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PubMed1994

[Efficacy of GRF (gelatin-resorcin-formalin) glue on surgery for type A aortic dissection].

The tissue biological adhesive GRF glue has been used in our department to have dissected aortic layers adhered and to reinforce the dissected aortic stumps during surgery for aortic dissection. From May 1992 to August 1993, 12 patients were operated for type A aortic dissection; 4 patients with acute dissection and 8 patients with chronic dissection. There were 5 men and 7 women whose ages ranged from 51 to 69 years with an average of 60.6 years. Replacement of the ascending aorta alone was performed for 6 patients. Replacement of both the ascending aorta and transverse arch was carried out for 4 patients, and replacement of the ascending aorta, transverse arch and the descending aorta was accomplished in 1 patient. Primary repair was performed for 1 patient with intraoperative acute dissection that occurred during surgery for mitral valve. There were no operative or hospital deaths. Preoperative aortic regurgitation was present in 5 patients. Following gluing the aortic root dissection, aortic regurgitation disappeared in all patients confirmed by postoperative aortograms. The use of GRF glue significantly reduced the average amount of intraoperative bleeding from 2893 ml to 1169 ml and also significantly reduced the use of Teflon felt strips for the proximal anastomosis. We believe that use of GRF glue can improve the surgical outcome for acute and chronic aortic dissection.

Aged↗

PubMed1993

[Internal carotid artery dissection].

Arterial dissection results from bleeding into the vessel wall. Some cases are associated with cervical trauma or have evidence of an underlying vascular disease; many occur without any history of injury or detectable arterial disease. Among the cervical cephalic arteries, the extracranial segment of the internal carotid artery is the vessel most commonly involved; intracranial carotid dissections are much rare. Carotid dissection occurs predominantly in young or middle-aged adults and shows no sex predominance. Although clinical manifestations can be extremely diverse (from isolated headache to rapidly lethal stroke), the most common and suggestive syndrome associates "local" symptoms (such as head or neck pain, Horner's syndrome, pulsatile tinnitus or lower cranial nerves palsy) and delayed (up to several weeks) symptoms of cerebral ischaemia in the territory of the internal carotid artery territory. Dissection can be bilateral or associated with dissection of the vertebral artery. Angiography has long been considered the gold standard for the diagnosis. As this procedure carries a risk of cerebral complications, noninvasive diagnostic approaches such as magnetic resonance imaging and ultrasound have been developed and are increasingly used. The prognosis of carotid dissections depends on the presence and severity of ischaemic brain damage. Recurrent dissections seem extremely rare. Normalization or improvement of the vascular abnormalities during the subsequent weeks is frequent and is an excellent argument in favour of the diagnosis. Although no controlled trial has ever been performed, anticoagulant treatment is often used for a few months when the dissection involves the extracranial segment of the carotid artery. No standard treatment of intracranial carotid dissection has emerged.

Adult↗

PubMed1995

[Diagnostic accuracy of transesophageal echocardiography in the diagnosis of aortic dissection: comparison with computerized axial tomography].

This study was designed to assess the sensibility, specificity and diagnostic accuracy of transesophageal echocardiography (TEE) and X-ray contrast enhanced computed tomography (CT) in the diagnosis of aortic dissection and its complications. Fifty patients with clinically suspected aortic dissection were examined. Imaging results were validated in each case by intraoperative and/or autopsy findings and/or the results of cineangiography. The Stanford and DeBakey classifications were used to differentiate the dissection type; the patients were also subdivided by TEE according to a modified DeBakey classification. The sensibility of TEE to detect aortic dissection was 100%, significantly higher (p < 0.05) than that of CT for type A dissections (77.2%). The two imaging procedures did not statistically differ (NS) in the detection of type B dissection (CT sensibility 87.5%). The specificity of TEE for the detection of type A aortic dissection was 94%; it was not significantly higher (NS) than that of CT (CT specificity 86.6%). Both TEE and CT had no false negative findings in the diagnosis of type B aortic dissection (100%; TEE vs CT, NS). TEE was reliable in the correct identification of the primary entry site in the ascending aorta (80%), the arch (62.5%) and descending aorta (71.4%), and also in the involvement of coronary arteries (62.5%), and aortic arch branch vessels (71.4%); CT scanning was not effective in detecting any of these complications. Aortic regurgitation was accurately identified by TEE in each case. Both TEE and CT scanning correctly identified thrombosis of the false lumen and pericardial effusion. Intraoperative TEE documented in all patients postrepair persistence of the intimal flap in aortic segments that were not operated; flow in the false lumen was detected in 46.6% of the patients; in 26.6% of them secondary tears, not seen before surgical treatment, were detected. In conclusion, TEE allows a bedside, safe and accurate diagnosis and classification of aortic dissection. It also provides the diagnostic information necessary for the therapeutical decision making. Intraoperative TEE allows improvement in preoperatory diagnosis and gives important information for the management of the patient immediately after cardiopulmonary bypass and in the follow-up.

