Time course and mechanism of early luminal diameter loss after percutaneous transluminal coronary angioplasty

To assess the time course and mechanism of early minimal luminal diameter (MLD) loss, serial angiographic observations were performed. Seventy-four patients (with 74 severe narrowings [≥70%]) with acute ischemic syndromes who had an early loss in MLD of >0.3 mm at 24 hours after percutaneous transluminal coronary angioplasty (PTCA) also underwent 1 hour post-PTCA angiography. In 12 consecutive patients with early loss 1 hour after PTCA, angioscopy was also performed to assess the mechanism of early loss. The percent diameter stenosis for the 74 lesions was 16.8 ± 8.4% immediately after PTCA, 35.1 ± 14.2% 1 hour after PTCA (p < 0.002 vs immediately after), and 41.4 ± 13.2% at 24 hours (p < 0.10 vs 1 hour after). The MLD also showed similar differences: 2.6 ± 0.3 mm immediately after to 2.0 ± 0.4 mm 1 hour after (p < 0.002) to 1.8 ± 0.4 mm 24 hours after PTCA (p < 0.10 vs 1 hour). In 60 patients (81%), the >0.3 mm loss was detected 1 hour after PTCA. These 60 patients had no further decreases in MLD at 24 hours (1.9 ± 0.4 vs 1.8 ± 0.4 mm at 1 and 24 hours, respectively, p = NS). Adequate angioscopic images available in 11 patients showed that red thrombus was present in 1, minor or multiple dissection in 5, and neither thrombus nor dissection in 5 other patients (consistent with early wall recoil). Thus, in narrowings demonstrating early loss in MLD at 24 hours, 81% showed that the early loss occurred within 1 hour after PTCA. Early loss is not related to thrombus but usually to dissection or recoil.