LESION MORPHOLOGY ASSESSED BY PRE-INTERVENTIONAL INTRAVASCULAR ULTRASOUND DOES NOT PREDICT THE INCIDENCE OF SEVERE CORONARY-ARTERY DISSECTIONS

Aims Coronary artery dissections are common findings following percuta neous transluminal coronary angioplasty and occur with an incidence of approximately 20% to 40%. The purpose of this study was to evaluate t he impact of intravascular ultrasound for the prediction of severe dis sections by pre-interventional analysis of lesion morphology and plaqu e composition. Methods and Results Pre-and post-interventional intrava scular ultrasound was performed in 197 patients with 205 lesions. Usin g intravascular ultrasound criteria, 24 lesions were classified as sof t (hypo- or iso-echogenic), 73 as intermediate (hyper-echogenic) and 1 08 as calcified (calcific are >90 degrees of the vessel circumference) . Additionally, calcium localization was defined as subendothelial, ce ntral or deep. The incidence of dissections was 37.5% in patients with soft lesions, 24.7% in patients with intermediate and 36.1% in patien ts with calcified lesions. In calcified lesions, the occurrence of sev ere dissections was not dependent on the localization of calcium depos its. The procedural parameters were similar in all patients. The minim al inflation pressure, however, was significantly higher in calcified lesions (P<0.01). Conclusion Assessment of lesion morphology by intrav ascular ultrasound cannot predict the occurrence of severe dissections following percutaneous transluminal coronary angioplasty. Furthermore , despite significantly higher inflation pressures in heavily calcifie d lesions, the incidence of dissections was found to be comparable in all lesions.