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To decrease the risk of iatrogenic side branch occlusion during coronary angioplasty of bifurcational lesions, we evaluated a technique in which two over-the-wire dilatation systems are positioned within the stenosed coronary artery and the side branch in jeopardy. The technique was used in eight patients undergoing angioplasty for a lesion in the left anterior descending or circumflex artery located near a large side branch. Successful dilatation of the major vessel lesion was achieved in all eight patients, and dilatation within the side branch was successful in all three patients whose lesion involved the side branch ostium. In one patient, dilatation within the major vessel led to partial closure of the side branch and the prepositioned guide wire facilitated prompt dilatation of the iatrogenic closure. There were no complications associated with use of the additional dilatation system. The technique appears to provide an efficacious method to perform safe coronary angioplasty in selected patients with bifurcational lesions.

Myocardial ischemia has been reported occasionally to produce transient T-wave normalization in certain patients. We present a case of "pseudonormalization" of T-waves occurring in the setting of coronary angioplasty. This case illustrates the potential of the transient coronary occlusion which occurs during coronary angioplasty as a model for understanding acute myocardial ischemia.

Symptomatic coronary artery dissection is a recognized complication of coronary angioplasty that is usually associated with immediate adverse consequences. In contrast, the asymptomatic angiographic finding of an "intimal tear" following otherwise successful angioplasty has been considered clinically unimportant. A case is reported of a primarily successful coronary angioplasty with intimal tear that progressed to occlusive coronary artery dissection requiring coronary bypass surgery at 4 weeks postangioplasty. This case demonstrates that an asymptomatic intimal tear following successful coronary angioplasty is not always an innocuous angiographic finding.