Transient acute ischaemic episodes during or immediately after percutaneous transluminal coronary angioplasty

Transient ischaemic episodes, defined as chest pain with ST segment elevation resolving in less than 15 min, have been encountered in 18 out of 130 patients during or in the 12h following percutaneous transluminal angioplasty (PTCA). During PTCA, ischaemic episodes occurred in 11 patients (8.5%) along with complete coronary artery occlusion (3 cases), high degree stenosis (6 cases) or no visible angiographic change (2 cases). After PTCA, 7 additional patients (5.3%) had transient ischaemic episodes; 4, within 15 min of the last balloon inflation, corresponding to a high-grade stenosis distal to the site of angioplasty and resolving after intra coronary nitrates; 3 from 45 min to 7h after PTCA, resolving spontaneously or with sublingual nitrates in a few minutes. Several pathophysiological mechanisms may be responsible: catheter induced coronary spasm, coronary artery thrombosis, migration of atheromatous debris from the plaque, bubble emboli, or fall of coronary blood flow. The clinical course is usually benign but repeat angiography and emergency bypass surgery may be necessary if the episodes of ischaemia are recurring or prolonged.