Adult↗

PubMed1996

[Conventional therapeutic strategy in PTCA-induced dissection: long-term re-PTCA, early re-coronary angiography].

A prospective randomized trial in 324 patients (pts.) analyzed the early clinical course of stabile dissections (stabile perfusion, degree of residual stenosis > 50% < 70% and stabile early result after 24 h). The results of quantitative recoronary angiography after 6 weeks and 3-4 months with differentiated reintervention (long time-PTCA, atherectomy, stent, CABG) were analyzed to determine the early clinical course. 57% of pts. demonstrated a type-I dissection (excentric stabile dissection with quantifiable degree of residual stenosis). By early recoronary angiography after 6 weeks with differentiated reintervention 68% of pts. (125 pts.) showed a sufficient result after 3.8 months. In 51% of pts. an additional sufficient result could be achieved by a second reintervention after 1/4 year. Considerable complications (infarction, CABG, acute death) occurred in 2.7% of pts. with type-I dissections. 108 pts. (33%) could be classified with type-II dissection (diagonal flap). Sufficient result after 3.5 months could be achieved in 84% pts. In 20 of 22 pts. an additional successful reintervention could be performed. The complication-rate (infarction, CABG) was 5.5%. In pts. with type-IV dissection (complex dissection) the early clinical course was more unfavorable with higher restenosis rate and considerable complications of 10%. The rare type-III dissection (short spiral dissection) showed a high recurrence rate already after 6 weeks (33%) and sufficient results after 3.2 months only in 42% of pts. Complication rate was high with 50% (2 x deaths, 2 x CABG).

Adult↗

PubMed1996

[Natural history and prognosis of medical treatment for the patients with aortic dissections].

The natural history of patients with acute aortic dissections in extremely poor. In 1958, Hirst et al reported 21% of such patients died within a 24 hours, 80% died within a 4 weeks and 93% died with in a 1 year if not treated aggressively. However, there has been a dramatic improvement in the prognosis of patients with aortic dissections since the introduction of surgical treatment by DeBakey et al, and that of medical treatment by Wheat et al. We studied the long-term results of medical treatment for aortic dissections and evaluated the risk factors that determine the prognosis of medically treated patients. The survival rates of medically treated patients with type A dissections at 24 hours, 1 week, 1 month, 1 year, and 10 years after the onset of the disease were 74, 41, 36, 34, 23%, respectively, and the survival rates in type B dissections were 100, 94, 92, 85, 60%, respectively. The risk factors in the acute phase of dissections were type A and serious complications. These in the chronic phase were increasing age, the large diameter of the dissecting aorta and serious complications in acute phase, excluding shock and pericardial tamponade. These results show that emergency surgical intervention is indicated in the patients with acute type A dissections and in those who had acute type B dissections with serious complications.

Acute Disease↗

PubMed1997

[Chest radiographic diagnosis of dissecting thoracic descending aorta].

Widening of the aortic shadow on chest radiography is one of the first indicators of aortic dissection. The degree of widening of the aortic shadow was estimated on two successive chest radiographs (mean [+/-SD] interval 0.8 +/- 0.7 years) before and after aortic dissection in 11 patients (four with DeBakey classification type I, seven with type III dissection). The distance between the center of each thoracic vertebra and the lateral margin of the descending aortic shadow (L) was measured. Since only a supine frontal film is usually available in acute aortic dissection, chest radiographs in both erect and supine positions were compared in 18 patients with hypertension. On supine films, L was larger than that on erect films, but the difference (delta L) was minimal (+2.6 mm) at the level of the tracheal bifurcation. Therefore, the L at the level of tracheal bifurcation (Lb) was best suited for comparing films taken in different positions. On supine films, Lb was significantly longer in patients with aortic dissection than in patients with hypertension (60.5 +/- 8.2 vs 46.0 +/- 7.9 mm, p < 0.001), and none with dissection showed Lb < 50 mm. Serial change of L over the follow-up of 1.4 +/- 0.7 years in patients with hypertension was also examined in erect films and was less than +1 mm. When the index film in a supine position was compared with the previous films in an erect position, delta Lb in patients with aortic dissection was +12.7 +/- 5.6 mm, which was significantly greater than that in patients with hypertension (+2.9 +/- 2.8 mm, p < 0.001). All 11 patients with aortic dissection showed delta Lb > or = +7 mm, but only one patient with hypertension (6%) exhibited this finding. Chest radiography is useful for identifying patients with aortic dissection, who characteristically show Lb > or = 50 mm on presentation and delta Lb > or = +7 mm, compared with previous films.

