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Coronary stenting for acute coronary dissection after coronary angioplasty: implications of residual dissection
F Alfonso1, R Hernandez, J Goicolea
1Cardiopulmonary Department, Hospital Universitario San Carlos, Madrid, Spain.
Insights
Coronary stenting effectively manages acute coronary dissections, with small residual dissections often resolving and having good outcomes. Large residual dissections also show good results if coronary flow is maintained.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Coronary stenting is utilized for coronary dissection post-angioplasty.
- Complete coverage of dissections by stents is not always achieved.
Purpose of the Study:
- To evaluate the outcomes of residual coronary dissections after stenting.
- To assess the long-term implications of these dissections on coronary flow and vessel patency.
Main Methods:
- Study included 42 patients with major coronary dissections post-angioplasty.
- Angiographic assessment of dissection size, occlusive nature, and post-stenting results.
- Follow-up angiograms at 24 hours and late stages were performed.
Main Results:
- 67% of dissections were small (< or = 15 mm) and 64% were occlusive (TIMI flow grade < or = 2).
- Good angiographic results were achieved in 93% of patients post-stenting.
- Residual dissections (small or large) were stable, did not compromise flow, and disappeared by late follow-up.
Conclusions:
- Coronary stenting is effective for acute coronary dissections.
- Small residual dissections typically resolve and have favorable outcomes.
- Large residual dissections can also have good outcomes if coronary flow is preserved and no significant stenosis is present.
Objectives:
The aim of this study was to assess the implications of residual coronary dissections after stenting.
Background:
Coronary stenting is currently used in selected patients with coronary dissection after angioplasty. However, in some patients the total length of the dissection may not be completely covered with the device.
Methods:
Forty-two consecutive patients (mean [+/- SD] age 58 +/- 11 years; 39 men, 3 women) undergoing stenting for a major coronary dissection after angioplasty were studied.
Results:
Thirty (67%) coronary dissections were small (< or = 15 mm), and 29 (64%) were occlusive (Thrombolysis in Myocardial Infarction [TIMI] flow grade < or = 2). In 3 patients, coronary stenting was unable to open large occlusive dissections, but a good angiographic result was obtained in 39 patients (93%). After stenting, 22 of these patients (56%) had no visible residual dissections, and 13 (33%) had small and 4 (10%) had large residual dissections. These residual dissections were stable and did not compromise coronary flow. In a repeat angiogram (24 h later) the stent was patent in all 39 patients. However, two patients experienced a subacute stent occlusion. Of the remaining 37 patients, 36 (97%) had a late angiogram after stenting. Quantitative angiography revealed a reduction in minimal lumen diameter at the stent site (2.6 +/- 0.4 vs. 2 +/- 0.7 mm, p < 0.05) and a trend toward improvement in vessel diameter at the site of the previous residual dissection (1.7 +/- 0.6 vs. 1.9 +/- 0.5 mm, p < 0.1). The angiographic image of residual dissection disappeared in all patients. These factors provided a rather smooth angiographic appearance at follow-up. The four patients with large residual dissections after stenting did not have restenosis and were asymptomatic at last visit.
Conclusions:
Coronary stenting is effective in the management of acute coronary dissections after angioplasty. In this setting, small residual dissections are frequently seen but have a good outcome and disappear at follow-up. Large residual dissections may have a good outcome if coronary flow is not impaired and no residual stenosis is visualized.