[Early occlusion and dissection in coronary angioplasty. Apropos of 855 patients]

Between June 1981 and may 1987, 855 patients were treated by transluminal coronary angioplasty at the Cardiovascular Hospital, Lyon. 778 primary successes (84 p. 100) were obtained, 84 of the 855 patients (9.8 p. 100) developed occlusion and/or angiographically proven dissection within the first 24 hours. These patients fell into two groups; group A (n = 35) with occlusion and occlusive dissection, group B (n = 49) with dissection but without coronary blood flow reduction. Among the parameters examined, only three concerning the morphology of the stenosis were associated with a statistically more frequent occurrence of occlusion: eccentric stenosis (p less than 0.05), irregular stenosis (p less than 0.01) and stenosis in a curvilinear segment (p less than 0.01). In addition, among the 84 patients with occlusion and/or dissection, 14 had myocardial infarction and 2 died during the 24 hours following angioplasty. Emergency aorto-coronary bypass was performed in 12 cases, mostly after failure of redilatation. Redilatation was carried out in 26 cases and was effective in 14.