1000–32 Spontaneous Evolution of Nonocclusive Coronary Dissection After PTCA: A 6 Month Angiographic Follow-up Study

Abstract

We have previously shown that, when good distal flow is maintained, dissection after PTCA has a favourable short term (24 hrs) evolution and does not require bail-out interventions or CABG.To evaluate the long term (6 months) clinical and angiographic evolution of non occlusive dissection, we submitted 129 consecutive patients (103 male, mean age 53±11 yrs) undergoing elective PTCA (147 lesions, 66 LAD, 49 CX, 32 DX) to repeat angiography 24 hrs and 6 months after the procedure. Lesions were measured by QCA and coronary dissection was graded using the NHLBI classification (types A-E; Huber Am J Cardiol 1991;68: 467). Mean stenosis was 85±11% before and 25±7% immediately after PTCA (p<0.001). Residual stenosis was not significantly different at the 24 hrs restudy (24±9%). Non occlusive coronary dissection (flow TIMI grade 3 in all pts) was seen in 49/147 lesions (33%) and evolved as follows:Dissection (tot)Immediate 49 (33%)24 hrs 41 (28%)6 months 18 (12%)A332710B1085C442D221At the 6 month follow-up study, restenosis was seen in 51/147 lesions (34%), of which 5/49 (10%) had dissection and 46/106 (43%) did not. No cardiovascular events or recurrence of symptoms were recorded in the absence of restenosis.Therefore 1) nonocclusive dissection after PTCA usually improves after 6 month; 2) in the absence of flow impairment and ischemia this complication does not require any further intervention; 3) non occlusive dissection is not associated with increased incidence of restenosis