A new technique to exchange one angioplasty guiding catheter for another with the guide wire in place and across a coronary artery stenosis has been developed to decrease the dangers of having to recross the stenosis with a guide wire. This technique utilizes a regular extended angioplasty guide wire and enables the exchange of guiding catheters during the angioplasty procedure. In 683 consecutive angioplasty procedures by one operator, this technique has been attempted 57 times in 43 patients (6.3%) and has been successful 51 times (90%). The only failures were when the second catheter had a large or open curve (left Amplatz II, 5/22 unsuccessful or multipurpose, 1/3 unsuccessful). There have been no complications. We conclude that exchange of a guiding catheter over a guide wire by the method described is safe and helpful in cases where different guiding catheters are needed for back-up power once the lesion has been crossed with a guide wire.

Synchronized coronary venous retroperfusion of autologous arterial blood was offered to patients referred for medically refractory unstable angina or evolving myocardial infarction with contraindications to thrombolytic therapy. Primary endpoints of angina, ST segment deviation, and two-dimensional echocardiographic systolic wall motion were followed to determine the efficacy of retroperfusion in patients prior to and then during angioplasty, surgical intervention, or pharmacological management, as the clinical picture warranted. Over a 12 month period, 21 patients were referred and 15 received retroperfusion. All experienced full relief of angina (p = 0.008). ST segment deviations and systolic wall motion of ischemic zones were observed to improve (p = 0.06 ST changes; p = 0.0001 wall motion changes) with synchronized retrograde perfusion. During attempts to remove patients from retroperfusion, statistically significant (p < 0.01) reproducible changes in these same endpoints were documented. Retroperfusion appears to improve acute myocardial ischemia. This technique functions well in the intensive care unit environment with only fluoroscopy as technical imaging support.