Angiographic prediction of dissection followed by ischaemic complications during coronary angioplasty.

Ischaemic problems occur in about 8% of coronary angioplasties and are the major cause of morbidity and mortality associated with the procedure. Although the ischaemic event is usually due to acute vessel closure due to vessel dissection, it is noteworthy that 80-90% of radiographically visible dissections cause no problem. We have reviewed 200 consecutive coronary angioplasties in order to find predictive factors for those patients likely to suffer dissection followed by ischaemic complications. Thirty-four (17%) of the patients undergoing coronary angioplasty had radiographically visible dissections, of whom 12 (35%) suffered ischaemic complications. There were 16 (8%) major ischaemic complications following angioplasty. In four of these cases no obvious dissection was visible within the vessel. Eight out of a subgroup of 16 patients who had sequential stenoses along one vessel dilated at angioplasty had a dissection. Six of these eight patients suffered a major ischaemic complication following the dissection. Thus in this group of patients, sequential stenosis not only conferred a high probability of dissection during angioplasty but additionally carried an increased risk of ischaemic complications following the dissection. Awareness of this may affect case selection and may indicate the need for early re-examination of the vessel should problems occur following angioplasty.