Clinical effectiveness of bilateral recanalization of chronic coronary artery occlusion

Abstract

Aim. To assess the short- and long-term angiographic and clinical effectiveness of endovascular bilateral recanalization of chronic coronary artery occlusion (CCAO), compared to conservative therapeutic strategy. Material and methods. The study included 56 patients with coronary heart disease and CCAO. Angina Functional Class (FC) was assessed clinically and in electrocardiography tests. Local and global myocardial contractility was assessed using echocardiography. Group I (n=36) included CCAO patients who underwent an attempt of bilateral percutaneous coronary angioplasty; Group II (n=20) included CCAO patients who were treated conservatively. Clinical effectiveness of the treatment was assessed at 12 months. Results. At baseline, 16 and 20 Group I patients had FC III and II, respectively. Out of 36 attempts of bilateral recanalization, 27 were successful, based on the angiography results. All these 27 cases were also clinically successful in the short term, and 20 in the long term. Global myocardial contractility increased from 54±3% to 56,9±4% (p=0,03). In Group II, 10 and 10 patients had baseline FC III and II, respectively. The long-term stabilisation of clinical status was observed in 15 patients, with the mean levels of left ventricular ejection fraction of 53,9±2,4% (p=0,9). Observed complications of coronary angioplasty did not result in clinically significant ischemic and haemorrhagic events, while the clinical improvement was substantially more pronounced, compared to Group II. Conclusion. Bilateral CCAO recanalization is a technically demanding procedure, requiring an extensive surgical expertise and experience, and linked to a higher risk of complications. However, it could be used when the antegrade access is impossible; the anaesthesiological risk of coronary artery bypass graft surgery is high; and the patient refuses the cardiac surgery intervention.