Technique and results of operative transluminal angioplasty in 81 consecutive patients

Eighty-one consecutive patients with distal multivessel coronary artery disease underwent 93 attempts at operative transluminal angioplasty at the time of coronary bypass operation. Lesions chosen for angioplasty were those in coronary arteries that otherwise would not have been bypassed because of small size and/or inaccessible location; 53% involved the distal anterior descending artery. A guide wire-tipped catheter with a 2 mm balloon was found to be the more satisfactory of the two devices used. An operative "successful" dilatation was achieved with 75 lesions (81%). Eighteen "unsuccessful" dilatations occurred primarily because of inability to transverse the lesions with the catheter. Postoperative angiography was performed in 29 patients to study 31 lesions. In 20 of 28 "successfully" dilated lesions (71%), the stenoses were completely alleviated. Three lesions were found unimproved and in two lesions, the coronary arteries were occluded distally. Two bypass grafts, involving two lesions with extensive dilatation, were closed. Two patients had definite perioperative myocardial infarction, and there were no deaths in this series. Whereas calcification did not influence success, the length of the lesion was inversely proportional to a successful dilatation. Operative dilatation of short coronary distal lesions is safe, has a high percentage of success, and offers a larger distal runoff for coronary bypass grafts. Areas of normal coronary arteries should not be dilated. Careful attention to detail and proper selection of the lesions to be dilated are required. The technique should be used only to dilate arteries that otherwise would not accept a bypass graft.