Coronary heart disease
Risk of side branch occlusion during coronary angioplasty

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Abstract

To assess the risk of side branch occlusion during percutaneous transluminal coronary angioplasty (PTCA), 600 consecutive procedures were analyzed. On the basis of pre-PTCA angiograms of 557 patients in whom the balloon was actually inflated, 365 side branches in 302 patients (54 % of patients) were deemed in jeopardy. A total of 122 side branches in 102 patients (18 %) originated from the lesion segment itself, i.e., their take-off was narrowed (Group I, 33 % of side branches at risk), whereas 243 side branches in 214 patients (38 %) originated from the immediate vicinity of the stenosis in a way that they were subjected to temporary occlusion during balloon dilatation (Group II, 67 % of side branches at risk). Patency of side branches was determined by consensus of 2 observers. Criteria for occlusion were disappearance, filling by collaterals, or stagnation of flow. After PTCA, 20 of 365 side branches (5 % ) were occluded and associated with chest pain in 5 patients, creatine kinase increase in 6, left anterior hemiblock, septal Q waves and transient atrial fibrillation in 1 and nonsustained ventricular tachycardia in 1 of the 20 patients. Exercise tolerance did not decrease. No local predilection for side branch occlusion was evident. Seventeen of 122 side branches (14 %) occluded in Group I, compared with 3 of 243 (1 %) in Group II (p < 0.001).

Thus, more than half of the patients who underwent PTCA had side branches at risk for iatrogenic occlusion. Side branches involved in the narrowing (Group I) must be regarded as high-risk side branches, whereas the more frequent side branches adjacent to the narrowing (Group II) can be considered low-risk side branches. The outcome of side branch occlusions was invariably favorable.

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