title: Lesion morphology assessed by pre-interventional intravascular ultrasound does not predict the incidence of severe coronary artery dissections.
abstract: OBJECTIVE
  Coronary artery dissections are common findings following percutaneous transluminal coronary angioplasty and occur with an incidence of approximately 20% to 40%. The purpose of this study was to evaluate the impact of intravascular ultrasound for the prediction of severe dissections by pre-interventional analysis of lesion morphology and plaque composition.
  
  
  RESULTS
  Pre- and post-interventional intravascular ultrasound was performed in 197 patients with 205 lesions. Using intravascular ultrasound criteria, 24 lesions were classified as soft (hypo- or iso-echogenic), 73 as intermediate (hyper-echogenic) and 108 as calcified (calcific arc > 90 degree of the vessel circumference). Additionally, calcium localization was defined as subendothelial, central or deep. The incidence of dissections was 37.5% in patients with soft lesions, 24.7% in patients with intermediate and 36.1% in patients with calcified lesions. In calcified lesions, the occurrence of severe dissections was not dependent on the localization of calcium deposits. The procedural parameters were similar in all patients. The minimal inflation pressure, however, was significantly higher in calcified lesions (P < 0.01).
  
  
  CONCLUSIONS
  Assessment of lesion morphology by intravascular ultrasound cannot predict the occurrence of severe dissections following percutaneous transluminal coronary angioplasty. Furthermore, despite significantly higher inflation pressures in heavily calcified lesions, the incidence of dissections was found to be comparable in all lesions.
authors.affiliation: Department of Cardiology, University of Tübingen, Germany.
authors.forename: A
authors.initials: A
authors.lastname: Athanasiadis
authors.forename: K K
authors.initials: KK
authors.lastname: Haase
authors.forename: B
authors.initials: B
authors.lastname: Wullen
authors.forename: A W
authors.initials: AW
authors.lastname: Treusch
authors.forename: H
authors.initials: H
authors.lastname: Mahrholdt
authors.forename: W
authors.initials: W
authors.lastname: Voelker
authors.forename: A
authors.initials: A
authors.lastname: Baumbach
authors.forename: M
authors.initials: M
authors.lastname: Oberhoff
authors.forename: K R
authors.initials: KR
authors.lastname: Karsch
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging* / Q000628:therapy; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000628:therapy; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging* / Q000628:therapy; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy; D003327:Coronary Disease / Q000000981:diagnostic imaging* / Q000628:therapy; D004867:Equipment Design; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012680:Sensitivity and Specificity; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional