Pathophysiology and Natural History Ptca

Between July 1980 and November 1982, there were 935 coronary angioplasties attempted at Emory University Hospital. Of these patients, 20 developed acute occlusion. Of these 20, 19 presented within 3 hr of surgery or within 3 hr after stopping a continuous heparin infusion. Five patients required emergency surgery, but in 15 nitrates, nifedipine, and/or repeat angioplasty reopened the artery and the patient could be stabilized on continuous infusions of heparin and nitroglycerin. In only one case was an occluding thrombus evident on angiographic examination. The mechanism of acute occlusion is unknown, but coronary artery spasm may play a role. Circulation 68, No. 4, 725-732, 1983. EMERGENCY BYPASS SURGERY was required after percutaneous transluminal coronary angioplasty (PTCA) in about 5% to 6% of patients entered into the National Registry of the National Heart, Lung and Blood Institute (NHLBI).l 2 The two principal reasons for emergency bypass surgery are acute occlusion and coronary artery dissection. ' Coronary artery dissection with compromise of blood flow occurs either as a result of subintimal passage of the balloon catheter3 or as a direct complication of the balloon injury process that can, by itself, result in intimal tearing.4 Intra-aortic balloon counterpulsation followed by emergency coronary bypass surgery5 might minimize myocardial injury in the PTCA patient who has coronary artery dissection. At present, no effective treatment short of these measures is available to treat the patient with coronary dissection. Acute occlusion after otherwise unremarkable PTCA was the most common reason given in the NHLBI registry for emergency bypass surgery. ' Earlier it had been recommended that all patients with acute occlusion undergo emergency bypass surgery.6 Unlike in the subset of patients with coronary dissection, we no longer perform emergency bypass surgery in all our patients with acute occlusion. The purpose of this report is to review the treatment, hospital course, complications, and follow-up data From the Department of Medicine (Cardiology) and Radiology, Emory University Hospital, Atlanta. Address for correspondence: Andreas R. Gruentzig, M.D., Emory University Hospital, 1364 Clifton Rd., Atlanta, GA 30322. Received March 4, 1983; revision accepted June 23, 1983. Present address: Department of Cardiology, Cleveland Clinic Foundation, 9500 Euclid Ave., Cleveland, OH 44106. Vol. 68, No. 4, October 1983 from 20 consecutive patients with acute corotlary occlusion.