Complicating Tears during Coronary Angioplasty: Where are they Most Prevalent and how do They Affect Patient Outcomes?

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 coronary 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 stents 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 and result in severe complications 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 control group of patients without dissection.

Coronary Angioplasty Coronary angioplasty is a treatment to widen narrowed sections of the coronary (heart) arteries. It is also known as percutaneous coronary intervention (PCI). It does not involve major heart surgery but involves the use of a catheter which is inserted into coronary arteries via the large blood vessels.

Overview

As you age, a waxy substance called plaque (plak) can build up inside your arteries. This condition is called atherosclerosis (ath-er-o-skler-O-sis).

Atherosclerosis can affect any artery in the body. When atherosclerosis affects the coronary arteries, the condition is called coronary heart disease (CHD) or coronary artery disease.

Over time, plaque can harden or rupture (break open). Hardened plaque narrows the coronary arteries and reduces the flow of oxygen-rich blood to the heart. This can cause chest pain or discomfort called angina (an-JI-nuh or AN-juh-nuh).

If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. This is the most common cause of a heart attack. Over time, ruptured plaque also hardens and narrows the coronary arteries.

Angioplasty can restore blood flow to the heart. During the procedure, a thin, flexible catheter (tube) with a balloon at its tip is threaded through a blood vessel to the affected artery. Once in place, the balloon is inflated to compress the plaque against the artery wall. This restores blood flow through the artery.