THE ROLE OF THE PERFUSION BALLOON CATHETER AFTER AN INITIALLY UNSUCCESSFUL CORONARY INTERVENTION

Major dissection and acute closure following conventional percutaneous transluminal coronary angioplasty (PTCA) occur in 5%-10% of cases and lead to significant morbidity. Newer percutaneous modalities such as directional coronary atherectomy (DCA), excimer laser coronary angiopl asty (ELCA), rotational ablation, and transluminal extraction atherect omy (TEC) can also be complicated by dissection and acute closure. Red ilatation with conventional balloon catheters can reestablish patency of the artery or improve flow in a minority of cases. The perfusion ba lloon catheter (PBC) has several advantages over conventional balloon angioplasty in this situation. In approximately 70% of these cases, su bsequent use of a PBC yields an acceptable clinical and angiographic r esult. The PBC permits rapid resolution of ischemia caused by acute cl osure or a flow-limiting dissection. New modifications of the PBC make it possible to position the catheter in neatly all segments of the co ronary arterial tree including locations not accessible to other modal ities, such as coronary stents or DCA, that are also used for salvage after a failed coronary intervention. Even if the PBC does not yield a definitive result, it allows rapid restoration of antegrade flow prio r to coronary artery bypass grafting or coronary stent placement. Beca use of its ease of use, wide applicability, and efficacy, the PBC shou ld be considered as the initial means of treatment in cases of major d issection ol acute closure following any modality of percutaneous coro nary revascularization.