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Is transluminal coronary angioplasty mandatory after successful thrombolysis? A quantitative coronary angiographic study

  • Chapter
Quantitative Coronary and Left Ventricular Cineangiography

Part of the book series: Developments in Cardiovascular Medicine ((DICM,volume 51))

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Summary

Percutaneous transluminal coronary angioplasty has been advocated as a mandatory procedure to prevent reocclusion after successful thrombolysis in acute myocardial infarction. This study describes our experience with both procedures over a 12 month period. Out of 105 patients catheterized in the acute phase of myocardial infarction, 64 were recanalized with 250.000 units of streptokinase, while in 25 patients recanalization could not be achieved. In the remaining sixteen, the infarct related vessel was patent at the time of the procedure. Eighteen of the 78 patients who had a patent infarct related vessel at the end of the recanalization procedure underwent transluminal angioplasty immediately afterwards.

Postlysis angiograms were analyzed quantitatively with a computerized measurement system. The contours of the relevant arterial segments were detected automatically. Reference diameter, minimal obstruction diameter, length of the lesions, and percentage diameter stenosis were averaged from multiple views. In 31% of our patients a diameter stenosis of less than 50% was found, whereas one of 70% or more was seen only in 19% of the patients. Eleven stenotic lesions, recanalized at the acute stage, reoccluded in the short term, and in the long term eight other patients sustained a reinfarction in the same myocardial territory. Seventeen of these 19 recanalized lesions had a diameter stenosis of 58% or more.

In view of these results, we felt justified in combining recanalization and angioplasty in 18 patients selected from the most recent admissions. In these patients, the mean diameter stenosis decreased from 59% to 30% and mean pressure gradient from 41 to 8 mmHg. Late follow-up showed reocclusion in one case.

Although percutaneous transluminal coronary angioplasty does not seem to be mandatory at the acute stage in the majority of patients, it is feasible to undertake in one sitting and seems to prevent reocclusion in patients selected on the basis of quantitative angiographic criteria.

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Authors and Affiliations

  1. Department of Cardiology (Chief: P.G. Hugenholtz, M.D., F.A.C.C.) Thoraxcenter, Erasmus University, and University Hospital Dijkzigt, Rotterdam, The Netherlands

    J. H. C. Reiber Ph.D., P. W. Serruys M.D. & C. J. Slager M.Sc.

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  1. J. H. C. Reiber Ph.D.
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  2. P. W. Serruys M.D.
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  3. C. J. Slager M.Sc.
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© 1986 Martinus Nijhoff Publisher, Dordrecht

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Reiber, J.H.C., Serruys, P.W., Slager, C.J. (1986). Is transluminal coronary angioplasty mandatory after successful thrombolysis? A quantitative coronary angiographic study. In: Quantitative Coronary and Left Ventricular Cineangiography. Developments in Cardiovascular Medicine, vol 51. Springer, Dordrecht. https://doi.org/10.1007/978-94-009-4239-4_16

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  • DOI: https://doi.org/10.1007/978-94-009-4239-4_16

  • Publisher Name: Springer, Dordrecht

  • Print ISBN: 978-94-010-8382-9

  • Online ISBN: 978-94-009-4239-4

  • eBook Packages: Springer Book Archive

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