Therapeutic dissection after successful coronary balloon angioplasty: No influence on restenosis or on clinical outcome in 693 patients

Abstract

These data indicate that a successfully dilated coronary lesion with an angiographically visible dissection is no more likely to develop restenosis, and is not associated with a worse clinical outcome, at 6-month follow-up than is a dilated lesion without visible dissection on the post-balloon angioplasty angiogram.

Significado clínico das dissecções coronarianas não complicadas após o implante de "stents"

“…Leimgruber et al 13 reported similar rates of angiographic restenosis in 986 patients with or without dissection, with the exception of those with final transstenotic gradients < 15 mmHg, who experienced better evolvement. Hermans et al 14 studied a prospective series of 693 patients with angiographic follow-up in 94% of cases, demonstrating that a successful angioplasty with residual dissection does not increase restenosis. Cappelletti et al 15 demonstrated that most dissections disappear during angiographic follow-up and that patients with uncomplicated dissections have lower restenosis rates than do those without dissections.…”

“…Although atherosclerotic plaque rupture is a sine qua non condition for an effective coronary angioplasty, the incidence of angiographically visible dissections is 30% after balloon angioplasty and 5 to 10% after stent implantation [1][2][3][4]14 . The factors associated with coronary dissections after conventional angioplasty are angiographic calcification 2 , presence of a significant residual stenosis 6,7 , and the type of dissection according to the ACC 8 classification.…”

“…Of 1149 patients treated with 1221 stents, 145 patients with coil stents were excluded. The other exclusion criteria were patients who had at least one of the following features: residual stenosis ≥ 30% (31), postprocedure vessel flow TIMI 0 or 1 (14), acute vessel occlusion immediately after the procedure or within the first 24 hours (33), procedure failure due to stent loss (1), procedure failure due to stent positioning outside the lesion (2), impossibility to cross the lesion with the stent (4), acute myocardial infarction related to the procedure (9), emergency surgery (4), and death within the first 24 hours of the procedure (12), amounting to 87 of the 998 patients experiencing angiographic failure, clinical failure, or acute ischemic complications within the first 24 hours of the procedure.…”

“…These residual dissections are generally treated with a second stent, but the total length of the implanted stent is also associated with a greater risk of adverse events 9 and is consistently reported as one of the factors most strongly associated with restenosis [10][11][12] . The studies [13][14][15] that analyzed the influence of uncomplicated residual dissections after coronary angioplasty in long-term followup do not suggest that a greater risk of restenosis exists in these patients. On the other hand, late follow-up of patients with uncomplicated coronary dissections after stent implantation is rarely studied 16,17 .…”

Angiographic Classification of Coronary Dissections after Plain Old Balloon Angioplasty for Prediction of Regression at Follow-up.

“…There is still controversy about whether a relationship exists between dissection type defined by the NHLBI criteria and subsequent restenosis. 18,32,33) Leimgruber, et al initially raised the concept of "therapeutic" dissection in 1985. They reported a study, specifically focused on the relationship between dissection and restenosis, wherein 248 patients with angiographic evidence of intimal dissection were found to have a restenosis rate of 24% and 738 patients without dissection had a 30% rate of restenosis (p=0.08).…”