Initial Results and Angiographic Follow-up Patients with Coronary Artery Stenting

BACKGROUND: Percutaneous transluminal coronary angioplasty(PTCA) is one of the most widely used therapeutic procedures in the treatment of patients with coronary artery disease. However, acute closure and late restenosis remain a major limitation of PTCA despite extensive efforts to prevent. Coronary artery stents have been proposed as a treatment modality for acute closure and restenosis. We evaluated the initial success rate, complications, the restenosis rate, and the clinical outcomes after coronary artery stenting. METHODS: We implanted 56 stents(Palmaz-Schatz(PS) stent : 38 ; #3.0-14, #3.5-7, #4.0-17, Gianturco-Roubin(GR) stent : 18 ; #2.5-4, #3.0-10, #3.5-1, #4.0-3) in 51 patients(male : 40, mean age : 58+/-1 year). The clinical characteristics of the subjects were unstable angina in 26(51%), stable angina in 2, and myocardial infarction in 23(45%) patients(acute : 18). Follow-up angiography was done at a mean duration of 5.4 month(1-12) after coronary stenting for 34 lesions(61%) of 30 patients. RESULTS: 1) The indications of stenting(n=56) were De novo in 33(59%), bailout procedure in 15(27%), suboptimal result after PTCA in 6, and restenosis after PTCA in 2 stents. The location of lesions were LAD in 24, RCA in 27, and circumflex artery in 5 lesions. Angiographic morphologic characteristics were type B in 38(BI : 3, B2 : 35) and type C in 18 lesions. 2) The angiographic and clinical success rate was 96%(54/56) and 94%(52/56). There were no significant difference in stent modality, lesion site and morphology, and indication of stent. 3) Procedural complications were 1 acute closure which was recanalized by emergency coronary artery bypass graft(CABG), 1 death with subacute closure, 2 dissection, and 5 hemorrhages requiring transfusion. 4) The overall restenosis rate was 26%(9/34). The restenosis rate was reduced significantly in PS stent[PS : 9%(2/22) vs GR : 58%(7/12), P or =3.5mm of stent size[> or =3.5mm : 6%(1/18) vs 3.5mm : 50%(8/16), p 12atm) [High pressure(+) : 7%(1/14) vs High pressure(-) : 40%(8/20), p<0.05]. 5) The restenosis sites were managed with re-PTCA in 4, elective CABG in 1, and medical follow-up in 4 patients. CONCLUSION: Coronary stenting is an effective and safe procedure for the management of coronary artery disease. The PS stent and GR stent are considered as a safe means for bail-out, and the PS stent can reduces the restenosis rate especially.

Two Cases of Renal Artery Stenosis Caused by Takayasu's Arteritis : Treatment with the Palmaz-Schatz Biliary Stent

Percutaneous transluminal renal angioplasty(PTRA) has become the treatment of choice for major renal artery stenosis. Nonetheless, about 10% of renal artery stenosis could not be properly dilated and 10-15% had a recurrence among the parients successfully dilated. Especially, PTRA in Takayasu's arteritis has technical diffculties due to the tough, noncompliant nature of the stenosis, which art difficult to cross and resist the respeated, prolonged balloon inflations. Intraluminal renal artery stent placement in unsuccessful balloon angioplasty and unsuitable lesions to PTRA may be an attractive approach to improve flow conditions. We report two cases of proximal renal artery stenosis caused by Takayasu's arteritis, who treated with intraluminal renal stenting(Palmaz-Schatz biliary stent). In both cases, clinical and angiographical improvement was achieved.

Efficacy of Interavascular Ultrasound in the Palmaz-Schatz Stent Implantation: Clinical Experience of 3 Coronary Artery Disease Patients

Intravascular ultrasound is a usful too to assess the adequate stent strut expansion after stent implantation and nowadays it can bo also used as a dicision making method about omitting anticoagulant therapy. We used intravascular ultrasound before and after Palmz-schatz stent implantation in 3 patients with coronary artery narrowings and analysed serial post porcedure lumen diameter, cross sectional area. We think it is a useful tool to assess the effect of stent implantation and post stent balloon dilatation.

