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PubMed1982

[Angiological functional evaluation following transluminal catheter recanalization].

The percutaneous transluminal angioplasty is regarded as valuable enrichment of the therapeutical possibilities in peripheral arterial obstructive disease. Frequently by its application an arterial dilatation of the lumen and thus a local improvement of the blood supply can be achieved. As was shown by our measurements the haemodynamic factors and the quality of the prophylaxis of recidivations by medicaments have a decisive influence on the early results. Apart from clinical and X-ray morphological findings also oscillographic, Doppler-sonographic, plethysmographic and ergometric parameters are used for indication. In the same way angiological examinations of the function were performed within the further control of course and therapy. Changes of the peripheral haemodynamics could be particularly well read at the behaviour of the systolic pressure gradients and indices. When the technical and apparative prerequisites for the performance of the percutaneous transluminal angioplasty are given, the close interdisciplinary cooperation between radiologists and angiologists is important for achievement of optimum results of the treatment.

Aged↗
PubMed1983

[Hemopericardium after coronary recanalization with streptokinase in the acute phase of myocardial infarction. Drainage and early aortocoronary bypass on the 4th day].

A case of hemopericardium after coronary recanalisation with streptokinase during the acute phase of myocardial infarction is reported, emphasising the value of routine daily echocardiography in all cases of intracoronary thrombolysis. The patient was a 48 year old man with a primary antero-lateral infarct in whom coronary angiography was performed at the 4th hour, showing total proximal obstruction of the left anterior descending artery. The streptokinase protocol of intracoronary thrombolysis was performed, resulting in recanalisation of the left anterior descending artery at the 30th minute. Improved left ventricular function and persistance of coronary patency were confirmed 14 hours after recanalisation. In the following days the patient showed signs of right ventricular failure with successive echocardiogrammes demonstrating an increasing pericardial effusion. On the 4th day, 600 ml of blood were drained surgically and aorto-coronary bypass carried out on the left anterior descending artery. This procedure maintained coronary patency and the improvement in left ventricular function. Several studies have shown that the hemorrhage of reperfusion only occurs in the zones of necrosis, and thrombolytics, especially streptokinase, may aggravate this condition.

Coronary Artery Bypass↗
PubMed1984

[Accentuation of myocardial ischemia during coronary recanalization in the acute phase of myocardial infarction].

Coronary recanalisation during the acute phase of myocardial infarction, especially by in situ infusion of thrombolytic agents, is accompanied in most cases by rapid regression of chest pain and a reduction in the degree of ST elevation. However, a multicentre retrospective study of 104 attempts at recanalisation, including 78 successful procedures, showed in 10 cases (12.8 p. 100), an apparently paradoxical accentuation of the chest pain with or without increased ST elevation, at the time of angiographically demonstrable recanalisation. This phenomenon may be interpreted as being the result of aggravation of the ischaemia of the border zone, the objective of therapy. Several pathogenic hypotheses, all with experimental proof, may be suggested to explain these observations (haemorrhagic infarction, non reperfusion, ischaemic contraction due to massive intracellular flow of calcium, etc.). It is usually associated with arrhythmias and may be considered to be a reliable sign of recanalisation. It may also explain certain cases of persistence of chest pain and ECG changes despite the demonstration of a permeable epicardial artery on initial coronary angiography.

Coronary Angiography↗