RESUMO
A transluminal intracoronary reperfusion catheter was used in eight patients, seven with acute myocardial infarction and one with unstable angina after failed emergency coronary angioplasty. After placement of the reperfusion catheter across the occlusion, symptoms of ischemia resolved in each patient. Chest pain recurred 3 hr later in a single patient who underwent successful repeat angioplasty. The catheter was withdrawn within 6 hr after introduction. Control coronary angiography showed a patent vessel in all but one. Repeat angioplasty or bypass surgery was unnecessary. During 1 year mean follow-up time all patients remained free of symptoms. The reperfusion catheter is a safe and effective means of perfusing a coronary artery after failure of thrombolytic therapy and coronary angioplasty in cases where emergency bypass surgery is not performed because operative morbidity is expected to outweigh the benefit of myocardial salvage, or when it cannot be immediately organized.
Assuntos
Angina Pectoris/terapia , Angina Instável/terapia , Angioplastia Coronária com Balão/instrumentação , Doença das Coronárias/terapia , Emergências , Infarto do Miocárdio/terapia , Reperfusão Miocárdica/instrumentação , Adulto , Ponte de Artéria Coronária , Trombose Coronária/terapia , Humanos , Masculino , Pessoa de Meia-Idade , Estreptoquinase/administração & dosagemRESUMO
We describe a new technique for angioplasty of totally occluded coronary arteries and bypass grafts in the absence of acute myocardial infarction. We used a guiding catheter, a coronary infusion catheter, and a relatively stiff steerable guide wire to perforate the occlusion. Angioplasty of the recanalized vessel was subsequently performed. The procedure was attempted in nine patients; it was successful in eight. There were no complications. The advantages of this technique are discussed.
Assuntos
Angina Pectoris/terapia , Angioplastia com Balão/métodos , Ponte de Artéria Coronária , Doença das Coronárias/terapia , Oclusão de Enxerto Vascular/terapia , Adulto , Idoso , Circulação Coronária , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/terapiaRESUMO
A patient presented with an acute inferior myocardial infarction. Coronary angiography in the acute stage revealed total occlusion of the right coronary artery. Reperfusion was obtained after intracoronary infusion of 250,000 units of streptokinase. Angioplasty was subsequently performed because of a high grade residual stenosis. An 8-French right Judkins guiding catheter with a single side hole (USCI), a 3.0 mm balloon dilatation catheter (ACS), and a 0.018 high torque floppy guide wire (ACS) were used. After successful angioplasty angiography was repeated with the guide wire in the RCA, but the balloon was withdrawn into the guiding catheter. After injection of contrast, it was impossible to withdrawn the balloon catheter out of the guiding catheter. Fluoroscopy revealed extrusion of the balloon through the side hole in the guiding catheter.
Assuntos
Cateterismo Cardíaco/instrumentação , Doença das Coronárias/terapia , Constrição Patológica/terapia , Doença das Coronárias/diagnóstico por imagem , Falha de Equipamento , Humanos , Masculino , Pessoa de Meia-Idade , RadiografiaRESUMO
Balloon inflation caused by contrast injection through the guiding catheter has been observed during several angioplasty procedures. The phenomenon is observed when employing an 8F USCI guiding catheter in combination with an ACS dilatation catheter. Two cases demonstrating the phenomenon are described in detail, together with an in vitro experiment that illustrates and quantifies the mechanism.
