Creation and healing of severe coronary dissection by the use of oversized balloon for the treatment of restenosis after an initially successful angioplasty

We describe two patients who underwent successful coronary angioplasty with a balloon that matched the normal size of the artery. Both patients returned for a second angioplasty because of restenosis. The morphology of the restenotic lesion was very similar to that of the original lesion. In the second angioplasty a larger balloon was used, and in both cases severe dissection occurred. Repeat angiography 3 months later demonstrated an open artery with clinically insignificant residual stenosis. We believe that in these two cases the initial angioplasty stretched the artery and it recoiled slowly to its original dimensions. A larger balloon size was necessary to crack atherosclerotic plaque and cause a successful long‐term outcome.