[Direct recanalization with transluminal angioplasty in acute myocardial infarct].
Treatment of acute cardiac infarction by invasive recanalization permits simultaneous removal of stenosis and occlusion: this is achieved by direct transluminal angioplasty, passage of the occlusion with the folded balloon catheter and dilatation of the stenosis. In a 42-year-old patient with anterior wall infarction and cardiogenic shock a high subtotal occlusion of the interventricular anterior branch with a thrombus beyond the 99% occlusion was seen. Due to the life-threatening state of the patient the narrowing was directly passed and relieved by dilatation. The patient survived the severe cardiogenic shock. In a second patient with posterior wall infarction complete occlusion of the right coronary artery occurred. A balloon catheter was passed without prior manipulation of the guide wire, and the occlusion was passed without difficulty. After dilatation, only moderate narrowing could be observed. Both cases demonstrate that recanalization and simultaneous removal of stenosis is possible when transluminal angioplasty is used from the beginning.