Early recovery of wall motion abnormalities after recanalization of chronic totally occluded coronary arteries: A dobutamine echocardiographic, prospective, single-center experience

Background: Patients with symptomatic myocardial ischemia from a chronic totally occluded coronary (TOC) artery are usually referred for coronary artery bypass surgery. Because guide wire technology has improved considerably in recent years, percutaneous coronary angioplasty has become a useful technique in opening chronic TOC arteries. We evaluated the early functional results of successful percutaneous recanalization by performing dobutamine stress echocardiography (DSE). Methods: Fifteen patients with a chronic TOC artery who underwent a successful recanalization were prospectively studied. Each patient had a DSE within 24 hours before and 48 hours after the procedure. Wall motion was scored according to a 16- segment/5-point model. A clinical and angiographic follow-up of 6 months was obtained. Results: The wall motion score index at rest improved from 1.26 ± 0.23 before to 1.22 ± 0.21 after the procedure (P < .05). Of those 10 segments that improved at rest, 7 were collateral recipients and 3 were collateral donors. The number of ischemic segments decreased from 46 before to 4 after the procedure (P < .0001). Wall motion score index at peak stress improved from 1.34 ± 0.20 before to 1.15 ± 0.12 after the procedure (P < .05). DSE was positive for ischemia in 15 patients before and 2 patients after the procedure (P < .0001). Angina was present in 12 patients before and in 2 patients after recanalization (P < .0001). Two patients (13%) had angiographic reocclusion and 5 (33%) restenosis after 6 months of follow-up. Conclusions: Successful percutaneous recanalization of chronic TOC artery results in an early improvement of both clinical status and resting or stress-induced wall motion abnormalities, as detected by DSE.

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