[Analysis of the complications of coronarography. Apropos of a series of 2,300 consecutive tests].

The coronarographic risk is 3 deaths per thousand and 2 non-fatal complications per cent. Fatal cases are always related to severe coronary lesions, particularly stenosis of main trunk. Their incidence is equivalent during catheterization by the humeral or femoral routes whereas local complications are more frequent by the humeral approach. In the series of 2,300 successive coronarography examinations reported there were less than 4 deaths per thousand and 1.82 complications per cent. Four factors contribute to the reduction in high risk coronarography mortality when the following protocol is used. First, routine coronary opacification at start of investigations after determination of left ventricular pressures allowing, in patients with very severe coronary lesions and/or markedly altered left ventricular function, the ventriculography to be postponed until the following day or even cancelled. Second, use of a new contrast medium of lower osmolarity possessing advantages over older products. Third, and principally, institution of a very strict pre- and per-coronarography drug protocol, controlled use of an intraaortic diastolic counter-current balloon, and notably placed in position during examination in patients with very pronounced stenosis of main trunk. In these cases the arterial desilet is left in place for 24 hours after examination to delay vagal reflex provoked by compression and to allow urgent insertion if necessary of an intra-aortic diastolic counter-current balloon catheter. Fourth, use of Diltiazem intracoronary in case of major spasm and Streptokinase and possible metallic guide to obtain repermeability of a thrombosis.(ABSTRACT TRUNCATED AT 250 WORDS)