Percutaneous transluminal coronary angioplasty: morphological findings in 3 patients.

Little morphologic information is available on the status of the major epicardial coronary arteries in patients dying after percutaneous transluminal coronary angioplasty. We studied hearts from 3 men (aged 60, 45 and 47 years) dying 3 days, 1 month and 7 months after balloon--dilatation of obstructed coronary artery segments. Twice the left anterior, once the left main coronary artery have been desobliterated. In one patient the procedure has not been successful and a venous bypass graft had to be implanted. Histologically the site of dilatation is clearly recognisable after 7 months. The characteristic findings are intimal tears in the segment opposite to the obstructing plaque. The intimal gaps are filled after 7 months by a neointima. In the dilated left main coronary we find 1 month after angioplasty an extensive proliferation of smooth muscle cells resulting in restenosis. Two patients died suddenly after an interval without angina. In the third patient--ome hours after bypass grafting--spasm of the non-involved right coronary artery occurred resulting in inferior infarction; this patient died 3 days after dilatation.