Open AccessDiffuse Embolization Following Percutaneous Transluminal Coronary Angioplasty of Occluded Vein Grafts: The Blush Phenomenon
Author(s) -
Margolis James R.,
Mehta Sameer,
Chen ChengYun,
Krauthamer Dan,
Mogensen Lars
Publication year - 1991
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.4960140607
Subject(s) - medicine , myocardial infarction , angina , coronary arteries , angioplasty , atherectomy , cardiology , autopsy , unstable angina , coronary vein , embolization , percutaneous , artery , surgery , infarction , radiology , restenosis , stent , coronary sinus
Summary : Percutaneous transluminal coronary angioplasty (PTCA) was performed on 146 saphenous vein grafts in 116 patients. In 29 patients, 31 grafts were totally occluded. Myocardial staining lasting over 5 minutes—“the blush phenomenon”—followed the opening of the occluded grafts in 9 of these patients. In 5 of these 9, enzyme release suggested infarction. A sixth patient died within a few hours of PTCA, with suspected infarction. Autopsy demonstrated diffuse and extensive distal coronary arterial embolization of grumous material, including cholesterol crystals, platelets, and fibrin. The blush phenomenon was not seen following PTCA in the remaining 20 patients with total occlusions, nor in any of the 87 patients with stenosed grafts. We have not observed the blush phenomenon following PTCA of more than 3300 coronary arteries. Of the 9 patients demonstrating the blush phenomenon, 6 had a recent history of myocardial infarction or unstable angina pectoris, compared with 4 of the remaining 20 patients with occluded grafts. We now approach occluded grafts with injection of intragraft thrombolytic agents or with atherectomy prior to PTCA. Future approaches may include atherectomy or laser angioplasty.