[Immediate results of coronary endoprosthesis in threatening or occlusive dissections complicating angioplasty; the Geneva experience].
Between April 1988 and September 1993, 123 patients (average age 60.4 +/- 8.9 years) underwent coronary stenting for threatening or occlusive dissection complicating angioplasty. The anterograde coronary flow was disturbed in 51% of cases (TIMI-0-2). The artery concerned was the left anterior descending in 59% of cases, the right coronary in 28% of cases, the circumflex in 12% and a coronary bypass graft in 1% of cases. Technically, the stenting was successful in 118 cases (98%) and, in 21 cases, complete stenting of the dissection required the insertion of several stents. The minimal coronary diameter after expansion of the stent was 3.1 +/- 0.6 mm. During hospital follow-up, 3 deaths (3%) and 7 Q-wave infarcts were observed. Twenty-eight patients (23%) developed a haemorrhagic complication, including 2 retroperitoneal and 2 intracerebral bleeds. Eight patients (6%) underwent coronary bypass grafting, as an emergency in 4 cases and semi-electively in another 4 cases. One hundred and five patients (89%) survived the intra-hospital period without major complications (death, Q-wave infarction, emergency coronary bypass surgery or severe haemorrhage). Coronary stenting for threatening or occlusive dissection complicating angioplasty seems to be a reasonable solution and a usually definitive one. The frequency of haemorrhagic complications underlines the need for strict clinical and biological surveillance.
Metz
D
D
Service de cardiologie, hôpital Robert-Debré, Reims.
Urban
P
P
Meier
B
B
Hoang
V
V
Camenzind
E
E
Brzostek
T
T
Chatelain
P
P
Rutishauser
W
W
D000368:Aged; D000784:Aortic Dissection / Q000209:etiology* / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods; D001807:Blood Vessel Prosthesis; D003323:Coronary Aneurysm / Q000209:etiology* / Q000628:therapy; D017023:Coronary Angiography; D003327:Coronary Disease / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015642:Radiology, Interventional; D012008:Recurrence; D015607:Stents; D016019:Survival Analysis
Résultats immédiats des endoprothèses coronaires pour dissections menaçantes ou occlusives compliquant une angioplastie; l'expérience genevoise.