Edge Dissection after Intracoronary Stenting: Predictor, Angiographic and Clinical Follow-up after Additional Procedures

Doo, Young Cheoul; Park, Soo Jong; Kim, Jae Sam; Lee, Jun Ho; Hong, Kyung Soon; Park, Dae Gyun; Han, Kyoo Rok; Oh, Dong Jin; Ryu, Kyu Hyung; Rim, Chong Yun; Koh, Young Bahk; Lee, Kwang Hwahk; Lee, Yung

Abstract

BACKGROUND AND OBJECTIVES
This study was performed to determine the predictive factors for edge dissection (ED) and clinical significance of ED after coronary stenting.
MATERIALS AND METHODS
The study group comprised 215 patients (243 lesions, mean age 59 years, 157 male) in whom coronary stents were implanted between June, 1994 and June, 1998. By angiography, EDs were categorized into minor (a very focal segment <5mm from the stent margin), major (>5mm with prominent adventitial staining and >50% of lumen compromize), and acute closure.
RESULTS
1.ED occurred in 30 (12.3%, minor 15, major 12) out of 243 lesions. Twelve of 30 EDs were located at the distal margin of the stent and occurred during high pressure. 2.Development of ED after stenting significantly correlated with severity of stenosis at the stent margin (> or =30%, 19/30 vs. 33/213, p=0.0001), degree of angulation (>45 0 , 16/30 vs. 48/213, p=0.0001), and calcification in the lesion (2/30 vs. 4/213, p=0.02). 3.There was no significant difference in clinical success rate between two groups (27/30 vs. 175/185, NS). 4.CRR in major and acute closure EDs (n=12) were significantly higher in patients treated with repeated angioplasty than in patients treated with additional stents (5/6 vs. 1/8, p=0.02).
CONCLUSIONS
EDs after coronary stenting are relatively common and lesion's characteristics such as severity of stenosis (> or =30%) at the stent margin, angulation (>45 0 ), and calcification of the lesion are predictive factors for EDs. EDs are not associated with early adverse clinical events. However, CRR was significantly higher in patients treated by repeated angioplasty in major and acute closure EDs.