DISTAL CORONARY HEMOPERFUSION DURING PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Distal coronary hemoperfusion during percutaneous transluminal coronar y angioplasty (PTCA)-with an autoperfusion balloon or active system-fa cilitates prolonged balloon inflation. Prolonged inflations may tack u p intimal dissections and improve the primary angioplasty result in co mplex lesions. Additionally, distal perfusion may reduce the likelihoo d of cardiogenic shock during high-risk PTCA. Autoperfusion balloons a re most frequently used to treat acute or threatened closure. There cu rrently is no prospective clinical study showing that stent implantati on for this complication is more successful and more cost-effective. T he blood flow rates through autoperfusion balloons may not abolish myo cardial ischemia, and higher flow rates can often be achieved with pum ps. Therefore, during high-risk PTCA, pumps may be preferred to preven t hemodynamic collapse. Clinical application of perfusion pumps is ham pered by the risk for mechanical hemolysis during prolonged perfusion and the high velocity of the bloodstream that exits the PTCA catheter, causing distal vessel wall trauma. (C) 1996 Wiley-Liss, Inc.