Intracoronary Stents for Management of Coronary Dissection after Balloon Angioplasty

Abstract

Dissection after percutaneous transluminal coronary angioplasty (PTCA) is a risk factor for acute or subacute vessel closure. Intracoronary stenting was developed to avoid these complications by pressing the intimal and medial flaps against the vessel wall, thus reducing the risk of acute thrombosis. From March 1993 through December 1993, PTCA was performed in 252 patients and implantation into the coronary arteries of a total of 33 stents was attempted in 32 patients with dissection after PTCA. Indications for stent implantation were acute closure in 6 (18.2%), threatened closure in 6 (18.2%), and suboptimal result in 21 (63.6%). Thirty-one stents were successfully deployed in 30 patients (94%), and stenting resulted in an immediate angiographic improvement in diameter stenosis from 87% before stenting to 18% after stenting by caliper estimation. Emergency coronary artery bypass graft surgery was required in 1 patient (3%). A non-Q wave myocardial infarction occurred in 1 patient (3%). Other complications included hematoma of the arterial access site requiring blood transfusion in 4 patients (12.5%) and hemopericardium in 1 patient (3%). Our initial experience with the flexible coil stent indicates it is efficacious for dissections that are threatening or causing coronary closure after angioplasty; however, the long-term outcome in all groups of patients who received coronary stents is unknown.