Myocardial protection by coronary autotransfusion during angioplasty

: Coronary autologous blood perfusion may protect the myocardium against ischemia during arterial occlusion due to balloon inflation. During balloon inflation, arterial blood was perfused via the balloon catheter in 19 patients with single proximal severe left anterior descending artery stenosis and normal left ventricular function. Blood was perfused using a contrast medium injector at a flow rate of 40 ml/min. The balloon was maintained inflated for 60 seconds at 6 atmospheres. Two inflations were performed with perfusion and 2 without. Myocardial ischemia was assessed by ST elevations on both the peripheral and intracoronary ECGs, changes in left ventricular systolic and end diastolic pressures and peak positive and negative dP/dt. A positive response was obtained in 11 patients. In 5 patients, the myocardial ischemia induced by dilatation was not alleviated by the perfusion and in 3 patients ischemia was increased by perfusion. In conclusion, ischemia is inconsistently reduced by autologous blood perfusion and its adverse effect in some patients could limit its use.