CLINICAL, ANGIOGRAPHIC, AND PROCEDURAL DETERMINANTS OF MAJOR AND MINOR CORONARY DISSECTION DURING ANGIOPLASTY

被引:61
作者
SHARMA, SK
ISRAEL, DH
KAMEAN, JL
BODIAN, CA
AMBROSE, JA
机构
关键词
D O I
10.1016/S0002-8703(07)80008-1
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Angiographic evidence of coronary dissection after angioplasty is found in 25% to 30% of cases. Although patients are usually asymptomatic, in a small percentage angioplasty-induced coronary dissection results in luminal impairment and ischemic complications. The present study was undertaken to identify factors responsible for a predisposition to coronary dissection after angioplasty and to determine whether major and minor dissections share the same underlying risk factors. Clinical records and angiograms from 363 patients with 489 lesions were retrospectively graded for the presence and severity of dissection and complications. Both major and minor angiographic dissections were noted in 30.3%, and in 8.8% they were major. On multivariate analysis the most significant correlates of any dissection included a balloon-to-artery ratio >1.1 (p = 0.0001), calcification (p = 0.003), presence of other lesions in the angioplasty vessel (p = 0.018), and lesion length (p = 0.02). However, in a multivariate model there were no variables that could predict whether a dissection would be major or minor. Only the mean total number of inflations was significantly different, but this was likely the result rather than the cause of dissection. Thus a number of variables can predict the occurrence of angiographic coronary dissection after angioplasty. Major dissections constitute a small fraction of the total number but are difficult to predict differentially.
引用
收藏
页码:39 / 47
页数:9
相关论文
共 12 条
[1]   THE MORPHOLOGY OF CORONARY ARTERIAL DISSECTION OCCURRING SUBSEQUENT TO ANGIOPLASTY AND ITS INFLUENCE ON ACUTE COMPLICATIONS [J].
AGARWAL, R ;
KAUL, U ;
DEV, V ;
SHARMA, S ;
VENUGOPAL, P .
INTERNATIONAL JOURNAL OF CARDIOLOGY, 1991, 31 (01) :59-64
[2]   TEAR OR DISSECTION AFTER CORONARY ANGIOPLASTY - MORPHOLOGIC CORRELATES OF AN ISCHEMIC COMPLICATION [J].
BLACK, AJR ;
NAMAY, DL ;
NIEDERMAN, AL ;
LEMBO, NJ ;
ROUBIN, GS ;
DOUGLAS, JS ;
KING, SB .
CIRCULATION, 1989, 79 (05) :1035-1042
[3]   PERCUTANEOUS TRANS-LUMINAL CORONARY ANGIOPLASTY IN 1985-1986 AND 1977-1981 - THE NATIONAL-HEART-LUNG-AND-BLOOD-INSTITUTE REGISTRY [J].
DETRE, K ;
HOLUBKOV, R ;
KELSEY, S ;
COWLEY, M ;
KENT, K ;
WILLIAMS, D ;
MYLER, R ;
FAXON, D ;
HOLMES, D ;
BOURASSA, M ;
BLOCK, P ;
GOSSELIN, A ;
BENTIVOGLIO, L ;
LEATHERMAN, L ;
DORROS, G ;
KING, S ;
GALICHIA, J ;
ALBASSAM, M ;
LEON, M ;
ROBERTSON, T ;
PASSAMANI, E .
NEW ENGLAND JOURNAL OF MEDICINE, 1988, 318 (05) :265-270
[4]   ANGIOGRAPHIC AND CLINICAL PREDICTORS OF ACUTE CLOSURE AFTER NATIVE VESSEL CORONARY ANGIOPLASTY [J].
ELLIS, SG ;
ROUBIN, GS ;
KING, SB ;
DOUGLAS, JS ;
WEINTRAUB, WS ;
THOMAS, RG ;
COX, WR .
CIRCULATION, 1988, 77 (02) :372-379
[5]   CORONARY DISSECTION AND TOTAL CORONARY-OCCLUSION ASSOCIATED WITH PERCUTANEOUS TRANS-LUMINAL CORONARY ANGIOPLASTY - SIGNIFICANCE OF INITIAL ANGIOGRAPHIC MORPHOLOGY OF CORONARY STENOSES [J].
ISCHINGER, T ;
GRUENTZIG, AR ;
MEIER, B ;
GALAN, K .
CIRCULATION, 1986, 74 (06) :1371-1378
[6]   INFLUENCE OF HEPARIN-THERAPY ON PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY OUTCOME IN UNSTABLE ANGINA-PECTORIS [J].
LASKEY, MAL ;
DEUTSCH, E ;
BARNATHAN, E ;
LASKEY, WK .
AMERICAN JOURNAL OF CARDIOLOGY, 1990, 65 (22) :1425-1429
[7]   INFLUENCE OF INTIMAL DISSECTION ON RESTENOSIS AFTER SUCCESSFUL CORONARY ANGIOPLASTY [J].
LEIMGRUBER, PP ;
ROUBIN, GS ;
ANDERSON, HV ;
BREDLAU, CE ;
WHITWORTH, HB ;
DOUGLAS, JS ;
KING, SB ;
GREUNTZIG, AR .
CIRCULATION, 1985, 72 (03) :530-535
[8]   DOES LENGTH OR ECCENTRICITY OF CORONARY STENOSES INFLUENCE THE OUTCOME OF TRANS-LUMINAL DILATATION [J].
MEIER, B ;
GRUENTZIG, AR ;
HOLLMAN, J ;
ISCHINGER, T ;
BRADFORD, JM .
CIRCULATION, 1983, 67 (03) :497-499
[9]   INFLUENCE OF BALLOON SIZE ON INITIAL SUCCESS, ACUTE COMPLICATIONS, AND RESTENOSIS AFTER PERCUTANEOUS TRANS-LUMINAL CORONARY ANGIOPLASTY - A PROSPECTIVE RANDOMIZED STUDY [J].
ROUBIN, GS ;
DOUGLAS, JS ;
KING, SB ;
LIN, S ;
HUTCHISON, N ;
THOMAS, RG ;
GRUENTZIG, AR .
CIRCULATION, 1988, 78 (03) :557-565