Late recanalization at the site of failed percutaneous transluminal coronary angioplasty

Percutaneous transluminal coronary angioplasty (PTCA) was performed unsuccessfully, resulting in disruption and near-total closure of the proximal right coronary artery at the site of stenosis following balloon inflation. The artery could not be reopened in the catheterization laboratory despite intracoronary nitroglycerin, sublingual nifedipine, and multiple balloon inflations. Myocardial revascularization surgery was immediately performed with excellent graft flow. No apparent myocardial infarction resulted. Catheterization performed at one year showed normal left ventriculography, total occlusion of the bypass graft, and reopening and normalization of the right coronary artery at the site of PTCA-induced occlusion. Possible mechanisms for this phenomenon and its clinical implications are discussed.