Iatrogenic Coronary Ostial Stenosis

In theory, a coronary artery is liable to damage each time a catheter or a cannula is inserted into it. Actually, such complications occur only infrequently. When they do occur, the effects are immediate and easily recognized since the vessel wall is penetrated or perforated.¹Now, in a recent issue of theArchives of Pathology, Silver et al report on three patients who took months to manifest signs of coronary artery damage induced during cannulation and perfusion.²At autopsy the ostia and first 1 to 2 cm of one or both of their coronary arteries were severely stenosed by thickened intima. Wide discontinuities of medial elastic fibers were related to some zones of intimal thickening. The incidence and nature of such late complications is unknown. Silver and associates suggest that a high perfusion pressure caused injury to the vessels of their patients by overdistension; the media was destroyed