Emergent use of balloon-expandable coronary artery stenting for failed percutaneous transluminal coronary angioplasty

• Published in: Circulation (New York, N.Y.) N.Y.), 1992-09, Vol.86 (3), p.812-819
• Main Authors: HERRMANN, H. C, BUCHBINDER, M, CLEMEN, M. W, FISCHMAN, D, GOLDBERG, S, LEON, M. B, SCHATZ, R. A, TIERSTEIN, P, WALKER, C. M, HIRSHFIELD, J. W
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Catheterization; Coronary Angiography; Coronary Disease - therapy; Coronary heart disease; Coronary Vessels; Female; Follow-Up Studies; Heart; Humans; Male; Medical sciences; Middle Aged; Retrospective Studies; Stents
• ISSN: 0009-7322; 1524-4539
• DOI: 10.1161/01.cir.86.3.812

The balloon-expandable intracoronary stent developed by Palmaz and Schatz is undergoing clinical evaluation for use in unfavorable anatomic situations and in the prevention of restenosis. Because the stent's mechanism of action would suggest effectiveness in salvaging certain percutaneous transluminal coronary angioplasty (PTCA) failures, we retrospectively examined the results of emergency unplanned coronary artery stenting for failed PTCA procedures, including acute occlusion. The study population consisted of all US patients receiving emergency unplanned stent implantation in a nonrandomized fashion at seven centers over a 2 1/2-year period (n = 56). All available medical records and angiograms were reviewed to determine retrospectively the reason for stenting: Group 1 consisted of 23 patients with a suboptimal angioplasty result; group 2 included patients with evidence of impending vessel closure after PTCA (n = 15); and group 3 were patients with frank acute occlusion after PTCA (n = 18). The immediate and final (30-day) results of stenting were examined with respect to major complications, which included death, need for coronary artery bypass graft surgery, and occurrence of myocardial infarction. Finally, restenosis rates (greater than or equal to 50% stenosis) based on follow-up angiography were calculated. Baseline characteristics of the study population included a mean +/- SD age of 58 +/- 11 years and a large prevalence of angiographic characteristics generally considered unfavorable for PTCA, which include lesion eccentricity (49%), intimal dissection (9%), or angiographically visible thrombus (6%). After conventional balloon angioplasty, there was an increased incidence of intimal dissection (74%) and thrombus formation (38%), and overall stenosis severity was unchanged (75 +/- 12% versus 70 +/- 27%, p = NS). Successful stent deployment was achieved in 55 (98%) of 56 patients with initial success (freedom from death, surgery, and infarction) in 52 (93%) of 56 patients. The success rate at 1 month fell to 71% primarily because of the occurrence of subacute stent thrombosis (16%) and its associated complications. Overall, major complications occurred in 16 (29%) of 56 patients within 30 days. The only predictor of subacute stent thrombosis in multiple stepwise logistic regression analysis was the presence of angiographically visible thrombus after stenting (p = 0.03). Angiographic restenosis was documented in eight (23%) of 35 eligible patients.