Aged↗

PubMed1997

[Management and long-term follow-up results in patients with carotid artery dissection].

The recognized incidence of extra- and intracranial carotid artery dissection has increased concomitantly with the progress and development of diagnostic methods. However, management for this condition is still controversial. We report in the present study the management and long-term follow-up results of 15 patients with carotid artery dissection. Mean age of the patients at onset was 47.8 years old, and male/female ratio was 12:3. Two patients were considered to be traumatic dissections and the other 13 patients were spontaneous dissections. Dissection occurred in 10 patients at the extracranial carotid artery, in 4 at the intracranial carotid artery and in 1 at the middle cerebral artery. Nine of 15 patients demonstrated hemiparesis and 5 complained of headache or facial pain. However, it was not possible to identify a characteristic symptom of dissection. Final diagnosis of dissection was made by cerebral angiography in all patients. Serial angiography was carried out in 10 of those, and 5 of the 10 patients showed some improvements of dissection in the cerebral angiogram. Treatment for those patients was selected according to the neurological and angiographical changes. Five patients were managed conservatively and 10 patients underwent surgical revascularization. During the follow-up period (mean 77.6 months), none of them showed any symptoms of reattack, and all but one, who died of heart failure 193 months after revascularization surgery, have lived independently. Although diagnosis of dissection was difficult because of the lack of characteristic symptom, serial angiography was a useful method for diagnosis and adequate management has led to a good clinical outcome.

Adolescent↗

PubMed1997

[Dissection of the internal carotid artery with subarachnoid hemorrhage].

INTRODUCTION: Dissection of the intracranial arteries is uncommon, forming less than 10% of all cranio-cervical dissections. Apart from the classical clinical findings of extracranial dissections, intracranial dissection may cause subarachnoid haemorrhage (SAH), mainly dissections involving the posterior circulation. CLINICAL CASE: We describe the case of a 49 year old man, a smoker, who had a sudden onset of headache followed by loss of consciousness. On CT there was SAH and multiple cerebral infarcts. Arteriography showed findings compatible with dissection of the extracranial and intracranial carotid arteries. DISCUSSION: We discuss the epidemiology and mechanisms of SAH associated with intracranial dissections. Intracranial dissection. Intracranial dissection should be considered in the differential diagnosis of SAH and of ischaemic syndromes.

Aortic Dissection↗

PubMed1998

[MRI in typical and atypical aortic dissection].

PURPOSE: To determine the value of MRI in typical and atypical aortic dissections. METHODS: MRI investigations on 16 patients with aortic dissections were analysed retrospectively; for 8 patients CT investigations carried out at almost the same time were available for comparison. RESULTS: In all cases the diagnosis of aortic dissection was possible from MRI and CT. If a dissection membrane and a double lumen were present these were detected in all patients by both methods. In three patients with atypical dissections, only an asymmetrical abnormal wall thickening as sole sign for the presence of an aortic dissection was seen. A differentiation between true and false lumen was possible in 16 of 17 MRI investigations and in 5 of 8 CT investigations on the basis of differing blood flow velocities or, respectively, the detection of a thrombus in the false lumen. The relationship of the dissection membrane to the large aortic branches as well as the determination of the branch vessel origin with regard to true or false lumen could be evaluated better with MRI than with CT. CONCLUSIONS: Thus MRI has a significant role in the diagnosis and follow-up of aortic dissections. The advantage in comparison to the alternative spiral CT technique is, in addition to the absence of radiation exposure, the better analysis of the extent of the dissection as a result of the multi-planar slice orientation (especially in the region of the aortic arch and the arch vessel origins) without the necessity to administer iodine-containing contrast media.

