title: Coronary stenting for acute coronary dissection after coronary angioplasty: implications of residual dissection.
abstract: OBJECTIVE
  The aim of this study was to assess the implications of residual coronary dissections after stenting.
  
  
  BACKGROUND
  Coronary stenting is currently used in selected patients with coronary dissection after angioplasty. However, in some patients the total length of the dissection may not be completely covered with the device.
  
  
  METHODS
  Forty-two consecutive patients (mean [+/- SD] age 58 +/- 11 years; 39 men, 3 women) undergoing stenting for a major coronary dissection after angioplasty were studied.
  
  
  RESULTS
  Thirty (67%) coronary dissections were small (< or = 15 mm), and 29 (64%) were occlusive (Thrombolysis in Myocardial Infarction [TIMI] flow grade < or = 2). In 3 patients, coronary stenting was unable to open large occlusive dissections, but a good angiographic result was obtained in 39 patients (93%). After stenting, 22 of these patients (56%) had no visible residual dissections, and 13 (33%) had small and 4 (10%) had large residual dissections. These residual dissections were stable and did not compromise coronary flow. In a repeat angiogram (24 h later) the stent 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 reduction 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 diameter 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 angiographic appearance at follow-up. The four patients with large residual dissections after stenting did not have restenosis and were asymptomatic at last visit.
  
  
  CONCLUSIONS
  Coronary stenting is effective in the management of acute coronary dissections after angioplasty. In this setting, small residual dissections are frequently seen but have a good outcome and disappear at follow-up. Large residual dissections may have a good outcome if coronary flow is not impaired and no residual stenosis is visualized.
authors.affiliation: Cardiopulmonary Department, Hospital Universitario San Carlos, Madrid, Spain.
authors.forename: F
authors.initials: F
authors.lastname: Alfonso
authors.forename: R
authors.initials: R
authors.lastname: Hernandez
authors.forename: J
authors.initials: J
authors.lastname: Goicolea
authors.forename: J
authors.initials: J
authors.lastname: Segovia
authors.forename: M J
authors.initials: MJ
authors.lastname: Perez-Vizcayno
authors.forename: C
authors.initials: C
authors.lastname: Bañuelos
authors.forename: J C
authors.initials: JC
authors.lastname: Silva
authors.forename: P
authors.initials: P
authors.lastname: Zarco
authors.forename: C
authors.initials: C
authors.lastname: Macaya
mesh_terms: D000208:Acute Disease; D000368:Aged; D000704:Analysis of Variance; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D003331:Coronary Vessels / Q000293:injuries*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents