Supported angioplasty with synchronized retroperfusion in high-risk patients with left main trunk or near left main trunk obstruction

Abstract

To test the feasibility of synchronized retroperfusion (SRP) as a support device of percutaneous transluminal coronary angioplasty (PTCA) for high-risk patients, 10 patients with left main trunk or near left main trunk obstruction underwent PTCA with SPR. An 8.5F retroperfusion catheter was inserted from the antecubital vein into the coronary sinus. Arterial blood was supplied through the catheter into the myocardium with a retroperfusion pump during the diastolic phase by means of ECG triggering. In all patients, the narrowings were successfully dilated and an improvement of more than 20% in the luminal diameter stenosis was achieved; however, narrowing of more than 50% (58%) remained in one patient. In all patients, systemic hemodynamics was maintained for more than 30 seconds during balloon inflation. In seven patients, a 60-second balloon inflation was possible without any collapse of systemic hemodynamics. To test the protective effect of SRP on myocardial ischemia and impairment of systemic hemodynamics, balloon inflation without SRP was performed in eight patients after successful dilatation. The duration for balloon inflation with SRP (71 ± 30 seconds; n = 8) was significantly longer than that without SRP (56 ± 30 seconds; n = 8). The decrease in systolic aortic pressure, the increase in pulmonary diastolic pressure, and ST-T segment elevation in the precordial lead of ECG during balloon inflation with SRP were less than those during balloon inflation without SRP. After PTCA, angina was not provoked by exercise stress testing in any of the 10 patients. We concluded that SRP is a beneficial support device of PTCA for high-risk patients.