Prolonged dilation with an autoperfusion balloon catheter for refractory acute occlusion related to percutaneous transluminal coronary angioplasty.
OBJECTIVE
Efficacy and safety of redilation by an autoperfusion balloon catheter over several hours were investigated in this retrospective and observational study.


BACKGROUND
Acute occlusion, refractory to redilation, is a serious complication of coronary angioplasty.


METHODS
Of 1,123 patients who underwent angioplasty, 83 had a refractory acute occlusion. Thiry-five patients were treated with extended dilation. Seven had stable, 19 unstable and 6 postinfarction angina and 3 had an acute infarction at the time of angioplasty. The duration of dilation was (mean +/- SD) 17 (+/- 6) h.


RESULTS
Angiographically successful redilation, with a mean residual percent diameter stenosis of 13.5% (+/- 11.6%), was achieved in 22 (67.7%) of 34 patients. Five patients underwent bypass surgery. Three patients, who were poor surgical candidates, died. There was one new Q wave infarction and one death that occurred during extended dilation; one death and four operations were related to reocclusion immediately (< or = 30 min) after catheter withdrawal; and one death and one operation were related to in-hospital reocclusion. Overall success, defined as angiographic success and freedom from major events, was obtained in 20 (57%) of 35 patients (95% confidence interval 41% to 73%). Of the variables studied, only multilesion dilation was significantly (p = 0.018) associated with an unfavorable outcome. During a mean follow-up period of 13.8 (+/- 6.1) months, two patients underwent repeat angioplasty, one sustained an infarction and three underwent elective bypass surgery.


CONCLUSIONS
In approximately half of the patients (20 [57%] of 35), an initial angioplasty failure due to refractory occlusion could be reverted to a successful procedure by prolonged dilation with an autoperfusion balloon catheter.
van der Linden
L P
LP
Department of Cardiology, University Hospital Leiden, The Netherlands.
Bakx
A L
AL
Sedney
M I
MI
Buis
B
B
Bruschke
A V
AV
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000209:etiology; D000789:Angina, Unstable / Q000209:etiology; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D016001:Confidence Intervals; D017023:Coronary Angiography; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000145:classification / Q000150:complications / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016903:Drug Monitoring; D005500:Follow-Up Studies; D006493:Heparin / Q000008:administration & dosage / Q000627:therapeutic use*; D017052:Hospital Mortality; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D007507:Therapeutic Irrigation / Q000379:methods; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
D006493:Heparin