Prolonged dilation with an autoperfusion balloon catheter for refractory acute occlusion related to percutaneous transluminal coronary angioplasty

Abstract

Objectives: Efficacy and safety of redilation by an autoperfusion balloon catheter over several hours were investigated in this retrospective and observational study.

Background: Acute occlusion, refractory to redilation, is a serious complication of coronary angioplasty.

Methods: Of 1,123 patients who underwent angioplasty, 83 had a refractory acute occlusion. Thiry-five patients were treated with extended dilation. Seven had stable, 19 unstable and 6 postinfarction angina and 3 had an acute infarction at the time of angioplasty. The duration of dilation was (mean +/- SD) 17 (+/- 6) h.

Results: Angiographically successful redilation, with a mean residual percent diameter stenosis of 13.5% (+/- 11.6%), was achieved in 22 (67.7%) of 34 patients. Five patients underwent bypass surgery. Three patients, who were poor surgical candidates, died. There was one new Q wave infarction and one death that occurred during extended dilation; one death and four operations were related to reocclusion immediately (< or = 30 min) after catheter withdrawal; and one death and one operation were related to in-hospital reocclusion. Overall success, defined as angiographic success and freedom from major events, was obtained in 20 (57%) of 35 patients (95% confidence interval 41% to 73%). Of the variables studied, only multilesion dilation was significantly (p = 0.018) associated with an unfavorable outcome. During a mean follow-up period of 13.8 (+/- 6.1) months, two patients underwent repeat angioplasty, one sustained an infarction and three underwent elective bypass surgery.

Conclusions: In approximately half of the patients (20 [57%] of 35), an initial angioplasty failure due to refractory occlusion could be reverted to a successful procedure by prolonged dilation with an autoperfusion balloon catheter.