[Acute complications in coronary angioplasty: dependence on catheter material and adjuvant medication]

We report on the complication rates in 660 consecutive coronary angioplasties (725 lesions) performed using four procedures that differed with respect to catheter technology and adjuvant medication. After the PTCA regimen in our laboratory had been changed from conventional steerable systems to the monorail-technique, we observed an increase in the incidence of intermittent and recurrent vessel occlusions from 2.6% to 7.7%, of permanent occlusions from 3.6% to 8.8%, and of intracoronary thrombus-formation from 2.6% to 5.5%. This was associated with the frequent observation of thrombotic material on the guide wires. Coronary perfusion with urokinase (1670-6670 U/min) lead to a further increase in the complication rates (10.4%/10.3%/6.5%). Our present PTCA-regimen (monorail-technique with PET balloons, silicon-coated guide wires, no urokinase) shows an incidence of 3.8% for intermittent and recurrent coronary occlusions, and of 1.9% for permanent occlusions. We suspect that in case of PTCA-induced regional intimal dissection, fibrinolysis prevents reestablishment of intima-adherence to the vessel wall. We conclude that i.c. urokinase in PTCA is a potentially harmful regimen and that the monorail-technique should be performed with silicon-coated guide wires.