Percutaneous transluminal coronary angioplasty for chronic dialysis patients.
Accelerated forms of atherosclerosis continue to be responsible for considerable morbidity and mortality among patients on chronic hemodialysis, and coronary artery disease is responsible for approximately 20-30% of the deaths of such patients. The suitability of such patients for percutaneous transluminal coronary angioplasty (PTCA), however, remains unknown. Accordingly, the purpose of this study was to evaluate the feasibility of PTCA in a group of chronic dialysis patients. PTCA was performed on a total of 15 dialysis patients with medically refractory angina pectoris. Angiographic success was obtained in 16 of 21 (76%) stenoses attempted after the first PTCA. Restenosis was observed in 6 of 16 (38%) lesions, which was significantly related to longer dialysis history (p less than 0.01), and low maximal inflation pressure (p < 0.05). Five of the 6 patients with restenosis underwent a second PTCA, however, all 4 patients with successful second PTCA developed recurrence of angina. Three of 4 patients with a second episode of restenosis underwent a third PTCA, and angina recurred in 2. Thus, PTCA is a reasonable initial strategy for patients with chronic hemodialysis, especially when dialysis history is short. For restenotic lesions and when there is a long dialysis history, restenosis rates are high and coronary bypass surgery should be considered.