title: Prolonged dilation with an autoperfusion balloon catheter for refractory acute occlusion related to percutaneous transluminal coronary angioplasty.
abstract: 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.
authors.affiliation: Department of Cardiology, University Hospital Leiden, The Netherlands.
authors.forename: L P
authors.initials: LP
authors.lastname: van der Linden
authors.forename: A L
authors.initials: AL
authors.lastname: Bakx
authors.forename: M I
authors.initials: MI
authors.lastname: Sedney
authors.forename: B
authors.initials: B
authors.lastname: Buis
authors.forename: A V
authors.initials: AV
authors.lastname: Bruschke
mesh_terms: 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
chemical_list: D006493:Heparin