Therapy for acute vascular complications in percutaneous transluminal coronary angioplasty with the autoperfusion balloon catheter.

Prolonged dilatation with an autoperfusion balloon catheter (APBC) (High-Flow-CPC-Mainz (Schneider) in 23 cases and Stack Perfusion (ACS) in 50 cases) was carried out in 73 patients (60 men, 13 women, mean age 59.3 +/- 8.8 years) with acute vascular complications occurring during PTCA (25 occlusive dissections (34%), five thrombotic occlusions (7%), 42 non-occlusive dissections (58%) and one non-occlusive thrombus with reduction of flow (1%)) in order to avoid stent implantation or emergency bypass surgery. On average 1.5 +/- 0.8 inflations were carried out per patient with a mean maximum inflation time of 14.1 +/- 8.4 min and a mean total inflation time of 16.8 +/- 12.3 min. In 61 patients (83.5%), the vascular complication could be controlled successfully with APBC, but in 12 APBC was not successful. Eight patients (11%) had emergency surgery. A stent was implanted in three patients (4.1%), and one suffered an acute myocardial infarction. Out of the 61 patients with positive result after prolonged dilatation, the hospital phase was uncomplicated in 53 (86.9%), five (8.2%) suffered an infarct with a maximum rise in CK of 350 U.l-1, two with multivessel disease had elective operations and one was dilated a second time because of a subacute reocclusion. Our experience indicates that when an acute vascular complication occurs, prolonged dilatation with an APBC is good interventional therapy avoiding stent implantation or emergency bypass surgery. However, new techniques cannot always replace surgery so an emergency bypass operation may still be necessary.