[Conventional therapeutic strategy in PTCA-induced dissection: long-term re-PTCA, early re-coronary angiography].
A prospective randomized trial in 324 patients (pts.) analyzed the early clinical course of stabile dissections (stabile perfusion, degree of residual stenosis > 50% < 70% and stabile early result after 24 h). The results of quantitative recoronary angiography after 6 weeks and 3-4 months with differentiated reintervention (long time-PTCA, atherectomy, stent, CABG) were analyzed to determine the early clinical course. 57% of pts. demonstrated a type-I dissection (excentric stabile dissection with quantifiable degree of residual stenosis). By early recoronary angiography after 6 weeks with differentiated reintervention 68% of pts. (125 pts.) showed a sufficient result after 3.8 months. In 51% of pts. an additional sufficient result could be achieved by a second reintervention after 1/4 year. Considerable complications (infarction, CABG, acute death) occurred in 2.7% of pts. with type-I dissections. 108 pts. (33%) could be classified with type-II dissection (diagonal flap). Sufficient result after 3.5 months could be achieved in 84% pts. In 20 of 22 pts. an additional successful reintervention could be performed. The complication-rate (infarction, CABG) was 5.5%. In pts. with type-IV dissection (complex dissection) the early clinical course was more unfavorable with higher restenosis rate and considerable complications of 10%. The rare type-III dissection (short spiral dissection) showed a high recurrence rate already after 6 weeks (33%) and sufficient results after 3.2 months only in 42% of pts. Complication rate was high with 50% (2 x deaths, 2 x CABG).
Jacksch
R
R
Leitender Arzt der Kardiologischen Abteilung, St. Vincenz-Krankenhaus, Essen.
Niehues
R
R
Böckenförde
J
J
D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary; D017225:Atherectomy, Coronary; D003131:Combined Modality Therapy; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents; D015996:Survival Rate