Coronary embolization after balloon angioplasty or thrombolytic therapy: an autopsy study of 32 cases.
OBJECTIVE
This study was undertaken to examine the nature, extent and clinical relevance of coronary embolism after balloon angioplasty or thrombolytic therapy, or both.


BACKGROUND
Histopathologic documentation of postinterventional coronary embolization has been reported in only 10 patients from five studies.


METHODS
This retrospective autopsy-based study included 32 patients, treated with balloon angioplasty or thrombolysis, or both, who died within 3 weeks of the procedure and underwent autopsy at the Mayo Clinic. Clinical variables included patient age and gender, artery treated, site and type of obstruction, type of intervention, success of the procedure, and postprocedural changes in the electrocardiogram (ECG), cardiac enzymes and hemodynamic status. Histopathologic variables included characteristics of treated plaques, acutely infarcted myocardium and coronary microemboli. Associations between microemboli and clinical and microscopic factors were evaluated by t tests and simple and multiple linear regression.


RESULTS
Emboli were observed in 26 (81%) of the 32 patients. Among 83 emboli, 95% were thrombotic or atheromatous. The presence of microemboli was associated statistically with the development of postprocedural infarct extension, new myocardial infarction or new ECG abnormalities. Moreover, the greatest number of microemboli were associated with intervention in the left anterior descending coronary artery, multiple interventional sites, postprocedural medial dissection and plaque rupture or extrusion.


CONCLUSIONS
Among patients undergoing balloon angioplasty or thrombolytic therapy who die and undergo autopsy, coronary microemboli occur in a substantial percent. The frequency in survivors is unknown. However, in living patients who develop acute myocardial ischemia or new ECG abnormalities after these interventions, coronary microembolization should be considered a potential cause.
Saber
R S
RS
Division of Anatomic Pathology, Mayo Clinic, Rochester, Minnesota 55905.
Edwards
W D
WD
Bailey
K R
KR
McGovern
T W
TW
Schwartz
R S
RS
Holmes
D R
DR
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D001344:Autopsy; D002423:Cause of Death; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000150:complications / Q000453:epidemiology; D003328:Coronary Thrombosis / Q000150:complications / Q000453:epidemiology; D003331:Coronary Vessels; D004562:Electrocardiography; D004617:Embolism / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000473:pathology; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality / Q000473:pathology; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D015912:Thrombolytic Therapy / Q000009:adverse effects*