Emergency stenting for refractory acute coronary artery occlusion during coronary angioplasty

Acute coronary artery occlusion occurs in 2 to 11% of the patients who undergo coronary angioplasty and is the major cause of in-hospital mortality and morbidity associated with coronary angioplasty.1–4 This procedural complication is usually caused by an occlusive dissection in association with thrombosis, spasm and elastic recoil. If immediate redilatation is unsuccessful, emergency surgery is traditionally recommended, but because of the clinical instability of these ischemic patients, acute surgery is associated with high perioperative mortality and morbidity, and despite emergent revascularization, development of myocardial infarction cannot be prevented in a substantial number of patients.5 New methods that can restore anterograde flow and effectively stabilize the clinical condition after refractory acute occlusion are highly desirable. They may serve as a safe bridge until subsequent surgery or may even serve as an alternative to surgery. Emergency stent implantation in the dissected segment has been shown to restore anterograde flow.6,7 However, because the first generation of stents had a high tendency to acute thrombotic occlusion, it was decided that emergency stent implantation should be followed by “semi-elective” surgery. This study reports the acute results of the management of acute coronary artery occlusion refractory to redilation with emergency stent implantation followed by “semi-elective” bypass surgery in most of these patients.