ABSTRACT
BACKGROUND: Rescue PTCA is still a debatable procedure and the results published in the literature may not justify routine application of this strategy. AIM: To evaluate the hospital outcome of patients undergoing rescue PTCA with the aim of achieving a complete recanalization of the infarct-related artery (IRA)--residual stenosis assessed with QCA < 30% and TIMI 3 forward flow--obtained with adjuvant coronary stenting when needed. METHOD: From April 1993 to December 1997, 59 consecutive patients underwent rescue PTCA after thrombolysis failure (SK or front-loaded r-tPA, UK) within 6 hours of chest pain onset. All patients had a pre-procedure TIMI 0-1 flow. IRA was the right coronary artery in 23 cases (39%), the left anterior descending in 26 (44%), the left circumflex in 9 (15.3%) and a saphenous vein graft in 1 case (1.7%). In 2 (3.3%) patients, PTCA was not performed (impossibility of crossing the stenosis with the guide-wire). Fifteen patients (26.3%) had a successful procedure (TIMI 3 flow, residual stenosis < 30%) with lone PTCA. Forty-two patients (73.6%) had an intracoronary stent placed (Palmaz-Schatz, Micro-Stent, Multilink, IRIS III): 24 patients (57.1%) for suboptimal angiographic result (TIMI 2 flow, residual stenosis > 30%), 11 patients (26.2%) for dissection, 7 patients (16.7%) for intracoronary thrombosis. All 57 patients had a TIMI 3 flow and a residual stenosis < 30% at the end of the procedure. Mean vessel diameter was 3.22 +/- 0.4 mm, mean balloon size 3.3 +/- 0.4 mm, mean inflation pressure 12 +/- 4 atm, mean residual stenosis 8 +/- 9%. RESULTS: The overall procedure success rate was 96.6%. During hospitalization, three patients (5.1%) suffered subacute reocclusion managed conservatively in one case, with CAGB in another and with re-PTCA in the last one. Three patients (5.1%) had minor vascular complications (groin hematoma) not requiring surgical correction or blood transfusion. No patients died, suffered reinfarction or stroke. All patients were discharged alive and free of angina or clinical heart failure. CONCLUSIONS: Coronary stenting performed in the setting of rescue PTCA leads to a good procedural success rate allowing TIMI 3 flow and low residual stenosis (< 30%). Therefore, when conventional balloon angioplasty is unable to achieve an optimal angiographic result, stenting can be accomplished safely, thereby improving the procedural success rate and allowing a bright event-free survival rate.
