Acute occlusion developing during or immediately after percutaneous transluminal coronary angioplasty: nonsurgical treatment.

The authors report results of nonsurgical treatment of acute occlusion developing during percutaneous transluminal coronary angioplasty (PTCA). Of 514 consecutive PTCAs, acute occlusion of the dilated artery developed during or within 1 hour after PTCA in 44 patients (8.5%); of these acute occlusions, 11 (2.1%) were due to guide wire or catheter manipulation during PTCA, while 33 (6.4%) were due to abrupt closure occurring after initially successful dilation. In seven of the 11 patients with acute occlusions resulting from manipulation, PTCA was continued with attempts to cross the reoccluded segment; this was successful in two patients (29%). In 25 of the 33 patients with abrupt closure, repeat balloon dilation was immediately attempted rather than send the patients to surgery for emergency coronary artery bypass grafting. Sixteen of these 25 attempts were successful (64%) and resulted in conversion of a potential complication into a successful outcome. Abrupt closure following initial dilation seems more likely to be successfully treated by continuing with PTCA than is acute occlusion resulting from catheter and guide wire manipulation.