CONVENTIONAL THERAPEUTIC STRATEGY OF CORO NARY-ARTERY DISSECTION AFTER PTCA - LONG-TIME RE-PTCA, EARLY RECORONARY ANGIOGRAPHY

A prospective randomized trial in 324 patients (pts.) analyzed the ear ly clinical course of stabile dissections (stabile perfusion, degree o f residual stenosis > 50% < 70% and stabile early result after 24 h). The results of quantitative recoronary angiography after 6 weeks and 3 - 4 months with differentiated reintervention Gong time-PTCA, atherec tomy, stent, CABG) were analyzed to determine the early clinical cours e. 57% of pts. demonstrated a type-I dissection (excentric stabile dis section with quantifiable degree of residual stenosis). By early recor onary angiography after 6 weeks with differentiated reintervention 68% of pts. (125 pts.) showed a sufficient result after 3.8 months. In 51 % of pts. an additional sufficient result could be achieved by a secon d reintervention after 1/4 year. Considerable complications (infarctio n, CABG, acute death) occurred in 2.7% of pts. with type-I dissections . 108 pts. (33%) could be classified with type-II dissection (diagonal flap). Sufficient result after 3.5 months could be achieved in 84% pt s. In 20 of 22 pts. an additional successful reintervention could be p erformed. The complication-rate (infarction, CABG) was 5.5%. In pts. w ith type-IV dissection (complex dissection) the early clinical course was more unfavorable with higher restenosis rate and considerable comp lications of 10%. The rare type-III dissection (short spiral dissectio n) showed a high recurrence rate already after 6 weeks (33%) and suffi cient results after 3.2 months only in 42% of pts. Complication rate w as high with 50% (2 x deaths, 2 x CABG). Conclusion: Considering a spo ntaneous healing rate of about 40%, hemodynamic stabile dissections af ter PTCA can be managed successfully by early control coronary angiogr aphy with differentiated reintervention after 6 weeks and a restenosis rate after 3 - 4 months of only 25 - 30%. Even short spiral dissectio ns (< 2 cm) have an increased risk of recurrence after 6 weeks.