From 1978 to 1988, coronary angioplasty was performed in 422 patients with prior coronary artery bypass surgery (264 patients with native coronary artery angioplasty and 158 patients with graft angioplasty). Angioplasty was successful in 84%, unsuccessful but uncomplicated in 11% and complicated by one or more major cardiac events in 5% (myocardial infarction 5%, emergency bypass surgery 2% and death 0.2%). Follow-up data were obtained in 99% of 356 patients with successful angioplasty. At a mean of 33 +/- 26 months, 92% were alive, 73% had improvement in angina and 61% were free of angina. One or more of the following late events occurred in 67 patients (19%): myocardial infarction (6%), elective reoperation (13%) and cardiac death (6%). Repeat angioplasty was performed in 27%, with a success rate of 89% and no deaths. Initial success rates were equal in native vessel versus graft angioplasty, but late outcome was less favorable with the latter because of a higher rate of infarction (11% versus 4%, p less than 0.05) and need for reoperation (19% versus 10%, p less than 0.05). The initial success rate was higher in vein grafts less than 1 year old compared with grafts 1 to 4 years or greater than 4 years after operation (92% versus 85% versus 83%, respectively) and adverse late events were less frequent after angioplasty in recent vein grafts (less than 1 year 13%, 1 to 4 years 35%, greater than 4 years 29%; less than 1 versus greater than 1 year, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Unusually large native coronary arteries, in particular those supplying expansive regions of myocardium, may not be adequately dilated using currently available coronary angioplasty catheters. The "hugging balloon" technique, in which two dilatation catheter balloons are simultaneously inflated side-by-side, has been previously described for lesions in large saphenous vein grafts using the double guiding catheter (and dual entry site) technique. With the development of large lumen guiding catheters and lower profile dilatation catheters, we report the initial use of the hugging balloon technique via a single guiding catheter in oversized native coronary arteries.

Since the introduction of coronary angioplasty by Gruntzig et al. (Circulation [Suppl II] 56:84, 1977), a key determinant to overall success has been advancement in equipment technology. Major advances have been made in the availability of low-profile catheters in the last 5 years that have facilitated penetration of high-grade distal and complex lesions. The USCl probe TM catheter is an example of a low-profile catheter that has shown favorable applicability in dilating high-grade stenoses. Preliminary data indicate that this device has good trackability and an extremely low profile, which allows penetration of stenoses where other current low-profile catheters have failed.