L. Pizzulli et al., INFLUENCE OF MAXIMUM INFLATION PRESSURE A ND BALLOON SIZE ON DISSECTIONS COMPLICATING PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOGRAPHY, Herz, Kreislauf, 27(10), 1995, pp. 331-336
Overstretching of the vessel wall, which leads to large dissections du
ring PTCA, generally is dependent on the inflation pressure and the ba
lloon diameter. The aim of our study was to assess, to what extent the
maximum inflation pressure (MIP) and the balloon-to-artery-ratio (B-A
-R) contribute to the incidence of large dissections complicating coro
nary angioplasty. We studied the records and angiograms of 1017 consec
utive patients who underwent PTCA with a MIP of less than or equal to
6 atm (group A:n = 728) or greater than or equal to 10 atm (group B:n
= 289). Thus, we obtained the number of inflations (IN), total inflati
on time (IT), procedural success (PS) and the incidence of angiographi
c (dissection, total occlusion) and clinical complications [emergency
CAB G, Q-wave infarction (MI)] in group A and group B patients. There
was no significant difference between both groups in patient character
istics and lesion morphology pre-PTCA. The mean balloon diameter and t
he B-A-R were significantly higher, the residual stenosis (A:27+/-18%B
:39+/-12%,p<0.05) statistically significant lower in group A than grou
p B. PS, IN and IT were similar for both groups. The incidence of diss
ections (A:15.2%;B:7.5%;p<0.01), occlusions (A:7.4%:B: 3.2%1p<0.03), n
eed for CABG and MI were higher in group A than group B. The MIP of pa
tients with complications were lower than the MIP of patients without
complication (p<0.03), the B-A-R in patients with clinical complicatio
ns higher than in those without (p<0.05). In conclusion, high MIP do n
ot increase the incidence of large dissections complicating PTCA as fa
r as the B-A-R does not exceed a value of 1:1. The main mechanism lead
ing to large dissections is dilatation with an oversized balloon. In h
igh-risk PTCA or great area-at-risk, increasing the balloon size to op
timize the angiographic result should be avoided, because oversizing m
ay lead to angiographic and clinical complications.