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PERCUTANEOUS TRANSLUMINAL CORONARYANGIOPLASTY (PTCA) IN
MULTIVESSEL CORONARY REVASCULARIZATION
Présentateur : AZZOUZ ABDELMALEK, Alger - ALG
Auteurs : AZZOUZ ABDELMALEK - MERAD BOUDIA KHEIREDDINE - KARA MAAMAR
HAICHOUR TOUFIK
Co-Auteurs : N. MOHAMMEDI - A. SELMANE - S. SEDDIKI - S. BENKHEDDA - D. ZIARI
Introduction: Patients with multivessel coronary artery disease are often candidates for a strategy of
coronary revascularization. The results of pioneering studies (BARI, ARTS I) pro- bypass surgery have influenced
our choice of type of revascularization in such patients. This is despite the progress of percutaneous
transluminal coronary angioplasty (PTCA) related to the beneficial effects of drug- eluting stents on the rate
of re-intervention (TLR), progress confirmed by more recent studies (ARTS II, FREEDOM ……).
Materials and methods: Retrospective analysis of the last three years (2008/2009/2010) including all
patients (129 patients included, Sex Ratio 2H: 1F, Age 54 + / -8 years) with multivessel coronary disease admitted
to our cath lab. • The purpose of this analysis is to determine the place of percutaneous transluminal
coronary angioplasty (PTCA) as a strategie of revascularization in this group of patients. • The mode of
revascularization has been shown on the basis of a collective decision.
Results: CABG was performed in (79%) of our patients while (16% ) were revascularized by PTCA.
• CABG was prefered in diabetics patients with complex lesions , PTCA usig DES in more simple lesions.
• This attitude remains subjective, therefore we need objective criteria and Evidence Based Medicine to
select the optimal method of revascularization for patients with multivessel coronary artery disease and to
determine the place of PTCA in this group of patients. • Several randomized controlled trials have demonstrated
a similar safety profile for PTCA and CABG , CABG was associated with a significantly lower
risk for repeat revascularizations as compared with PTCA. • The SYNTAX study is one of them, using an
angiographic tool grading the complexity of the coronary disease : THE SYNTAX SCORE. • So how can
we select and perform PTCA in patients with multivessel coronary disease using all these new tools ? •
Two key elements guide the selection of a technique for revascularization: * The technical platform: skill
level of surgeons and interventional cardiologists , the use of DES….. * Coronary lesion complexity must
be assessed in each patient using objective criteria. These objective criteria are grouped into the SYNTAX
SCORE • The ultimate goal of this score is to: * Create an angiographic tool grading the complexity of the
coronary disease *Make the interventional cardiologist and the surgeon aware of the anatomical complexity
of the disease by calculating a semi quantitative, visual score *Obtain evidence based guidelines for selecting
the technique of revascularizaion ( CABG or PTCA). *Force the interventional cardiologist and the surgeon
to anticipate the procedural difficulties.
Conclusion: The attitude of all surgical in patients with multivessel disease is no longer justified. This especially
as this technique is relatively less accessible versus percutaneous transluminal coronary angioplasty
booming in our country with the implantation of several catheterisation laboratories.
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