Results of intracoronary stents for management of coronary dissection after balloon angioplasty

Abstract

Dissections after coronary balloon angioplasty are risk factors for acute or subacute vessel closures. 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. A total of 22 stents were implanted into the coronary arteries of 15 patients with dissections after balloon angioplasty causing angina pectoris or ischemic electrocardiographic changes. Stent delivery was successful in all cases. In 1 patient acute stent thrombosis was documented and treated successfully by thrombolytic therapy. Another patient underwent coronary artery bypass surgery 24 hours later because of persisting angina. Angiograms after 24 hours documented vessel patency in the remaining 14 patients. Late control angiograms after 4 to 6 months were obtained in 12 of 14 patients. Vessel patency without significant restenosis was observed in 8 patients, restenosis in 3 and reocclusion in 1 patient. All 3 patients with multiple stent implantation had restenosis (n = 2) or reocclusion (n = 1), compared with 1 patient with single stent implantation. Thus, intracoronary stenting appears to be a secure and effective method of handling bailout situations caused by dissection after balloon angioplasty, with good long-term results when only a single stent is implanted.