Circulation, Vol 88, 1569-1578, Copyright © 1993 by American Heart Association
JJ Popma, LF Satler, AD Pichard, KM Kent, A Campbell, YC Chuang, C Clark, AJ Merritt, TA Bucher and MB Leon
BACKGROUND. Despite their potential advantages, new coronary angioplasty
devices may be associated with more frequent vascular complications than
noted after standard balloon angioplasty, theoretically due to the larger
sheaths and prolonged periods of anticoagulation required by some of these
devices. This study sought to identify the incidence, predictors, and
clinical outcome of vascular complications after new device angioplasty.
METHODS AND RESULTS. The clinical course of 1413 patients was reviewed
after balloon or new device angioplasty. Vascular complications were
defined as formation of a pseudoaneurysm, arteriovenous fistula,
retroperitoneal hematoma, or groin hematoma associated with a > 15-point
hematocrit drop or the need for surgical repair. Stepwise logistic
regression was used to identify independent predictors for vascular
complications. Vascular complications developed after 84 (5.9%) procedures;
they occurred more frequently after intracoronary stenting (14.0%) and
extraction atherectomy (12.5%) than after balloon angioplasty (3.2%) (odds
ratios, 4.86; P < .001, and 4.26, P < .05, respectively). Independent
predictors of vascular complications included the use of intraprocedural
thrombolytic agents (P < .01), intracoronary stenting (P < .005), or
extraction atherectomy (P < .05); high maximum creatinine level (P <
.005); low nadir platelet count (P < .001); longer periods of excess
anticoagulation (P < .05); and the need for repeat coronary angioplasty
(P < .005). Vascular complications were not related to the size of the
arterial sheath used. CONCLUSIONS. Vascular complications developed more
frequently after new device angioplasty than after balloon angioplasty,
with the risk for vascular complications directly related to the degree of
periprocedural anticoagulation.
ARTICLES
Vascular complications after balloon and new device angioplasty
Department of Internal Medicine Cardiology Division, Washington Hospital Center, Washington, DC 20010.
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