Comparison of slow oscillating versus fast balloon inflation strategies for coronary angioplasty

Previous studies suggest that slow and/or oscillating balloon inflation dur ing coronary angioplasty may decrease the incidence of coronary dissection and improve clinical outcomes. To compare the effect of slow oscillating ve rsus conventional fast inflation techniques on the incidence of severe coro nary dissection during angioplasty, 622 patients were randomized to slow os cillating inflation versus fast inflation. Angiographic outcomes of the pro cedures and in-hospital clinical events were recorded. The primary end poin t of severe (type C, D, E, F) dissection occurred in 7.7% of patients under going slow oscillation and 6.6% of patients undergoing fast inflation (p = 0.87). Major complications (death, urgent coronary artery bypass graft surg ery, stroke, abrupt closure, or Q-wave myocardial infarction) occurred in 4 .7% of patients undergoing slow oscillation and 3.5% of patients undergoing fast inflation (p = 0.45). The 2 inflation strategies did not differ in th e pressure at which the balloon achieved full expansion, angiographic succe ss rate, residual stenosis, and incidence of all minor and/or major complic ations. We conclude that there is no benefit of slow oscillating inflation over routine fast inflation in angioplasty. Slow oscillating inflation did not dilate lesions at lower pressures, decrease the incidence of dissection or severe dissection, or reduce the incidence of adverse clinical outcomes . (C)1999 by Excerpta Medica, Inc.