Unusually long inflation times during percutaneous transluminal coronary angioplasty

Unusually prolonged balloon inflations (PBI) during percutaneous transluminal coronary angioplasty (PTCA) have been utilized in 26 consecutive patients to establish adequate coronary perfusion after shorter inflation times resulted in severe residual stenosis (N = 15), early arterial closure (N = 5), or extensive dissection (N = 6). Inflations lasted 1.5 to 15 min and 23/27 stenoses were successfully dilated. The average reduction in stenosis was 67% (90%-33%). Chest pain occurred in 34% vs. 7% (P less than 0.01), and ST changes occurred during 66% vs. 57% (NS) of PBI vs. short inflations. Four patients required coronary artery bypass surgery in spite of PBI, but none suffered an infarction. Electrocardiograms were unchanged in 22 patients and showed nonspecific ST-T wave changes in four. Cardiac enzymes obtained in nine patients failed to reveal a significant increase in serum concentration. We conclude that PBI is well tolerated and can successfully dilate lesions not responding to short inflations.