and the immediate result after dilatation.

The number of pathologically contracting segments was diminished from 6.2 ± 5.9 to 3.2±4.8 segments in patients with good results and remained constant (7.0±5.6 to 7.0±4.6 segments) in those with restenosis.

PTCA can be used with good results and a low complication rate (<3%) as well in unstable as in stable angina. Since the trauma for the patient and the costs for personnel and material are much lower than with bypass surgery, PTCA is an alternative in a remarkable percentage of patients.

Percutaneous transluminal coronary angioplasty (PTCA) can nowadays be regarded as an established therapy for patients with chronic stable angina pectoris [1, 2]. Since 1980 this method is also successfully applied to patients with unstable angina [3–8]. In this subgroup of angina pectoris a reasonable number of patients (approximately 30%) show localized major stenosis [9]. While some patients can be stabilized medically, others deserve emergency coronary bypass graft operation [10]. Since 1978 we regularly schedule coronary arteriographics in patients with unstable angina in such a way that PTCA can immediately be performed where necessary.