Angioplasty for Long Diffuse Coronary Lesions

HO ET AL . : Angioplasty for Long Diffuse Coronary Lesions. Long diffuse coronary artery stenosis is often encountered in elderly patients. Many of these patients have multivessel disease, previous myocardial infarction, diabetes and impaired left ventricular function. Due to a combination of diffuse disease, small caliber vessels and often heavy calcification, bypass graft surgery for such vessels is associated with poor short and long-term outcomes. By virtue of their length, long lesions often involve a multiple number of side branches or significant side branches, angulated segments, tapered segments and small caliber terminal branches. As a result, angioplasty for long diffuse lesions is associated with a slightly higher in-hospital complication rate and poorer long-term outcome. Despite the development of coronary stenting over the last decade, PTCA for long diffuse lesions remains problematic. Due to the nature of the disease, there is a higher risk of stent thrombosis and in-stent restenosis. Current approaches include the use of long balloons, rotational atherectomy, laser angioplasty, and a combination of primary or bail-out spot stenting. (J HK Coll Cardiol 2000;8:129-137)