Enhanced external counterpulsation: A new therapeutic option for patients who have failed coronary angioplasty and/or bypass surgery

There are many patients in whom repeat (or initial) PTCA and/or CABG are not appropriate-and in whom aggressive medical therapy still fails to maintain a quality of life that patients are comfortable with. EECP is 1 of several new treatment alternatives for such patients. In our initial studies, 18 patients were treated with EECP for 1 hour daily for a total of 36 hours. All 18 patients experienced substantial improvements in anginal symptoms after EECP. Thallium-201 stress testing showed a complete resolution of ischemic defects in 12 patients (67%), a decrease in the area of ischemia in 2 patients (11%), and no change in 4 patients (22%). The long-term, sustained efficacy of EECP was confirmed in a 3-year follow-up study. One possible explanation for the improvement in perfusion that we observed is that EECP may open, or enhance the development of, collateral channels when at least 1 patent conduit (native vessel or bypass graft) is present. The importance of having such a conduit was emphasized in our most recent study of 50 patients, all of whom underwent coronary angiography before EECP.