Adult↗

PubMed1999

Complications from planned, posttreatment neck dissections.

OBJECTIVE: To report the complication rate from planned, posttreatment neck dissections in patients who show control of primary squamous cell carcinoma by chemotherapy and radiotherapy or radiotherapy alone. DESIGN: Retrospective review of case series. SETTING: Georgetown University Medical Center, Washington, DC. PATIENTS: Thirty-four patients with clinically positive neck disease treated with organ preservation therapy for squamous cell carcinoma of the head and neck. INTERVENTIONS: Planned neck dissection after treatment with chemotherapy and radiotherapy or radiotherapy alone. MAIN OUTCOME MEASURE: Perioperative complications. RESULTS: Forty-one neck dissections were performed on 34 patients. Complications were seen in 13 (38%) of 34 patients and 15 (37%) of 41 neck dissections. Wound complications occurred in 9 (22%) of 41 dissections. Neck dissection complication rate did not correlate with previous use of chemotherapy or with the use of brachytherapy at the primary site at the time of the neck dissection. Preoperative radiotherapy dose greater than 70 Gy was associated with complications in 58% vs 29% when preoperative dose was less than 70 Gy (P = .09). This trend was reflected primarily in wound complications (42% vs 14%; P = . 10) and reached significance for skin flap necrosis (33% vs 0%; P = .005). Other factors that were associated with increased complications were preoperative albumin level less than 38 g/L and early neck drain removal. CONCLUSIONS: The complication rate associated with planned posttreatment neck dissection is similar to that previously reported for neck dissection. Wound complications are more common when higher preoperative radiotherapy doses are used.

Carcinoma, Squamous Cell↗

PubMed2003

Extended transmediastinal dissection: an alternative to gastroplasty for short esophagus.

HYPOTHESIS: The significance of short esophagus and its impact on failure after laparoscopic Nissen fundoplication are unknown. Although patients with severe esophageal shortening that requires Collis gastroplasty comprise a small percentage of patients undergoing fundoplication, we hypothesize that patients with moderate esophageal shortening requiring extended mediastinal dissection make up a larger subgroup and that extended laparoscopic mediastinal dissection is a good treatment strategy for such patients. DESIGN AND SETTING: Retrospective comparative analysis in an academic and private practice-based tertiary referral center. PATIENTS: A total of 205 patients underwent laparoscopic Nissen fundoplication for gastroesophageal reflux disease or paraesophageal hernias over 4 years. Outcomes in patients requiring either a type I (<5 cm) or type II (>5 cm) mediastinal dissection were compared. INTERVENTIONS: Laparoscopic Nissen fundoplication with or without extended mediastinal dissection and esophageal physiology testing. MAIN OUTCOME MEASURES: Symptom assessments, operative reports, and outcomes were prospectively recorded on standardized data sheets. Postoperative symptom assessment and esophageal physiology testing were performed. RESULTS: A total of 133 (65%) of the 205 patients underwent type I dissection, and 72 (35%) of the 205 patients underwent type II dissection. Failure occurred in 15 (11%) of 133 patients and 6 (10%) of 72 patients, respectively. The presence of a large hiatal or paraesophageal hernia predicted the need for type II dissection. CONCLUSIONS: No difference was seen in failure rates between patients who required a type II dissection and those who did not. This finding suggests that aggressive application of laparoscopic transmediastinal dissection to obtain adequate esophageal length may reduce fundoplication failure in patients with esophageal shortening and provide a success rate similar to that of patients with normal esophageal length. More liberal application of Collis gastroplasty in these patients is not warranted.

Chi-Square Distribution↗

PubMed1992

Groin dissection in the treatment of lower-extremity melanoma. Short-term and long-term morbidity.

Groin dissection was performed in 151 consecutive patients from 1970 to 1984. Groin dissections were therapeutic in 138 cases (91%) and elective in 13 (9%). One hundred forty-three patients (95%) underwent an ilioinguinal node dissection, while eight (5%) were treated with an inguinal node dissection. In 88 patients, the groin dissection was combined with isolated regional perfusion. Primary wound closure was performed in 140 patients (93%). There was no 30-day postoperative mortality. Complications included temporary seroma (26 [17%] of 151 patients), wound infection (14 patients [9%]), wound necrosis (five patients [3%]), and edema (30 patients [20%]). Residual inguinal node metastases after groin dissection did not occur. Morbidity of groin dissection did not increase when the groin dissection was combined with isolated regional perfusion. Quantification of the degree of edema in 66 patients revealed functional limitation due to edema in three patients (4.5%). This technique of groin dissection gives good results with minimal functional morbidity of the affected leg.

