title: [Extensive iatrogenic coronary dissection during coronary angioplasty: a series of 19 consecutive patients].
abstract: OBJECTIVE
  Extensive coronary dissection is a rare complication of intraluminal angioplasty. We report a retrospective study of 19 patients who consulted in a general hospital without cardiac surgery.
  
  
  METHODS
  After consulting our coronarography and angioplasty database, we included the extensive coronary dissections (type D, E and F) in our study. The medical files of the selected patients were analysed.
  
  
  RESULTS
  Between January 2003 and March 2010, 19 coronary angioplasty (total: 2542) were complicated with extensive dissections (incidence 0,75%). For 62,3% of the patients, the dissection was related to the guiding catheter. Eleven patients had type A and B1 lesions. The dissections affected the right coronary artery for 16 patients, the left anterior descending coronary artery for two patients and the left main coronary artery for one patient. After angioplasty, a final TIMI flow 3 was obtained for only 11 patients. In nine cases, we observed a limited extension to the aorta that did not need a chirurgical intervention and had no influence on the prognosis. The complications were common, such as death (n=1), coronary bypass (n=2), myocardial infarction (n=8), cardiogenic shock (n=2) and circulatory assistance (n=2).
  
  
  CONCLUSIONS
  Extensive coronary dissection is a rare complication of angioplasty. The right coronary is the most frequent vessel concerned and an extension to aorta is usual. The treatment is usually based on sealing the entry with a coronary stent. The complications are common and serious and we did not find any predicting factors to extensive coronary dissections that are unpredictable.
authors.affiliation: Service de cardiologie, CHI Le Raincy-Montfermeil, 10, rue du Général-Leclerc, 93370 Montfermeil, France.
authors.forename: M
authors.initials: M
authors.lastname: Zidi
authors.forename: O
authors.initials: O
authors.lastname: Nallet
authors.forename: J-B
authors.initials: JB
authors.lastname: Esteve
authors.forename: P
authors.initials: P
authors.lastname: Michaud
authors.forename: S
authors.initials: S
authors.lastname: Cattan
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003331:Coronary Vessels / Q000293:injuries*; D005260:Female; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies