Coronary stenting in unstable angina: angiographic and clinical implications.

BACKGROUND: The pathogenesis of unstable angina involves the presence of intracoronary thrombus which may have potential bearing on the therapeutic efficacy of intracoronary stenting to reduce acute complications and restenosis rate. METHODS: In order to evaluate in-hospital and long-term outcome of coronary stenting in patients with unstable angina, we retrospectively examined our experience in 311 consecutive patients. Braunwald class III angina (B or C) was present in 35% of the cases. Three hundred seventy one stents were implanted in 315 lesions, most of them (62.4%) with complex morphology. Angiography identified an intraluminal thrombus in 22 target sites. Stent indication was elective in 146 cases (46.9%), for suboptimal results in 149 (47.9%) and for bail-out in 16 (5%). RESULTS: Procedural success was obtained in 96.3% of the study population. Major complications occurred in 12 (3.7%) patients: myocardial infarction in 6 (1.9%) cases, emergency bypass surgery in 3 (0.9%) and death in 3 (0.9%), none of them related to acute stent thrombosis. Vascular complications occurred in 5 patients (1.6%). The mean hospital stay after stenting was 2.8 +/- 1.6 days. Subacute stent thrombosis occurred in one patient and led to a Q-wave anterior myocardial infarction. Follow-up (9 +/- 5 months) status was ascertained in 216 patients and revealed an overall clinical success rate of 87.3%. Restenosis occurred in 23.5% of 157 patients who underwent angiographic follow-up. Late events included 3 non-fatal myocardial infarction, 6 new PTCA, 3 elective bypass surgery and 1 cardiac death. CONCLUSIONS: Intracoronary stenting appears safe and effective in patients with unstable angina, despite the presence of a thrombogenic milieu. Optimal immediate angiographic results, related to the mechanical properties of stents, together with a vigorous antithrombotic regimen, contributes to the favorable outcomes in this adverse setting.

Intracoronary stent insertion after balloon angioplasty of chronic total occlusions.

OBJECTIVES: This retrospective analysis was performed to assess the medium-term effectiveness of implanting intracoronary stents into chronic total occlusions that are successfully opened by balloon angioplasty. BACKGROUND: The value of percutaneous transluminal coronary angioplasty of chronic total occlusions is limited by a very high restenosis rate of 50% to 68%. Intravascular stents have been shown to reduce restenosis in a subset of patients with subtotal stenoses. It has not been demonstrated that the placement of stents into successfully opened chronic total coronary artery occlusions leads to lower rates of restenosis. METHODS: A consecutive series of patients with chronic total coronary occlusions successfully opened by balloon angioplasty received Palmaz-Schatz stents. Patients underwent clinical and angiographic follow-up at a mean of 6 months after stent insertion. Angiographic and clinical results were retrospectively analyzed. RESULTS: Fifty-nine patients underwent stenting of 60 chronic total coronary occlusions, with a 98% rate of successful stent deployment. Complications occurred in 5% of cases, all with subacute thrombosis. Angiographic follow-up was obtained in 88% of patients at a mean of 6 months and demonstrated an angiographic restenosis rate of 20%, with only one reocclusion. Among several variables examined, only the presence of a procedure-related moderate to severe dissection was associated with higher follow-up percent diameter stenoses and clinical events. At a mean of 14 months after stent insertion, 77% of patients remained free of symptoms or clinical events. CONCLUSIONS: The implantation of intracoronary stents into vessels with opened chronic total coronary occlusions is associated with favorable rates of angiographic restenosis and relief of symptoms. A randomized clinical trial comparing balloon angioplasty with stent-assisted balloon angioplasty in the treatment of chronic total coronary occlusions is indicated.

Treatment of simple and complex coronary stenosis using rotational ablation followed by low pressure balloon angioplasty.

High speed coronary rotational ablation followed by adjunctive low pressure coronary balloon angioplasty was used in 166 patients. Complex lesions were present in 63% of patients. Clinical success was achieved in 157 patients (95%). Angiographic success rate was 10% in A lesions, 95% in B1 lesions, 98% in B2 lesions, and 93% in C lesions. Mean vessel lumen diameter has increased from 0.4 mm to 1.4 mm after rotational ablation and to 2.3 mm following adjunctive balloon angioplasty. Left ventricular dysfunction, the presence of total occlusion, and the severity of stenosis before the procedure were predictive of clinical failure. There were three abrupt vessel closures (1.8%) with one Q wave myocardial infarction. Non-Q wave myocardial infarction occurred in 14 patients (8.4%) and three patients died during hospitalisation (1.8%). We conclude that rotational atherectomy followed by adjunctive low pressure balloon angioplasty gives comparable high success rates in different coronary lesions.