Arterial blood infusion for myocardial protection during percutaneous transluminal coronary angioplasty

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Abstract
Much of the potential risk of percutaneous transluminal coronary angioplasty relates to regional myocardial ischaemia during balloon inflation. We have investigated the protective effect of infusing arterial blood through the angioplasty catheter into the distal coronary artery during 60 second balloon inflations. Symptomatic, electrocardiographic and echocardiographic indices of regional ischaemia were monitored during inflations with and without blood infusion. The effect of infusing Hartmann's solution was also evaluated to control for washout effects. Twelve patients were studied. Inflation without blood produced chest pain in eight patients, ST-segment elevation in ten patients and regional wall motion abnormalities in every case. During blood infusion manifestations of ischaemia were either delayed or prevented altogether. Chest pain occurred in only one patient while ST segment elevation and regional wall motion abnormalities occurred in three and four patients, respectively. Infusion of Hartmann's solution, on the other hand, had no significant effect on the development of regional myocardial ischaemia during balloon inflation indicating that delivery of arterial oxygen and not washout of metabolites was responsible for the beneficial effects of blood infusion. These data indicate that distal coronary perfusion with arterial blood during angioplasty reduces regional myocardial ischaemia and has the potential to improve the safety of the technique and to permit more prolonged periods of balloon inflation.