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Emergency surgery after coronary disruption complicating PTCA. Report of four cases

J M Gonzalez-Santos, J L Vallejo, T Pineda

    The Thoracic and Cardiovascular Surgeon
    |August 1, 1985
    PubMed

    Insights

    Coronary artery disruption during percutaneous transluminal coronary angioplasty (PTCA) is rare but serious. Emergency surgery is often required for these arterial injuries, with most patients recovering well.

    Area of Science:

    • Cardiology
    • Interventional Cardiology
    • Vascular Surgery

    Background:

    • Percutaneous transluminal coronary angioplasty (PTCA) is a common procedure for treating coronary artery disease.
    • Coronary artery disruption is a rare but potentially life-threatening complication of PTCA.

    Purpose of the Study:

    • To report on the incidence, management, and outcomes of coronary artery disruption following PTCA.
    • To highlight the clinical presentation and surgical intervention for this complication.

    Main Methods:

    • Retrospective review of patients who underwent PTCA at our institution.
    • Analysis of cases with coronary artery disruption requiring emergency surgery.
    • Evaluation of surgical procedures and patient outcomes.

    Main Results:

    • Four out of 150 patients (2.7%) experienced coronary artery disruption post-PTCA.
    • All affected patients had severe stenosis of the left anterior descending (LAD) artery, with some involving diagonal branches.
    • Three patients developed cardiac tamponade due to subepicardial artery rupture; one had intramyocardial rupture.
    • All patients experienced severe hemodynamic compromise; one suffered cardiac arrest and died postoperatively.
    • Two survivors had non-transmural myocardial infarction; all three survivors recovered well.

    Conclusions:

    • Coronary artery disruption during PTCA necessitates prompt surgical intervention.
    • Despite severe complications, surgical repair offers a good prognosis for most patients.
    • Careful patient selection and procedural technique are crucial to minimize PTCA-related complications.

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