Copyright © 1998 by the European Society of Cardiology.
Lesion morphology assessed by pre-interventional intravascular ultrasound does not predict the incidence of severe coronary artery dissections
a Medical Clinic, Department of Cardiology, University of Tübingen, Tübingen
b Medical Clinic Mannheim, Department of Cardiology, University of Heidelberg/Mannheim, Mannheim, Germany
accepted September 19, 1997
Aims
Coronary artery dissections are common findings following percutaneous transluminal coronary angioplasty and occur with an incidence of approximately 20% to 40%. The purpose of this study was to evaluate the impact of intravascular ultrasound for the prediction of severe dissections by pre-interventional analysis of lesion morphology and plaque composition.
Methods and Results
Pre- and post-interventional intravascular ultrasound was performed in 197 patients with 205 lesions. Using intravascular ultrasound criteria, 24 lesions were classified as soft (hypo- or iso-echogenic), 73 as intermediate (hyper-echogenic) and 108 as calcified (calcific arc >90° of the vessel circumference). Additionally, calcium localization was defined as subendothelial, central or deep. The incidence of dissections was 37·5% in patients with soft lesions, 24·7% in patients with intermediate and 36·1% in patients with calcified lesions. In calcified lesions, the occurrence of severe dissections was not dependent on the localization of calcium deposits. The procedural parameters were similar in all patients. The minimal inflation pressure, however, was significantly higher in calcified lesions (P<0·01).
Conclusion
Assessment of lesion morphology by intra-vascular ultrasound cannot predict the occurrence of severe dissections following percutaneous transluminal coronary angioplasty. Furthermore, despite significantly higher inflation pressures in heavily calcified lesions, the incidence of dissections was found to be comparable in all lesions.
Key Words: angioplasty • intravascular ultrasound • dissections • lesion morphology
This paper was presented in part at the 68th Scientific Sessions of the American Heart Association, Anaheim, CA, U.S.A., November 1995.
f2 Correspondence: Anastasios Athanasiadis, MD, University of Tübingen, Medical Clinic, Department of Cardiology, Otfried-Müller-Str. 10, 72076 Tübingen, Germany.
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