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

John D. Jackman, James P. Zidar, James E. Tcheng, Amy B. Overman, Harry R. Phillips, Richard S. Stack

Research output: Contribution to journalArticle

42 Citations (Scopus)

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.

Original languageEnglish
Pages (from-to)1417-1421
Number of pages5
JournalThe American journal of cardiology
Volume69
Issue number17
DOIs
StatePublished - Jun 1 1992
Externally publishedYes

Fingerprint

Coronary Balloon Angioplasty
Economic Inflation
Pathologic Constriction
Myocardial Infarction
Angioplasty
Dissection
MB Form Creatine Kinase
Stable Angina
Unstable Angina
Coronary Vessels

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Outcome after prolonged balloon inflations of >20 minutes for initially unsuccessful percutaneous transluminal coronary angioplasty. / Jackman, John D.; Zidar, James P.; Tcheng, James E.; Overman, Amy B.; Phillips, Harry R.; Stack, Richard S.

In: The American journal of cardiology, Vol. 69, No. 17, 01.06.1992, p. 1417-1421.

Research output: Contribution to journalArticle

Jackman, John D. ; Zidar, James P. ; Tcheng, James E. ; Overman, Amy B. ; Phillips, Harry R. ; Stack, Richard S. / Outcome after prolonged balloon inflations of >20 minutes for initially unsuccessful percutaneous transluminal coronary angioplasty. In: The American journal of cardiology. 1992 ; Vol. 69, No. 17. pp. 1417-1421.
@article{4ca89babcd174261b631d7582f31408c,
title = "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.",
author = "Jackman, {John D.} and Zidar, {James P.} and Tcheng, {James E.} and Overman, {Amy B.} and Phillips, {Harry R.} and Stack, {Richard S.}",
year = "1992",
month = "6",
day = "1",
doi = "10.1016/0002-9149(92)90893-4",
language = "English",
volume = "69",
pages = "1417--1421",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",
number = "17",

}

TY - JOUR

T1 - Outcome after prolonged balloon inflations of >20 minutes for initially unsuccessful percutaneous transluminal coronary angioplasty

AU - Jackman, John D.

AU - Zidar, James P.

AU - Tcheng, James E.

AU - Overman, Amy B.

AU - Phillips, Harry R.

AU - Stack, Richard S.

PY - 1992/6/1

Y1 - 1992/6/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=0026776634&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0026776634&partnerID=8YFLogxK

U2 - 10.1016/0002-9149(92)90893-4

DO - 10.1016/0002-9149(92)90893-4

M3 - Article

C2 - 1590230

AN - SCOPUS:0026776634

VL - 69

SP - 1417

EP - 1421

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 17

ER -