Circulation, Vol 78, 1323-1334, Copyright © 1988 by American Heart Association
TA Fischell, G Derby, TM Tse and ML Stadius
To determine whether percutaneous transluminal coronary angioplasty (PTCA)
increases coronary artery luminal dimensions by stretching and injuring
("paralyzing") the smooth muscle of the arterial wall, we prospectively
analyzed spontaneous changes and then intracoronary nitroglycerin-induced
changes in segmental coronary artery diameters during the first 30 minutes
after uncomplicated single-vessel PTCA in 10 patients. Five additional
patients received intravenous nitroglycerin throughout the procedure to
determine whether nitroglycerin could prevent vasoconstriction after PTCA.
All of the patients were maintained on oral doses of diltiazem and aspirin
at the time of the study. Coronary arteriography was performed at 2, 5, 15,
and 30 minutes after PTCA and then 3 minutes after 300 micrograms i.c.
nitroglycerin. Quantitative measurements (computerized edge-detection) were
performed at each time, in coronary segments centered in the dilated
segment, distal to the dilated segment, and in a control vessel not
manipulated with the balloon catheter or guidewire. Progressive
vasoconstriction (defined as a loss of diameter that was reversed by
intracoronary nitroglycerin) was observed after PTCA in the dilated and
distal segments (10 of 10 patients) but not in the control segment. The
vasoconstriction in the dilated segment at 30 minutes (mean, 30 +/- 4%) was
highly statistically significant compared with vasoconstriction at 2 and 5
minutes after PTCA (p less than 0.001) and compared with the control
segment at 30 minutes (p less than 0.005). There was no significant loss of
diameter after PTCA in the dilated segment in the five patients who
received intravenous nitroglycerin. In conclusion, 1) spontaneous coronary
artery vasoconstriction after PTCA occurs routinely at and distal to the
site of balloon dilatation despite pretreatment with aspirin and calcium
channel blockers; 2) coronary artery vasoconstriction after PTCA is rapidly
reversed by intracoronary nitroglycerin and can be prevented by the
continuous administration of intravenous nitroglycerin during and after the
procedure; 3) these results are incompatible with the hypothesis that PTCA
improves coronary luminal dimensions by arterial "paralysis"; and 4) these
findings have implications concerning the etiology and prophylaxis of
abrupt vessel closure after PTCA.
ARTICLES
Coronary artery vasoconstriction routinely occurs after percutaneous transluminal coronary angioplasty. A quantitative arteriographic analysis
Division of Cardiology, Stanford University Medical Center, CA 94305.
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