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Proximal Stent Edge Dissection

After an NSTEMI heart attack and 3 stents, this description is on my husband's cath report: "Post dilation of the proximal edge of the stent resulted in proximal edge dissection and required a third stent."  Is this dangerous or cause greater worry for the future?
2 Responses
20748650 tn?1521032211
It is certainly a complication of the case.

Before you get too upset though, this complication is something the operating team often has little control over. It’s the sort of accident that can’t be prevented 100% of the time, no matter how good you are at putting stents in. Sometimes arteries just dissect. You can’t really avoid it Or predict it sometimes.

There are different degrees of severity and it can result in some pretty catastrophic consequences in a case if the team isn’t skilled enough to manage it quickly.

The dissection resulted in another stent placement, perhaps even a special kind of stent called a “covered” stent or graftmaster. This is pretty standard.

Fortunately the team managed to work effectively and address the issue and your husband is alive and well. He may have a slight increased risk of a future heart attack and it may complicate any future open heart surgery if he ever needs it. In general however there is nothing really *too* significant you need to be concerned with as a result of the dissection. The biggest danger is already passed in the laboratory.
20748650 tn?1521032211
To clarify: put some emphasis on the SLIGHT increase of risk.

This applies any time you have to add another stent. Every additional millimeter of metal that has to go into the arteries comes with its own risks and benefits.

Whether it has to go in for a dissection or to fix a blockage doesn’t really matter. Most interventionalists will try their best to minimize stent use to avoid putting metal into the artery unless they absolutely NEED to have it.

So yes,  naturally it kind of sucks when you think you only really need to have 20mm ofstent and you wind up needing 30mm because of a dissection.
2 Comments
Thank you for your kind answers! They didn’t really explain this the only way we knew it was by reading the report. But what I thought was going to take an hour was a three hour procedure and so I was wondering if something went wrong. Does this happen often? Is this a weird complication?

From what I’ve read the stent  edge is not as dangerous as a regular artery dissection. Is that true?
Yeah, edge dissections are fairly common.

You have a part of a tube that’s blocked and another part that’s not. Sometimes in inflating a balloon to open up the blocked part the unblocked part can’t handle the “stretch” and “cracks” a bit and you have to patch it. It’s not uncommon and is not something you can always predict or avoid.

It probably wasn’t told to you because they fixed it easily and didn’t want to stress you out.

As for procedure time 3 hours is very normal.

It’s extremely common for doctors to give poor time estimates for a procedure because their approximation of time includes the time they scrub in and start until the time they scrub out. It does not include the time to setup, break down and transfer. It also doesn’t factor in the possibility of the case perhaps being more technically challenging; it tends to be the best case scenario for time. It’s a big “pet peeve” of mine because it can leave a patients family to worry

Cath procedures with stents can take upwards of 6 hours but tend to average 2-3 hours
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