CORONARY STENTING FOR ACUTE CORONARY DISSECTION AFTER CORONARY ANGIOPLASTY - IMPLICATIONS OF RESIDUAL DISSECTION

Objectives. The aim of this study was to assess the implications of re sidual coronary dissections after stenting. Background. Coronary stent ing is currently used in selected patients with coronary dissection af ter angioplasty. However, in some patients the total length of the dis section may not be completely covered with the device. Methods. Forty- two consecutive patients (mean [+/- SD] age 58 +/- 11 Sears; 39 men, 3 women) undergoing stenting for a major coronary dissection after angi oplasty were studied. Results. Thirty (67%) coronary dissections were small (less than or equal to 15 mm), and 29 (64%) were occlusive (Thro mbolysis in Myocardial Infarction [TIMI] flow grade less than or equal to 2). In 3 patients, coronary stenting was unable to open large occl usive dissections, but a good angiographic result was obtained in 39 p atients (93%). After stenting, 22 of these patients (56%) had no visib le residual dissections, and 13 (33%) had small and 4 (10%) had large residual dissections. These residual dissections were stable and did n ot compromise coronary flow. In a repeat angiogram (24 h later) the st ent 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 r eduction 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 diame ter 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 a ngiographic appearance at follow-up. The four patients with large resi dual dissections after stenting did not have restenosis and were asymp tomatic at last visit. Conclusions. Coronary stenting is effective in the management of acute coronary dissections after angioplasty. In th is setting, small residual dissections are frequently seen but have a good outcome and disappear at follow-up. Large residual dissections ma y have a good outcome if coronary how is not impaired and no residual stenosis is visualized.