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Acute occlusion developing during or immediately after percutaneous transluminal coronary angioplasty: nonsurgical
M F Meyerovitz1, P L Friedman, P Ganz
1Department of Radiology, Brigham and Women's Hospital, Boston, MA 02115.
Insights
Nonsurgical treatment of acute occlusion during percutaneous transluminal coronary angioplasty (PTCA) showed success. Repeat balloon dilation for abrupt closure after PTCA was more effective than continuing PTCA for guidewire-induced occlusions.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Acute occlusion is a complication during percutaneous transluminal coronary angioplasty (PTCA).
- Understanding treatment outcomes for different causes of acute occlusion is crucial for patient management.
Purpose of the Study:
- To evaluate the efficacy of nonsurgical management for acute occlusions occurring during or shortly after PTCA.
- To compare treatment success rates for occlusions caused by catheter manipulation versus abrupt closure after successful dilation.
Main Methods:
- Retrospective analysis of 514 consecutive PTCA procedures.
- Categorization of acute occlusions into those from guidewire/catheter manipulation and those from abrupt closure.
- Assessment of outcomes for repeat balloon dilation or continued PTCA in managing these occlusions.
Main Results:
- Acute occlusion occurred in 8.5% of PTCAs (44/514).
- Guidewire/catheter manipulation caused 2.1% (11/514) of occlusions, with a 29% success rate for continued PTCA.
- Abrupt closure after successful dilation occurred in 6.4% (33/514), with a 64% success rate for repeat balloon dilation.
Conclusions:
- Repeat balloon dilation is a successful nonsurgical strategy for abrupt closure post-PTCA.
- Nonsurgical management of abrupt closure is more successful than for occlusions caused by catheter manipulation.
Abstract:
The authors report results of nonsurgical treatment of acute occlusion developing during percutaneous transluminal coronary angioplasty (PTCA). Of 514 consecutive PTCAs, acute occlusion of the dilated artery developed during or within 1 hour after PTCA in 44 patients (8.5%); of these acute occlusions, 11 (2.1%) were due to guide wire or catheter manipulation during PTCA, while 33 (6.4%) were due to abrupt closure occurring after initially successful dilation. In seven of the 11 patients with acute occlusions resulting from manipulation, PTCA was continued with attempts to cross the reoccluded segment; this was successful in two patients (29%). In 25 of the 33 patients with abrupt closure, repeat balloon dilation was immediately attempted rather than send the patients to surgery for emergency coronary artery bypass grafting. Sixteen of these 25 attempts were successful (64%) and resulted in conversion of a potential complication into a successful outcome. Abrupt closure following initial dilation seems more likely to be successfully treated by continuing with PTCA than is acute occlusion resulting from catheter and guide wire manipulation.