ABSTRACT
Some of the force exerted by the angioplasty balloon causes compression of the plaque and some causes plaque fracture. The radial force of the angioplasty balloon causes plaque fracture at areas of fixed stenosis, especially where the heterogeneous plaque forms a calcified circumferential ring (Fig. 1). There is often evidence of dissection on completion images immediately following the angioplasty, and the more thorough the investigation, the more that can be found. Contrast fills cracks in the plaque, most of which are longitudinal. Experience with balloon angioplasty before the development of stents indicates that most of these dissections, even dissections with seemingly terrible angiographic results, heal without treatment. The availability of stents has made it possible to treat most dissections safely and quickly. This has prompted the current dilemma. How aggressively should mild-to-moderate postangioplasty dissections be stented? This will gradually be solved in each vascular bed.
