Follow-up Angiographic Results after MultiLink Coronary Stent Implantation

BACKGROUND AND OBJECTIVES: The objective of this study was to assess the in-hospital clinical outcome and 6 months follow-up angiographic results after flexible balloon expandable MultiLink coronary stenting. The impact of post-stenting excessive high pressure balloon dilation on late outcome is controversial. The other purpose was to investigate the impact of post-stenting high pressure balloon dilation (HPD group > or =14 atm) on clinical and angiographic outcome in comparison to moderate pressure dilation (MPD group < 14 atm). MATERIALS AND METHOD: The MultiLink stents were implanted in 124 patients (mean age 58+/-9, M/F=94/30) with 128 lesions. Post-stenting high pressure balloon dilation was performed to have less than 10% of residual stenosis and smooth in-stent lumen without IVUS guidance. RESULTS: The indications for stenting were elective in 88 lesions (69%), suboptimal angioplasty results in 27 lesions (21%), and bail-out in 13 lesions (10%). The incidence of in-hospital major adverse cardiac events was 1.6% and major vascular complication rate was 3.2%. The follow-up angiography was performed in 86 patients (69%) at 7.9+/-2.6 months. The angiographic restenosis rate was 22.7%. The acute gain of HPD group had a tendency to be higher than MPD group (HPD:MPD=2.33+/-0.51 mm:2.22+/-0.44 mm, p=0.08) and the late loss of MPD group had a tendency to be lower than HPD group (MPD:HPD=0.86+/-0.73 mm:0.95+/-0.84 mm, p=0.09). And the net gain and restenosis rate of both groups were similar respectively (HPD:MPD=1.38+/-0.94 mm:1.36+/-0.83 mm, p=ns, HPD:MPD=22.5%:22.9%, p=ns). CONCLUSION: The MultiLink coronary stent system is a safe and effective device with high procedural success rate and also has the acceptable angiographic restenosis rate for the treatment of coronary artery disease. The post-stenting excessive high pressure balloon dilation might not be necessary during the deployment of MultiLink stent.

Initial Results after Implantation of Coronary Artery Stents with Antiplatelet Agents

Backgound: The placement of stents in coronary arteries has been shown to reduce acute closure and restenosis in comparison to balloon angioplasty. However, clinical use of intracoronary stents is impeded by the subacute stent thrombosis and hemorrhagic complications associated with the anticoagulant regimen. It's known that the complete stent deployment with high pressure inflation and new antiplatelet agents are effective in reduction of subacute thrombosis and hemorrhage. So we evaluated initial results (success and complication rate) after high pressure-stent deployment with new anticoagulation protocol. METHODS: One hundred and ninety one patients with 201 lesions were treated with 231 stents of various types. The high pressure balloon inflation and antiplatelets agents were used in all cases. Final high pressure balloon inflation guided by IVUS were performed in 23 consecutive cases with incomplete stent deployment according to angiographic findings. RESULTS: 1) The indications of stenting (n=210) were De novo in 124 (59%), bailout procedure in 57 (27%), suboptimal result after PTCA in 19 (8%), and restenosis after PTCA in 14 (6%). The location of lesions were LAD in 101, RCA in 67, circumflex in 28, ramus intermedius in 3, and LMT artery in 2 lesions. Angiographic morphologic characteristics were type A in 2, type B in 158 (B1: 57, B2: 101), and type C in 22 lesions. 2) The angiographic and clinical success rate was 96% (192/201) and 92% (186/201) respectively. 3) In angiographic analysis, the baseline average reference vessel dirmeter was 3.33+/-0.35 mm. Baseline minimum lumen diameter (MLD) was 0.58+/-0.29 mm, with baseline percent diameter stenosis of 82.86+/-8.64%. The final stent diameter was 3.37+/-0.29 mm, with mean final percent stenosis of 0.63+/-8.25. The mean MLD after stenting was significantly increased (p12atm) (p<0.001). The length of lesions in GR I (cook), GR II, and Micro II stents were significantly longer than ones in PS, Cordis, Wiktor, Nir (p<0.001). 4) In intravascular ultrasound analysis, the mean lumen CSA at the tightest point within stent increased 11%, from 8.4+/-2.4 mm2 at the intial intravascular ultrasound to 9.4+/-2.1 mm2 at the final intravascular ultrasound (p<0.001). 5) The procedural and postprocedural complications were 2 acute closures associated with AMI and emergent CABG, 1 subacute closure which was revascularized by bail out stenting, 5 major hemorrhage requiring transfusion associated with 1 CVA and 2 metabolic acidosis induced by acute renal failure, and 5 death. CONCLUSION: The high pressure stent deployment procedure and new anticoagulation protocol associating tidopidine and aspirin without coumadin or prolonged heparin infusion allow us to obtain an acceptably low subacute thrombosis or bleeding complication rate. These results are encouraging and allow a wide use of coronary stenting.