Immediate and six-month outcome of self-expanding Wallstent for long lesions in native coronary arteries.

ABSTRACT

Between April and December 1996, 50 less-shortening Wallstents were deployed in the native coronary arteries of 44 patients, with lesions more than 20 mm long and minimum vessel diameter of at least 3.0 mm. There were 39 males and 5 females with an age range of 35-77 years. The majority (70.4%) had multivessel disease (MVD). The target vessel was LAD for 17 (34%), RCA 23 (46%) and LCx-OM for 10 (20%) stents. All lesions were type C, according to the ACC/AHA Task Force Classification. The length of the lesions ranged from 21-60 mm (mean 31 +/- 8). The stent selection was based upon oversizing by 1.5-2.0 mm compared to the minimum vessel diameter, and covering approximately 4-5 mm of the apparently normal vessel on either side of the target lesion. The stent was deployed successfully without any major complications, including myocardial infarction, emergency coronary artery bypass grafting (CABG) and death in 43 out of 44 (97.7%) patients. One patient in whom there was failure to reach the target site with stent, developed non-Q wave inferior myocardial infarction. Post-discharge, two patients reported to have died within one month after the procedure. The event-free survival, defined as the absence of angina, myocardial infarction, need for revascularisation or death was 93.2 percent at 30 days and 84 percent at 6 months following stent implantation. From our data, it is concluded that (i) the delivery of the new, less-shortening, self-expanding Wallstent at the target site was possible in almost all the cases; (ii) clinical success with < 30 percent residual diameter stenosis could be achieved in approximately 98 percent of cases, and (iii) there was an impressive event-free survival of 84 percent at 6 months of follow-up. The occurrence of 2 deaths during the first 30 days, however, necessitates close supervision for possible subacute stent thrombosis. The results of angiography after six months would help to define the true incidence of restenosis.