Coronary dissection: a predictor of restenosis?

To determine if arterial dissection resulting from transluminal coronary angioplasty (TCA) leads to a greater incidence of restenosis, 273 consecutive patients who had undergone TCA with at least 1 year of follow-up were examined. Success was graded as a greater than or equal to 20% increase in intraluminal diameter. Dissection was defined as a prominent intimal defect at the site of angioplasty. Restenosis was defined as a 50% loss of the initial angiographic gain. Of 216 patients in whom TCA was successful, 64 (30%) had dissections at the site of angioplasty and 152 (70%) had no dissection. During follow-up, 135 patients were asymptomatic with normal results of exercise tolerance tests, recurrent symptoms developed in 81 patients, and 64 patients underwent repeat angiography. The overall restenosis rate was 21%. In the dissection group, 11 (18%) had documented restenosis and 49 (82%) did not develop restenosis. In the nondissection group, 35 (24%) had documented restenosis and 113 (76%) did not develop restenosis. These data show that patients who develop dissections at the time of TCA are no more likely to develop restenosis during follow-up.