Ruptured Coronary Artery Following Angioplasty

Abstract

Although percutaneous transluminal coronary angioplasty (PTCA) appears to be a relatively safe procedure, reported complications include coronary occlusion and dissection with or without myocardial infarction. Coronary rupture is a very infrequent complication of PTCA, there being only one case in 3,079 patients enrolled in the NHLBI PTCA Registry. The case reported in the literature⁽¹⁾ regarded a 77 year old man with unstable angina pectoris with focal severe stenosis of a dominant right coronary artery. PTCA of the right coronary artery was performed. After an initially successful dilatation, coronary angiography three months later disclosed significant stenosis again at the same site. Repeat PTCA was performed. Multiple inflations of a 3 mm. catheter at a manual pressure of 9 atmospheres dilated the stenosis to about a 60% occlusive lesion. A 3.7 mm. catheter was subsequently positioned and inflated five times at the maximal pressure of ten atmospheres. On the fifth inflation the proximal end of the balloon ruptured. Angiography demonstrated extravasation of contrast material into the epicardial tissue plus runoff into the distal right coronary artery. The heart rate and arterial blood pressure quickly decreased, blood was drained from the pericardial sac, but fatal cardiac arrest ensued. At necropsy an elliptical rupture site measuring 0.6 cm. in the long axis was present in the right coronary artery.