Progressive coronary dilation: An angioplasty technique that creates controlled arterial injury and reduces complications

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The incidence of dissection or acute closure during coronary angioplasty has remained unchanged in spite of increased operator experience and technologic advances. To test the hypothesis that progressive coronary dilation, that is, predilation of the stenosis with a smaller balloon (2.0 or 2.5 mm) and then maximal dilation with an optimally sized (3.0, 3.25, 3.5, 3.75, or 4.0 mm) balloon may produce controlled injury and thus reduce the incidence of major complications, the procedural success rate and acute complications of progressive coronary dilation were analyzed in 1087 patients (1486 vessels) and compared with other large series. To determine whether progressive coronary dilation would improve success rates for complex lesions, the last 167 vessels were also prospectively characterized by American College of Cardiology/American Heart Association criteria. Of the 1248 vessels with partial occlusions, the success rate was 98.7%. Attempts to dilate total occlusions in 16% (353) of vessels yielded a success rate of 88%. The primary success rates for types A, B, and C lesions were 100%, 97%, and 91%, respectively. Multivessel angioplasty with progressive coronary dilation was done in 32.4% of cases. Acute closure, major dissection, emergency coronary bypass, periprocedural myocardial infarction, and in-hospital death were noted in 1.4%, 1.3%, 0.7%, 0.8%, and 0.09% of the patients, respectively; the incidence was significantly lower than in previously reported series. Mean residual stenosis was 20.0% ± 10.6%. Thus progressive coronary dilation by controlled injury to the plaque offers a high primary success rate; low residual stenosis; and markedly lower incidence of acute closure, major dissection, emergency coronary bypass, and death in dilation of both simple and complex lesions.