Tears during coronary angioplasty: Where are they and how do they affect patient outcomes?

March 24, 2012

Researchers from Thomas Jefferson University Hospital discovered that blockages in the right coronary artery and those in bending areas of the coronary artery are the most common places for dissection, a tear in the artery that can occur during balloon angioplasty of the coronary arteries.

They will present their findings at the American College of Cardiology annual meeting in Chicago on Saturday, March 24 at 9 AM.

A 'controlled tear' is the mechanism by which angioplasty dilates the blocked vessels. A large tear, or spiral dissection, that continues almost entirely down the artery, however is associated with serious complications. When such a dissection occurs, the interior wall of the artery is torn, causing it to fold into the path of blood flow and sometimes block flow of blood in the artery altogether.

"This used to cause patients to be rushed to the operating room during angioplasty to open their chest and fix the blockage," says Rajesh Pradhan, MD, cardiology fellow at Jefferson and first author on the study. Modern technology now allows for to be used to open the blockage and repair the torn artery in most cases.

"We wanted to look at these large tears that can dramatically affect blood flow to understand where they happen most and how good we are at fixing them for our patients," says Pradhan.

The team retrospectively reviewed 24 cases of spiral dissection and matched them against a of patients without dissection.

Their analysis showed that the right (RCA) was seven times more likely to be complicated by propagating dissection compared to other coronary arteries. Also, lesions () on a bend of 45 degrees or greater were 12 times more likely to develop a dissection compared to lesions that were not on a bend.

Stenting was successful in treating the dissection in 75 percent of patients. Major in-hospital adverse (stroke, heart attack, need for emergent bypass surgery, stent thrombosis or death) occurred in 54 percent of patients in the large dissection group and none in the control group. Adverse events in the dissection group included 11 heart attacks, need for emergent in four patients, and one stent thrombosis.

"Armed with this knowledge, we can more readily anticipate this complication and be better prepared when treating patients with lesions in these areas," says Pradhan.

Explore further: Complications in patients undergoing percutaneous coronary intervention tend to occur within first 30 days

Related Stories

Complications in patients undergoing percutaneous coronary intervention tend to occur within first 30 days

March 24, 2012
Percutaneous coronary intervention (PCI), also known as coronary angioplasty or angioplasty, is a procedure used to treat acute coronary syndromes. PCI involves opening a blocked blood vessel by threading and inflating a ...

Patients fare just as well if their nonemergency angioplasty is performed at hospitals

November 14, 2011
Hospitals that do not have cardiac surgery capability can perform nonemergency angioplasty and stent implantation as safely as hospitals that do offer cardiac surgery. That is the finding of the nation's first large, randomized ...

Recommended for you

Could aggressive blood pressure treatments lead to kidney damage?

July 18, 2017
Aggressive combination treatments for high blood pressure that are intended to protect the kidneys may actually be damaging the organs, new research from the University of Virginia School of Medicine suggests.

Quantifying effectiveness of treatment for irregular heartbeat

July 17, 2017
In a small proof-of-concept study, researchers at Johns Hopkins report a complex mathematical method to measure electrical communications within the heart can successfully predict the effectiveness of catheter ablation, the ...

Concerns over side effects of statins stopping stroke survivors taking medication

July 17, 2017
Negative media coverage of the side effects associated with taking statins, and patients' own experiences of taking the drugs, are among the reasons cited by stroke survivors and their carers for stopping taking potentially ...

Study discovers anticoagulant drugs are being prescribed against safety advice

July 17, 2017
A study by researchers at the University of Birmingham has shown that GPs are prescribing anticoagulants to patients with an irregular heartbeat against official safety advice.

Protein may protect against heart attack

July 14, 2017
DDK3 could be used as a new therapy to stop the build-up of fatty material inside the arteries

Heart study finds faulty link between biomarkers and clinical outcomes

July 14, 2017
Surrogate endpoints (biomarkers), which are routinely used in clinical research to test new drugs, should not be trusted as the ultimate measure to approve new health interventions in cardiovascular medicine, according to ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.