[Coronary intramural ruptures caused by transluminal angioplasty. Incidence, significance and development controlled by coronary angiography]
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Coronary intimal rupture (CIR) occurred in 34% of angioplasties, particularly with long, calcific, and eccentric stenoses. While often asymptomatic, CIR can lead to complications like myocardial infarction.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Imaging
Context:
- Transluminal angioplasty is a common procedure for treating coronary artery disease.
- Coronary intimal rupture (CIR) is a potential complication observed during post-angioplasty angiography.
- Understanding factors predicting CIR is crucial for optimizing patient outcomes.
Purpose:
- To identify predisposing factors associated with coronary intimal rupture (CIR) after transluminal angioplasty.
- To compare the incidence and characteristics of CIR in different patient subgroups.
- To evaluate the complications and outcomes of CIR following angioplasty.
Summary:
- A study of 150 angioplasty cases found coronary intimal rupture (CIR) in 34%.
- Long, calcific, and eccentric stenosis morphology significantly predicted CIR.
- CIR was complicated in 19.6% of cases, including myocardial infarctions, with eccentric stenosis being a strong predictor of complicated CIR.
Impact:
- Findings highlight the importance of lesion morphology in predicting CIR during angioplasty.
- Identifying high-risk lesions can guide procedural adjustments to minimize complications.
- This research contributes to improving the safety and efficacy of interventional cardiology procedures.
Abstract:
The authors report their experience of coronary intimal rupture (CIR) observed at control angiography performed at the end of transluminal angioplasty in a series of 150 cases. This lesion was observed in 34 p. 100 of cases. Two subgroups were established according to the presence (Group I: 51 cases) or absence of CIR (Group II: 99 cases) in order to try and identify any predisposing factor. The following features were compared in each group: age, sex, number of risk factors, duration of the disease, its severity, the site and morphology of the lesions (calcification, length, excentric or concentric) on the artery dilated and the technique used (number of inflations, maximal pressure, guidable catheter). The only significant feature associated with CIR was the morphology of the stenosis. Intimal rupture was statistically more frequent when the stenosis was long, calcific and excentric (p less than 0.05). The excentric character was highly predictive of CIR +/- 0.02) and even of complicated CIR (p less than 0.01). The CIR was complicated in 10 cases (19.6 p. 100) with a higher incidence than in the rest of the population (p less than 0.05). These complications were immediate presenting as attacks of angina leading on to 4 myocardial infarctions (7.8 p. 100) but no deaths. The treatment consisted in an attempt to redilate the artery with effective angioplasty in 3 out of 4 cases. Medical therapy alone was sufficient in 2 cases and 4 patients underwent coronary bypass. There were no complications in cases of initially asymptomatic intimal rupture. The 6 months outcome was controlled by coronary angiography in 131 angioplasties.(ABSTRACT TRUNCATED AT 250 WORDS)