SUPPORTED CORONARY ANGIOPLASTY AND STANDBY SUPPORTED CORONARY ANGIOPLASTY FOR HIGH-RISK CORONARY-ARTERY DISEASE

Despite advances in technology and experience, there continues to be an appreciable acute closure rate1-3 associated with percutaneous transluminal coronary angioplasty (PTCA). Hemodynamic compromise may also occur when a wire or balloon is advanced across or inflated in a strategically located vessel. Therefore, in high-risk patients, techniques are necessary to enable support of the coronary or systemic circulation, or both, should hemodynamic collapse occur. Prophylactic coronary support strategies have included coronary sinus retroperfusion 4 and regional coronary perfusion of blood5,6 or oxygenated fluorocarbons.7 The intraaortic balloon pump8 and percutaneous cardiopulmonary bypass9,10 have been advocated to support the systemic circulation during high-risk interventional procedures or crises during more routine invasive procedures. The purpose of this report was to relate our experience using supported coronary angioplasty (PTCA with percutaneous cardiopulmonary bypass) and to compare it to a similar group of patients undergoing PTCA when the cardiopulmonary bypass system was not inserted but used as standby. This comparison will serve to (1) describe morbidity of these procedures, (2) define indications for percutaneous cardiopulmonary bypass use during PTCA, and (3) demonstrate the safety of expectant percutaneous cardiopulmonary bypass use. © 1990.