Slow coronary flow complicating elective balloon angioplasty in postthrombolytic patients.
BACKGROUND
Coronary blood flow after percutaneous transluminal coronary angioplasty (PTCA), as judged by the clearance of contrast media from the arterial bed, is usually brisk. Reduced coronary blood flow after PTCA in the absence of arterial dissection, air embolism, and large vessel spasm is unusual and the mechanism that causes it is incompletely understood.


METHODS
All cases of reduced coronary blood flow after PTCA during a 12-month period were identified from a prospective database. Clinical, procedural, and angiographic findings were reviewed.


RESULTS
Four patients demonstrated reduced coronary flow after PTCA in the absence of intimal dissection, air embolism, or large vessel spasm. All of the patients had been treated several days earlier with thrombolytic agents for acute myocardial infarction. The reduced coronary flow developed despite pretreatment with aspirin, heparin, and vasodilators. Symptoms of myocardial ischemia developed in each patient, including myocardial necrosis in three patients, complete heart block in one, and delayed cardiac rupture in one. This syndrome was not rapidly reversed with intracoronary nitroglycerin and thrombolytic agents.


CONCLUSIONS
Percutaneous transluminal coronary angioplasty of recently lysed or freshly thrombotic coronary arteries may predispose to the activation of potent vasoconstrictors or distal embolization of microparticulate atherothrombotic debris, leading to slow coronary flow and myocardial ischemia.
Kahn
J K
JK
Michigan Heart and Vascular Institute, St. Joseph Mercy Hospital, Ann Arbor.
D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D003131:Combined Modality Therapy; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000187:drug effects / Q000502:physiology; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014568:Urokinase-Type Plasminogen Activator / Q000627:therapeutic use
D010959:Tissue Plasminogen Activator; D014568:Urokinase-Type Plasminogen Activator