Circulation, Vol 90, 2716-2724, Copyright © 1994 by American Heart Association
A Schomig, A Kastrati, H Mudra, R Blasini, H Schuhlen, V Klauss, G Richardt and FJ Neumann
BACKGROUND: Abrupt vessel closure after percutaneous transluminal coronary
angioplasty (PTCA) is associated with major adverse events. Different
surgical and nonsurgical approaches have been advocated to treat or prevent
this complication. This study summarizes our 4-year experience with
Palmaz-Schatz stenting for the management of 339 patients with present or
threatened occlusion after PTCA. METHODS AND RESULTS: Stent implantation
was attempted in a total of 339 and 4959 patients with PTCA during the
study period and was successful in 327 (96.5%). During the follow-up,
events like death, myocardial infarction, need for revascularization
(bypass surgery and repeat in- stent angioplasty), and major vascular
complications were recorded. Angiographic follow-up at 6 months was
performed in 89.3% of the eligible patients. As part of an initial policy,
stenting was intended as a bridge to nonemergency bypass surgery in 26
patients. In 301 patients for whom stenting was intended as permanent
treatment, early clinical course (first 4 weeks) was characterized by a
1.3% cardiac mortality and a 4.0% nonfatal myocardial infarction rate;
bypass surgery was necessary in 1%, and 6.3% required early repeat PTCA.
Surgical repair for peripheral vascular complications was required in 5.6%,
and major bleeding events were encountered in 9%. The incidence of subacute
stent closure was 6.9%, with subsequent recanalization successful in 86%;
subacute stent closure was predicted by presence of vessel occlusion before
stenting and localization of the stent in a vessel other than the right
coronary artery. Survival rate at 2 years was 95.4%, survival without
myocardial infarction was 91.1%, and event- free survival was 70.7%.
Survival at 2 years was lower for patients with stents in bypass vein
grafts and with myocardial infarction after stenting. Six-month control
angiography revealed a restenosis rate of 29.6%. CONCLUSIONS: Patients with
present or threatened occlusion after PTCA may benefit from Palmaz-Schatz
stenting. It is associated with a low mortality and myocardial infarction
rate and with a long-term event- free rate comparable to that of
uncomplicated PTCA.
ARTICLES
Four-year experience with Palmaz-Schatz stenting in coronary angioplasty complicated by dissection with threatened or present vessel closure
1. Medizinische Klinik, Technischen Universitat, Munchen, Germany.
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