ANGIOGRAPHIC-PATHOLOGICAL CORRELATIONS AFTER ELECTIVE PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Background. The local effect of coronary angioplasty is evaluated on t he basis of postangioplasty angiograms. Smooth-walled dilation is cons idered to represent minimal or no injury, whereas intraluminal hazines s corresponds with wall laceration. This study correlates the preangio plasty and postangioplasty angiograms with the histopathology of the t arget sites. Methods and Results. The study includes 12 patients, each undergoing an elective procedure, and covers 19 angioplasty sites. Sm ooth-walled dilation and intraluminal haziness were not mutually exclu sive. The angiograms were interpreted as smooth-walled dilation (n=3), smooth-walled dilation with intraluminal haziness (n=4), intraluminal and extraluminal haziness (n=5), extraluminal dissection (n=5), spira l-type dissection (n=1), and aneurysm (n=1). The histology of the arte rial segments revealed wall laceration in all. Smooth-walled dilation without intraluminal haziness correlated with laceration limited to th e intima in two, but with medial injury in one. Smooth-walled dilation with intraluminal haziness correlated with laceration limited to the intima in two and with medial injury in two. Intraluminal and extralum inal haziness corresponded with extensive laceration with deep involve ment of the media in each. Extraluminal dissection correlated with a d issection along the shoulder area of the plaque, creating a broad-base d flap. The spiral-type dissection corresponded with a true dissection into the plaque-free media. The aneurysm correlated with partial wash out of an atherosclerotic plaque. Conclusions. The angiographic image of intraluminal and extraluminal haziness indicates extensive medial l aceration. Smooth-walled dilation, with or without intraluminal hazine ss, is not a reliable indicator. The study emphasizes the need to reco nsider the interpretations of postangioplasty coronary angiograms.