Outcome after prolonged balloon inflations of >20 minutes for initially unsuccessful percutaneous transluminal coronary angioplasty

Abstract

Prolonged balloon inflation with or without autoperfusion techniques is a common initial approach to major dissection or abrupt occlusion after percutaneous transluminal coronary angioplasty (PTCA). To assess such a strategy in the setting of unsuccessful angioplasty, 40 patients who underwent prolonged balloon inflations of >20 minutes between January and July of 1991 after initially unsuccessful angioplasty were studied. These patients (median age 59 years) underwent PTCA for progressive or unstable angina (16 [40%]), symptomatic or asymptomatic residual stenosis after myocardial infarction (10 [25%]), acute myocardial infarction (3 [8%]), stable angina (3 [8%]), reinfarction (2 [5%]), and other indications (6 [15%]). The significant stenoses were primarily in the proximal and midportions of the right coronary (53%), left anterior descending (30%) and left circumflex (17%) coronary arteries. Before prolonged balloon inflation, the longest single inflation was 11 ± 6 minutes and the total time of all inflations was 17 ± 8 minutes (mean ± standard deviation). Stenosis was reduced from 91 ± 9 to 68 ± 16% before prolonged inflation. After prolonged balloon inflation of 30 ± 9 minutes, the residual stenosis was 47 ± 21% (p = 0.0001 vs value before prolonged inflation). Furthermore, improvements in the appearance of filling defects or dissections, or both, occurred in 19 patients (48%). Procedural success was obtained in 32 of 40 patients (80%). Coronary bypass grafting was performed in 8 patients (20%): 4 after unsuccessful PTCA (3 emergently) and 4 electively after initially successful PTCA. Although 5 patients had creatine kinase-MB elevations >20 IU/liter after the procedure, only 1 sustained a Q-wave myocardial infarction. There were no deaths in the hospital. In summary, prolonged balloon inflations of >20 minutes are successful in 80% of patients in whom initial extensive PTCA attempts were not. Prolonged inflations may thus be desirable before consideration of bypass grafting or stenting.