Disrupted coronary artery caused by angioplasty: Supportive and surgical considerations
| Autor: | L.A. Iannone, André Grignon, Mark Spector, Steven J. Phillips, James R. Skinner, Robert H. Zeff, Richard S. Toon, Chamnahn Kongtahworn |
|---|---|
| Rok vydání: | 1989 |
| Předmět: |
Pulmonary and Respiratory Medicine
medicine.medical_specialty Bypass grafting medicine.medical_treatment Myocardial Infarction Lumen (anatomy) Hemopericardium Angioplasty Internal medicine Occlusion medicine Humans Myocardial infarction Coronary Artery Bypass Cardiopulmonary Bypass Intra-Aortic Balloon Pumping medicine.diagnostic_test business.industry medicine.disease Coronary Vessels Surgery medicine.anatomical_structure Angiography Cardiology Emergencies Cardiology and Cardiovascular Medicine business Angioplasty Balloon Artery |
| Zdroj: | The Annals of Thoracic Surgery. 47:880-883 |
| ISSN: | 0003-4975 |
| DOI: | 10.1016/0003-4975(89)90025-8 |
| Popis: | Of 2,859 patients having percutaneous transluminal coronary angioplasty, 201 (7%) underwent emergency coronary artery bypass grafting. Two categories of patients were reviewed. Group 1 consisted of 126 patients of 2, 304 who had immediate coronary artery bypass grafting after failed elective percutaneous transluminal coronary angioplasty. Ninety-eight of these patients had angiographic evidence of occlusion of a coronary artery, and 28 had angiographic evidence of coronary artery dissection. Epicardial hemorrhage was observed at operation in 20% (25 patients). Three deaths (2.4%) occurred in group 1, and an average of 3.3 grafts was performed per patient. Group 2 comprised 75 of 555 patients who had unsuccessful attempted percutaneous transluminal coronary angioplasty during an evolving myocardial infarction and required immediate coronary artery bypass grafting. Angiography revealed coronary artery occlusion in 61 patients with dissection in 14. All group 2 patients had evidence of myocardial injury by electrocardiographic and enzymatic (myocardial-specific isoenzyme of creatine kinase) criteria. Three deaths (4%) occurred in this group, and there was an average of 3.4 grafts per patient. Percutaneous transluminal coronary angioplasty is routinely performed without surgical consultation, although an operating room and team are usually available. Supportive techniques include the intraaortic balloon pump and percutaneous cardiopulmonary bypass. In those patients with coronary artery dissection, care must be taken to reestablish the true lumen of the coronary artery. Hemopericardium should be surgically explored and broken guidewires or other foreign bodies or debris removed. From 1979 through 1986, the number of patients requiring emergency coronary artery bypass grafting after percutaneous transluminal coronary angioplasty steadily declined to less than 5%. |
| Databáze: | OpenAIRE |
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