Clinical Experience with the Palmaz-Schatz Coronary Stent: Initial Results and 7 Month Follow-up

BACKGROUND: Although percutaneous transluminal coronary angioplasty(PTCA), first reported in 1977, represents a major advance in cardiovascular therapeutics, acute closure and restenosis are major limitations of PTCA. The focus of this report is to describe the procedural results and short-term follow-up obtained at Yonsei Cardiovascular center. METHODS: We implanted 12 balloon expandable Palmaz-Schatz stents in 12 patients with significant stenosis of coronary artery. Five patients presented as candidates for primary stenting and the remainder presented with restenosis. Clinically, there were unstable angina in 4, stable angina in 5, old myocardial infarction with stable angina in 2, and old myocardial infarction in 1. The stented vessels were the right coronary artery in 4 and left anterior descending artery in 8. All patients received a single stent. The sizes of stents were 3.0mm in 9, 3.5mm in 2, and 4mm in 1. The lesion morphology according to AHA/ACC classification were type A in 1, type B in 10, and type C in 1. The extent of coronary artery disease was 1-vessel in 4, 2-vessel in 6 and 3-vessel in 2. RESULTS: Successful delivery was accomplished in all patients and complications including acute and subacute thrombosis bleeding requiring transfusion, myocardial infarction, and death were absent. Vessel patency after mean follow-up of 7 month showed restenosis in 4 out of 7 patients : 50% in 1, 60% in 1., 0% in 1 and total obstruction in 1 patient. PTCA was done in the patient with 80% restenosis successfully. CONCLUSION: Balloon-expandable intracoronary stenting is a feasible method for treating the acute complication of balloon angioplasty. It seemed to reduce the rate of restenosis for single stent implantation, but long-term results and indications should be evaluated more extensively.

Coronary Artery Stenting(Palmaz-Schatz) ; Immediate Results

Since after first report of percutaneous transluminal coronary angioplasty in 1977, improved operator technique and advanced equipment designs have resulted in an increase in primary success rate from 67% to 92% in recent days. Despite these improvement, acute closure and restenosis remain as serious limitations to both the short and long-term success of PTCA. Coronary artery stents have been proposed as a method of treating acute closure and preventing restenosis. We implanted 21 balloon expandable Palmaz-Schatz Stent in selected 21 Patients(mean age 62+/-8 years, M/F : 16/5) with atherosclerotic coronary artery disease. The indications were elective stenting in 17, acute dissection postangioplasty in 2 and restenosis following angioplasty in 2. The clinical diagnosis of the subjects was unstable angina in 12 pts(57%), stable angina in 1, and post infarction angina in 8 including 6 acute myocardial infarction. The target vessel was right coronary artery In 12(57%), left anterior descending artery in 6(29%) and left circumflex in 3(14%). The size of implanted stent was 3mm in 15, 3.5mm in 5 and 4.0mm in 1. The morphology of attempted lesion was AHA/ACC classification type A in 1, type B in 17(B1 ; 1, B2 ; 16) and type C in 3. Angiographic findings were 1-vessel disease in 16 patients, 2-vessel disease in 4 and 3-vessel disease in 1. Coronary artery stenting wast technically successful in 21 all patients(100%) and complications included subacute total occlusion 1 week after stenting in 1, which was recanalized successfully by repeat PTCA without myocardial infarction, prolonged sinus arrest after stenting due to microembolism in 1 and puncture site bleeding requiring transfusion in 1. CONCLUSION: Coronary artery stenting was a safe and effective procedure to obtain adequate coronary blood flow in selected patients but long-term efficacy of primary elective coronary stenting should be evaluated prospectively.

Coronary Artery Stenting(Palmaz-Schatz) ; Immediate Results

Since after first report of percutaneous transluminal coronary angioplasty in 1977, improved operator technique and advanced equipment designs have resulted in an increase in primary success rate from 67% to 92% in recent days. Despite these improvement, acute closure and restenosis remain as serious limitations to both the short and long-term success of PTCA. Coronary artery stents have been proposed as a method of treating acute closure and preventing restenosis. We implanted 21 balloon expandable Palmaz-Schatz Stent in selected 21 Patients(mean age 62+/-8 years, M/F : 16/5) with atherosclerotic coronary artery disease. The indications were elective stenting in 17, acute dissection postangioplasty in 2 and restenosis following angioplasty in 2. The clinical diagnosis of the subjects was unstable angina in 12 pts(57%), stable angina in 1, and post infarction angina in 8 including 6 acute myocardial infarction. The target vessel was right coronary artery In 12(57%), left anterior descending artery in 6(29%) and left circumflex in 3(14%). The size of implanted stent was 3mm in 15, 3.5mm in 5 and 4.0mm in 1. The morphology of attempted lesion was AHA/ACC classification type A in 1, type B in 17(B1 ; 1, B2 ; 16) and type C in 3. Angiographic findings were 1-vessel disease in 16 patients, 2-vessel disease in 4 and 3-vessel disease in 1. Coronary artery stenting wast technically successful in 21 all patients(100%) and complications included subacute total occlusion 1 week after stenting in 1, which was recanalized successfully by repeat PTCA without myocardial infarction, prolonged sinus arrest after stenting due to microembolism in 1 and puncture site bleeding requiring transfusion in 1. CONCLUSION: Coronary artery stenting was a safe and effective procedure to obtain adequate coronary blood flow in selected patients but long-term efficacy of primary elective coronary stenting should be evaluated prospectively.