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[Should moderate coronary stenosis be dilated in patients with multi-vessel disease?]
M Hamon1, C Bauters, E P McFadden
1Service de cardiologie B et hémodynamique, Hôpital cardiologique, Lille.
Insights
Dilating non-significant coronary stenoses (<50%) during multiple revascularization is uncommon and offers no benefit. This practice may accelerate atherosclerosis progression, leading to worse outcomes at six months.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Multiple revascularization procedures are common in treating coronary artery disease.
- The management of non-significant coronary stenoses (<50%) during these procedures is debated.
- Quantitative angiography is crucial for assessing lesion severity and outcomes.
Purpose of the Study:
- To evaluate the frequency of performing coronary angioplasty on non-significant stenoses during multiple revascularization.
- To determine the angiographic outcome of dilating non-significant stenoses at six months.
- To compare the progression of atherosclerosis in initially non-significant versus significant stenoses.
Main Methods:
- Retrospective analysis of 696 patients undergoing multi-vessel angioplasty.
- Quantitative coronary angiography performed before, immediately after, and at 6-month follow-up.
- Patients divided into two groups: initially non-significant (<50%) and significant (≥50%) stenoses.
Main Results:
- Only 29 patients (4.2%) had non-significant stenoses dilated during multi-vessel angioplasty.
- Post-angioplasty stenosis was similar between groups (30.7% vs. 33%).
- At 6 months, 17% of initially non-significant lesions progressed to >50% stenosis, while 19% of significant lesions restenosed.
Conclusions:
- Dilatation of non-significant coronary stenoses during multiple revascularization is infrequent and should be avoided.
- There is no angiographic benefit at six months from dilating non-significant lesions.
- This intervention may potentially accelerate the progression of coronary atherosclerosis.
Abstract:
This study evaluated the frequency of coronary angioplasty of non-significant (< 50%) stenoses during procedures of multiple revascularisation, and also determined the angiographic outcome of these dilatations at 6 months. All coronary lesions were assessed by quantitative angiography before and after angioplasty and at the 6 month control examination. In a population of 696 patients undergoing angioplasty of at least two coronary segments, 29 had a stenosis of < 50%. Angiographic control at 6 months was obtained in 26 of these patients (90%), corresponding to 61 coronary stenoses 29 of which were not significant (< 50%) (Group 1), and 32 of which were significant (Group 2) before angioplasty. By definition, before angioplasty, the lesions in Group 1 were less severe than in Group 2 (41.8 +/- 6.6% versus 65.9 +/- 9.6% respectively, p < 0.0001). After angioplasty, the degree of stenosis was comparable in the two groups (30.7 +/- 9.4% and 33 +/- 10.4%). At the 6 month control angiography, the percentage stenosis of the lesions in Group 2 (39.7 +/- 16%) remained significantly lower than before angioplasty (p < 0.0001). Six of these lesions (19%) developed restenosis. In Group 1, the percentage stenosis at control (39.5 +/- 18%) was comparable to that before angioplasty. Moreover, 5 lesions in Group 1 (17%) which were initially non-significant had > 50% stenosis at the 6 month control. These results show that dilatation of non-significant coronary stenosis during multiple revascularisation procedures is not common and should be avoided. Not only is there no benefit at 6 month control angiography but also the procedure may accelerate the evolution of the atherosclerosis.