PubMed · 2531853
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J Stone. 1989. Balloon man.. https://pubmed.ncbi.nlm.nih.gov/2531853/
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BACKGROUND: We hypothesized that successful reperfusion of an occluded infarct-related coronary artery even late after acute myocardial infarction would result in improved regional wall motion and that such improvement might be related to the presence of collateral blood flow within the infarct bed. METHODS: We assessed regional wall motion by two-dimensional echocardiography at base line and one month after angioplasty was attempted in the occluded infarct-related artery in 43 patients who had had a myocardial infarction two days to five weeks earlier. A wall-motion score was assigned to each patient on a five-point scale (from 1 [normal function] to 5 [dyskinesia]). The percentage of the infarct bed perfused by collateral flow was assessed with myocardial contrast echocardiography. RESULTS: In the 41 patients who had abnormal wall motion at base line, improvement in function was noted in 25 (78 percent) of the 32 in whom angioplasty was successful, as compared with only 1 (11 percent) of the 9 in whom it was unsuccessful (P < 0.001). The percentage of the infarct bed supplied by collateral flow at base line was directly correlated with wall function and inversely correlated with the wall-motion score one month after successful angioplasty (r = -0.64, P < 0.001). Among the patients in whom angioplasty was successful, the 23 in whom > 50 percent of the infarct bed was supplied by collateral flow had better wall motion (P < 0.001) and greater improvement in wall motion at one month (P = 0.004) than the 9 in whom < or = 50 percent of the bed was supplied by collateral flow. The degree of improvement in function was not influenced by the length of time between the infarction and the attempted angioplasty. CONCLUSIONS: The myocardium remains viable for a prolonged period in many patients with acute infarction and an occluded infarct-related artery. Viability appears to be associated with the presence of collateral blood flow within the infarct bed.
The case history of a girl aged 10 years with renovascular hypertension is presented. The symptoms were atypical. The diagnosis was made on basis of positive captopril renography. Angiography showed delayed filling of the right main renal artery by a long collateral vessel. The right renal artery was found to be occluded proximally by intimal hyperplasia. Renal angioplasty was performed and resulted in normalized blood pressure and normalized right kidney function.
Since 1981, 93 intraoperative balloon dilatation have been performed in 78 patients suffering from occlusive arterial disease of the lower extremities. 42 iliac dilations were performed on 34 patients, where 8 patients required dilatations at two sites, and 26 patients only at one site (common iliac artery: 15, external iliac artery: 27). 44 patients received femoro-popliteal dilations of which 7 patients required dilations at two sites, and 37 patients only at one site for a total of 51 dilations. The follow-up period ranged from 1 to 60 months with an accumulated patency rate of 92% in iliac and 39.3% in femoro-popliteal segment at 5 years. Fourteen patients died by the fifth year after intervention. Most of these deaths were due to concurrent cardiac disease. By improving inflow or outflow and reducing operative stress in poor risk patients balloon angioplasty is a valuable adjunct to vascular reconstruction.