Complications of Plain Old Balloon Angioplasty

Abstract

A 68-year-old man with a recent history of new-onset angina and a positive stress thallium showing a reversible anterior defect underwent coronary angiography. The angiogram demonstrated a high-grade stenosis of the left anterior descending artery (Figure 4-1). Percutaneous transluminal coronary angioplasty (PTCA) was attempted using a 2.5 × 15-mm Maverick-2 coronary angioplasty balloon (Boston Scientific, Natick, MA) over a Whisper 0.014″/190-cm coronary guidewire (Cordis, Miami Lakes, FL). One inflation was performed at 8 atm, yielding the results shown in Figure 4-2. An intravascular ultrasound (Figure 4-3, see color plate, part B) was performed to further investigate the angiographic lesion and a coronary artery dissection was confirmed. A 3.0 × 18-mm Express-2 stent (Boston Scientific, Natick, MA) was deployed and yielded an excellent result; no residual dissection was indicated (Figure 4-4) and the patient did well. Open image in new window Figure 4-1. High-grade left anterior descending coronary artery (LAD) stenosis (arrow) in a 68-year-old man. Open image in new window Figure 4-2. Left anterior descending coronary artery with type B dissection postangiosplasty. Note double lumen (arrow) without flow compromise. Open image in new window Figure 4-3. (A) Intravascular ultrasound of LAD dissection postangioplasty; (B) schematic represention; (C) angiographic comparison. (See color plate, part B only.) Open image in new window Figure 4-4. Left anterior descending coronary artery after stenting (arrow).