The safety and short-term therapeutic benefit of multilesion percutaneous transluminal coronary angioplasty was assessed in 135 patients, 66 of whom had a minimum of 6 months of follow-up study. Primary success, defined as successful dilation of the most critical lesion or all lesions attempted without major in-hospital complications was obtained in 117 (87%) of the 135 patients. Cardiac complications associated with the procedure were uncommon; prolonged angina occurred in 5% and myocardial infarction in 3%; emergency coronary bypass surgery was performed in 4% of the patients. There were no deaths. Complete revascularization was achieved in 46% of the 117 patients with a primary success. Of the 66 patients eligible for 6 month follow-up, 80% had an uncomplicated course and required no further procedures. Clinical improvement by at least one angina functional class was observed in 90% of the patients. Cardiac events such as the need for a second revascularization procedure were significantly more common in patients who had incomplete versus complete revascularization (35 versus 9%; p = 0.018). Repeat coronary angiography performed an average of 5 months after angioplasty revealed restenosis in 18 of 22 symptomatic patients and 3 of 9 asymptomatic patients. Restenosis occurred at the site of a single dilation in 12 patients, at two sites in 8 patients and at three sites in 1 patient. Thus, multilesion coronary angioplasty is an important therapeutic option for selected patients with multivessel disease and can be performed with relatively low risk. Improvement in angina status can be expected even in patients who have incomplete revascularization.(ABSTRACT TRUNCATED AT 250 WORDS)

Background: For patients with complicated acute thoracic aortic syndromes, endovascular treatment, when feasible, is preferred over open surgery. However, there are limited data on the long-term benefits of endovascular treatment in complicated acute aortic syndromes affecting the descending thoracic aorta. Hypothesis: The endovascular treatment is expected to have more favorable long-term mortality and fewer late reintervention in complicated acute thoracic aortic syndromes. Methods: Of 155 consecutive patients with acute aortic syndromes, 94 met the inclusion criteria of the study; 63 underwent endovascular repair (group 1) and 31 underwent open repair (group 2). Patients with a diagnosis of acute aortic syndrome localized in the descending thoracic aorta distal to the emergence of the left subclavian artery, complicated by rupture, malperfusion syndrome, and/or acute aortic expansion, were included. Indications for repair of the descending thoracic aorta included impending rupture in 70.2%, malperfusion syndrome in 29.8%, and persistence of pain with aortic expansion (aortic diameter >40 mm) in 2 patients. Results: During the follow-up period (63.0 ± 24.6 months), the cumulative survival free from cardiovascular death rates at 5 years was 92.0% and 51.4% in group 1 and 2, respectively (log rank P = 0.0001). Late mortality related to the aorta was 1.6% with thoracic endovascular aortic repair and 0% with surgical treatment. Conclusions: Endovascular treatment in patients with complicated acute thoracic aortic syndromes localized at the descending thoracic aorta is feasible and safe, with a lower rate of early complications and similar long-term benefits when compared with surgical treatment.

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Treatment of ascending aorta disease is surgical; however, some series have evaluated the effectiveness of endovascular treatment. We report the case of a patient with a ruptured pseudoaneurysm who underwent endovascular repair via the left common carotid artery. The clinical and neurological evolution was satisfactory during the in-hospital follow-up. ( Level of Difficulty: Intermediate. )