Adolescent↗

PubMed1997

Elective neck dissection versus observation in the treatment of early oral tongue carcinoma.

BACKGROUND: The aim of the present review is to evaluate the results of elective neck dissection and "watchful waiting" in the surgical treatment of stages I and II squamous cell carcinoma of oral tongue. METHODS: This is a retrospective study of patients with surgical treatment between January 1980 and December 1994. RESULTS: There were 63 patients including those with 34 T1 and 29 T2 carcinoma. The first sites of tumor recurrence were 5 (8%) local, 17 (27%) regional, 2 (3%) distant, 1 (2%) locoregional, and 1 (2%) both regional and distant. Of the 30 NO neck patients who had no elective neck dissection, the regional recurrence rate was 47%, and eventually 23% died of tumor related to regional recurrence. Elective neck dissection significantly reduced the regional recurrence rate to 9% and also significantly reduced the regional recurrence related mortality to 3%. Elective neck dissection also increased the 5-year disease-free actuarial survival rate to 86% compared with 55% for "watchful waiting." CONCLUSIONS: Regional recurrence was the most common cause of failure after surgical treatment of oral tongue carcinoma. Elective neck dissection significantly reduced mortality due to regional recurrence and also increased the overall survival. There was no significant difference between elective radical neck dissection and selective I, II, and III neck dissection in the improvement of treatment results. This retrospective study suggests that elective selective I, II, III neck dissection is a treatment strategy of choice for stages I and II carcinoma of the oral tongue. A prospective randomized study is worthwhile to further evaluate the benefit of elective neck dissection in the treatment of early carcinoma of the tongue.

Adult↗

PubMed1999

Selective neck dissections for squamous carcinoma of the upper aerodigestive tract: patterns of regional failure.

BACKGROUND: Surgeons have been using selective neck dissections in the treatment of squamous carcinoma of the upper aerodigestive tract for over 20 years. To date, no data is available that can answer the question "What are the patterns of failure in the neck following a selective neck dissection and is a selective neck dissection a reliable procedure for metastatic disease?" METHODS: To answer this question, the medical records of all patients with squamous carcinoma of the oral cavity, oropharynx, larynx, and hypopharynx treated at The University of Texas M. D. Anderson Cancer Center from January 1, 1985-December 31, 1990, with a selective neck dissection were reviewed. Five hundred seventeen neck dissections were analyzed: suprahyoid (41), supraomohyoid (284), and anterolateral (192). The end point of the study was regional failure and survival. RESULTS: Regional recurrence in patients treated with a suprahyoid dissection was 43% with pathologically positive nodes. The regional recurrence in the patients treated with a supraomohyoid neck dissection was 1.9% with pathologically negative nodes, 35.7% with path N1 without postoperative radiation therapy, and 5.6% with postoperative radiation therapy. The neck staged pathologically N2B failed with and without postoperative radiation, 8.3% and 14%, respectively. Thirteen percent of the anterior/lateral neck dissections failed regionally. If multiple pathologically positive nodes (N2B) were present, the regional failure with postoperative radiation was 30% and 33.3% without postoperative radiation. CONCLUSION: The results of this retrospective study suggest that a selective neck dissection is a satisfactory staging procedure and is a definitive operation if all the nodes are pathologically negative. However, if a node is found to be invaded with cancer, the use of postoperative radiation is advisable.

Carcinoma, Squamous Cell↗

PubMed1994

Spontaneous coronary artery dissection.

