Coronary Morphology Postpercutaneous Transluminal Coronary Angioplasty

pp 493-501

Abstract

Background

Despite the therapeutic success of percutaneous transluminal coronary angioplasty, the exact mechanism by which this technique improves vessel patency remains unsettled. Morphologic observations in coronary arteries of patients undergoing percutaneous transluminal coronary angioplasty are scant but provide clues regarding its mechanism of action. The aim of this study was to describe morphologic findings postpercutaneous transluminal coronary angioplasty.

Methods

The autopsies of three patients who underwent percutaneous transluminal coronary angioplasty and died within 3 days after the procedure were studied. Clinical and angiographic data were reviewed. All autopsies included post-mortem angiography, serial sectioning of the epicardial coronary arteries and histology of these arteries and the myocardium.

Results

Patients were male with ages ranging from 63 to 73 years. One had history of chronic effort angina, one of recent onset angina, and the third of previous myocardial infarction. 'They were admitted for prolonged chest pain, acute myocardial infarction and elective percutaneous transluminal coronary angioplasty. The procedures were performed to right, left and left anteriordescending coronary arteries respectively. In two cases intracoronary streptokinase was used. Patients died 5, 11 and 58 hours postpercutaneous transluminal coronary angioplasty due to ventricular fibrillation. In the autopsy, plaque fracture and localized or extensive dissection were seen in all cases; 2 subjects presented also intimal flaps with local and distal thrombi; and the third case presented subadventitial dissection with compressive hematoma. In the 2 cases where reperfusion was achieved hemorrhagic myocardial infarction was found.

Conclusions

In all cases percutaneous transluminal coronary angioplasty produced a fracture in the weakest area of the fibrous capsule of the plaque. Complications of percutaneous transluminal coronary angioplasty were related to local thrombus, extensive dissection and hemorrhagic acute myocardial infarction in the reperfused cases.