Investigations Abrupt Coronary Closure After Percutaneous Transluminal Coronary Angioplasty

51 cases of abrupt occlusion who had undergone PTCA at the Invasive Cardiology Laboratory of the TYIH between January 1984 and March 1993 were retrospectively studied. Decrease of coronary flow was graded in accordance with TIMI classification. Once an abrupt closure was noted during PTCA, intracoronary nitrate and heparin infusion was started immediately in addition to the main procedure, and long-term dilation (>120 sec) was carried out using the same balloon. If insufficient, a long-term autoperfusion balloon catheter was utilized. Streptokinase was used in only one case. Directional coronary atherectomy was performed in a patient because of intimal flap. In one further case we used Palmaz-Schatz stent. Twelve patients (23 percent) in whom ischaemic findings could not be relieved were treated with coronary artery bypass grafting. In 18 of the 51 cases (35 per cent), successful backflow was realized. No successful result was obtained in 33 patients. Best results were seen in Cx lesions in 5 of nine patients. LAD lesions, in contrast, displayed the least success rate: in 5 of 23 patients. Non-Q MI developed later in four of the 18 patients who were categorized initially as successful cases. While the acute occlusion rate was 6.6 per cent and successful backflow was 18.2 per cent between October 1984 and October 1990 in 333 patients in whom old technologic instruments were used; with subjected to PTCA developed technologies, these were 3.4 per cent and 48.3 per cent, respectively in 842 patients between October 1990 and March 1993. Though new technologic instruments are increasingly used in invasive cardiology with high success rates, further work is clearly necessary to reduce morbidity and mortality in abrupt coronary occlusion.