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High-risk coronary angioplasty with elective intra-aortic balloon pump support
I Kreidieh1, D W Davies, R Lim
1Department of Cardiology, St. Bartholomew's Hospital, London, UK.
Insights
Elective intra-aortic balloon pump support safely stabilizes high-risk patients during percutaneous coronary angioplasty. This approach achieves a high success rate for complex coronary artery disease interventions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- High-risk patients undergoing percutaneous coronary angioplasty (PTCA) often present with complex conditions.
- Severe left ventricular dysfunction and multivessel coronary disease increase procedural risks.
Purpose of the Study:
- To evaluate the safety and efficacy of elective percutaneous intra-aortic balloon pump (IABP) support in high-risk patients undergoing PTCA.
- To assess the success rate and complication profile of IABP-assisted PTCA.
Main Methods:
- A prospective study involving 21 high-risk patients undergoing PTCA with elective IABP support.
- Procedures included patients with unstable angina, multivessel disease, severe left ventricular dysfunction, or ventricular fibrillation.
- Detailed analysis of lesion complexity, procedural success, and complications.
Main Results:
- No angioplasty-related deaths occurred.
- Successful dilatation was achieved in 90% of lesions and 84% of procedures.
- Complications were infrequent, with local hematoma being the most common IABP-related issue.
Conclusions:
- Elective IABP support is a safe strategy for stabilizing high-risk patients during PTCA.
- This approach leads to a satisfactory primary success rate in complex coronary interventions.
Abstract:
Percutaneous transluminal coronary angioplasty was attempted with elective percutaneous intra-aortic balloon pump support in 21 patients (mean age 60 years, range 40-82; 18 males) with unstable angina (n = 2), multivessel coronary disease requiring multivessel angioplasty (n = 2), severe left ventricular dysfunction (ejection fraction 10-30%; n = 16) or ventricular fibrillation at diagnostic angiography (n = 1). Fourteen patients had 3-vessel disease (1 with vein grafts also diseased), 6 had 2-vessel disease and 1 had isolated left anterior descending disease. Twenty-five procedures were performed (one in 18 patients, two in 2 patients and three in one patient) on 42 lesions in 34 vessels/grafts. There was no angioplasty-related death. Successful dilatation was achieved in 38/42 lesions (90%) in 21/25 procedures (84%) without major complication. Three procedures were complicated: one by major coronary dissection without sequelae, one by haemodynamic deterioration due to distal occlusion and one by an unstable residual stenosis in the attempted vessel necessitating urgent bypass surgery. The only complication related to the intra-aortic balloon pump was local haematoma in 2 patients. In conclusion, elective intra-aortic balloon pump support may be safely used to stabilise high-risk patients undergoing coronary angioplasty, leading to a satisfactory primary success rate.