Short- and long-term complications of coronary angioplasty.

CASE REPORT T his 48-year.old man was in good health until April 1988, when he noted the onset of exertional chest pain. One month later, he underwent cardiac catheterization, which revealed a totally occluded left circumflex coronary artery. His only risk factor for atherosclerotic cardiovascular disease was cigarette use. He underwent successful percutaneous transluminal coronary angioplasty (PTCA) of the occluded circumflex coronary artery. He was free of symptoms until October 1988, when his exertional chest pain recurred. Coronary arteriography again demonstrated total occlusion of the circumflex coronary artery with collateral filling of the distal obtuse marginal branches (Fig 1). A second angioplasty was successfully performed (Fig 2) with no significant residual stenosis, and his angina pectoris resolved. One month later, his symptoms reappeared, and coronary arteriography revealed reocclusion of the circumflex coronary artery. Despite antianginal medications, his lifestyle was limited by angina pectoris, and he was referred for coronary artery bypass surgery. In September 1977, in Zurich, Andreas Gruentzig performed the first percutaneous transluminal coronary angioplasty (PTCA). Despite initial skepticism about the procedure’s utility, it has now been performed successfully in hundreds of thousands of patients with coronary artery disease. In the United States alone, over 200,000 coronary angioplasties were performed in 1988. It has gained widespread acceptance because of its high likelihood of success and its attractiveness as an alternative to coronary artery bypass surgery. At the same time, however, several shortand longterm complications may develop in patients undergoing PTCA.