Frequency, management and follow-up of patients with acute coronary occlusions after percutaneous transluminal coronary angioplasty.

Angiograms from 1,500 consecutive patients undergoing percutaneous transluminal coronary angioplasty (PTCA) at the Cleveland Clinic were reviewed to determine the frequency of acute coronary occlusion after successful PTCA. Thirty-two patients (2%) had acute coronary occlusions. Of these, 27 (84%) presented within 6 hours. Compared with control group, only the presence of eccentric lesions (72% vs 24%) and intimal tears (78% vs 34%) was more predominant in the group with acute occlusion. Redilation was attempted in 31 patients and was successful in 27 (87%). Nine of these patients eventually required coronary bypass surgery and 18 were discharged and followed for 11 to 34 months (mean 18). Thus, redilation is a safe and effective approach to manage patients in whom coronary occlusion develops after PTCA.