Spontaneous coronary artery dissection is a rarely identified entity whose exact incidence, etiology, pathogenesis, medium-term evolution, and optimal treatment have not yet been firmly established. This article describes five new cases with additional specific characteristics. Five of 2,241 coronary arteriograms taken between September 1989 and November 1992 showed angiographic signs of coronary dissection. Three of the patients were treated pharmacologically, and two were operated on. All were evaluated angiographically 10-18 months after diagnosis and followed up clinically for > or = 20 months. Three patients exhibited acute myocardial infarction, one showed effort angina and the fifth unstable angina. In four cases, coronary dissection was associated with coronary atherosclerosis, but in the fifth the coronary tree was apparently healthy except for the dissection. Dissection affected the right coronary artery in three cases and the left in two. Angiographic evolution varied among the five and was uncorrelated with treatment. Dissection disappeared in three; it persisted, with total obstruction of the artery in the middle of the dissected segment in one case; and advanced to affect the whole left coronary tree in the fifth. After an 18-month follow-up, none of the five patients experienced symptoms. These cases provide a good illustration of the variability of spontaneous coronary dissection as regards etiology, clinical presentation, treatment, and evolution. Coronary dissection is always caused by hemorrhage in the media of the arterial wall; its variability in evolution and in optimal treatment may be derived from the cause of the hemorrage, which possibly was not the same in all cases.

Adult↗

PubMed2001

Surgical treatment of cervical node metastases from squamous carcinoma of the upper aerodigestive tract: evaluation of the evidence for modifications of neck dissection.

BACKGROUND: This review article examines the role of the different types of neck dissection in the treatment of squamous carcinoma metastases to the cervical nodes. METHODS: A critical evaluation of the literature on the pathologic basis, oncologic effectiveness, and functional outcome of neck dissection. RESULTS: Pathologic data show preferential metastasis to different lymph node levels, in N0- and N+-staged disease, depending on the primary tumor site. Comparative studies on control of regional metastases suggest that modified radical is no less effective than radical neck dissection, but there is insufficient data to draw firm conclusions on the role of selective neck dissection. Selective and modified radical dissections result in less shoulder disability than radical neck dissection. CONCLUSIONS: Modified radical neck dissection is supported by pathologic and clinical evidence in N1- and 2-staged disease. There may be a role for selective dissection, but there is a need for more information on oncologic outcome. Prospective multicenter systematic data collection on the outcome of neck dissection is a pragmatic alternative to a trial.

Carcinoma, Squamous Cell↗

PubMed2000

Significance of extended systemic lymph node dissection for thoracic esophageal carcinoma in Japan.

In 1986, several institutions in Japan began to employ extensive lymphadenectomy for thoracic esophageal cancer. The aim of this article is to point out several confusing factors concerning the use of the terms "tow-field" and "three-field" lymph node dissection for thoracic esophageal cancer. In two-field nodal dissection, two components are included with (modern two-field) or without (traditional two-field) nodal dissection around both recurrent laryngeal nerve chains in the upper mediastinum. We studied a series of 353 patients resected for thoracic esophageal cancer in our institution. The patients were divided into three groups. Group A was the traditional two-field group of patients who underwent thoracoabdominal lymphadenectomy without upper mediastinal lymph node dissection after preoperative irradiation; group B was the modern two-field group, with additional upper mediastinal lymph node dissection; and group C was the three-field group with additional neck lymph node dissection. Groups B and C were operated on during the same period and did not received preoperative irradiation. The 5-year survival rate in group B was 54.9%, which was better than the 47.6% rate after three-field dissection (group C). The key to extensive lymphadenectomy for thoracic esophageal cancer does not lie in "cervical dissection" but in the meticulous dissection of the lymph nodes around the right and left recurrent laryngeal nerves.

Esophageal Neoplasms↗

PubMed1996

Intravascular ultrasound detected classification of coronary lesions as a predictor of dissections after balloon angioplasty.

Dissection after balloon angioplasty of coronary arteries may give rise to an unfavourable early outcome. Compared with coronary angiography, intravascular ultrasound (IVUS) allows more detailed characterisation of dissections. We investigated the incidence and type of dissections after balloon angioplasty in calcified coronary lesions. IVUS was performed in 43 patients with 48 lesions before and after percutaneous balloon angioplasty. Significant calcification was defined as an arc of more than 90 degrees with typical acoustic shadowing. Dissections were classified as type A when the media was not involved by the dissection and as type B when media involvement had occurred. In the group with significant calcification dissection was observed in 79% of the cases vs 38% in the control group (p < 0.03). Type B dissection was present in 71% of the dissections in the calcified lesions vs. 15% in the control group (p < 0.02). The balloon diameter and the ratio of balloon area to vessel area was not different in both groups but the required pressure for the first complete balloon inflation was significantly greater in the group with calcified lesions (9.46 +/- 3.6 atm vs. 6.65 +/- 2.6 atm; p < 0.001). Thus balloon angioplasty in calcified coronary lesions is more likely to lead to dissection with frequency involve the media.

Adult↗