Catheter Reperfusion to Allow Optimal Coronary Bypass Grafting Following Failed Transluminal Coronary Angioplasty

At present, intimal dissection, restenosis, or vessel closure occurs in approximately 5 to 10% of patients undergoing percutaneous transluminal coronary angioplasty. Coronary artery bypass grafting is usually required to remedy this complication and prevent substantial myocardial damage. The results of these revascularization procedures, however, are less satisfactory than those of elective coronary bypass grafting. Hemodynamic instability of the patients and the presence of ongoing myocardial ischemia usually necessitate that the operations be performed on an emergent basis. This report describes a series of 9 patients who had either dissected or restenosed coronary arteries at the time of angioplasty, as well as acute onset of ischemic symptoms. All underwent emergent coronary bypass grafting, but once it became apparent that angioplasty had failed, a specially designed reperfusion catheter was placed across the coronary lesion to reestablish blood flow to the ischemic area of myocardium. This catheter was removed after aortic cross-clamping and delivery of cardioplegic solution. The presence of the catheter thus reduced the ischemic period to the interval from the onset of dissection until the positioning of the catheter across the lesion. In all patients, the catheter temporarily reestablished coronary blood flow to the region of ischemic myocardium, thereby producing resolution of symptoms, and allowed antegrade delivery of cardioplegic solution infused into the aortic root to this area of myocardium. Thus, in turn, made it possible to perform the subsequent coronary bypass operation as a controlled, optimal revascularization procedure.