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Percutaneous transluminal coronary angioplasty (PTCA), a procedure in which a balloon catheter is used to widen constricted coronary arteries, was originally used in cases where arteries were narrowed but not totally blocked. Improvements in technology and operator skill have extended the use of PTCA to the treatment of totally occluded arteries. The outcomes of 44 patients with total occlusion of a coronary artery who underwent PTCA were evaluated. The short-term success rate of the procedure, defined as restoration of blood flow with greater than 50 percent of the vessel's interior diameter restored, was 59 percent. Follow-up among the successfully treated patients showed recurrence of constriction in 65 percent, almost half of whom had no symptoms of constriction. More patients among the initially unsuccessfully treated group had coronary bypass surgery. One third of the patients who had an initially successfully procedure had a second PTCA. The study indicates that although repeat PTCA may be needed in patients with total coronary occlusions, the procedure leads to a reduction in the need for bypass surgery for symptom control. (Consumer Summary produced by Reliance Medical Information, Inc.)

Aims: To assess the clinical outcomes of patients where drug eluting stents (DES) were restricted to those at highest risks of restenosis, we compared three different strategies for stent implantation: bare metal stents (BMS) only, DES only and a group where DES use was restricted (RES)., Method and Results: Initial comparison was made between BMS only (279 patients, 316 lesions) and DES only (272 patients, 302 lesions). The endpoints of death, non-fatal myocardial infarction and target lesion revascularisation (TLR) [MACE] were assessed at 12 months. The incidence of MACE in the BMS only and DES only groups were 14% and 7% (p=0.002) and TLR was 8% and 1% (p<0.0001). Comparison was then made between these results and a third group where DES was restricted to patients at highest risk of restenosis. The restricted group (RES) comprised 249 patients (271 lesions) of which 53% received DES. RES remained significantly better than BMS, MACE (14% vs. 8%, p=0.02) and TLR (8% vs. 3%, p=0.02). When RES was compared with DES only, there was no significant difference in MACE (8% vs. 7% p=0.42), but there was a significantly lower TLR rate in the DES only group (1% vs. 3% p=0.04)., Conclusions: The overall incidence of events in patients where DES use was restricted to 53% of patients remains low and this may be an acceptable treatment strategy to reduce costs.