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[Stents for treatment of transluminal percutaneous coronary angioplasty (PTCA) complications]
P Pieniazek1, T Przewłocki, K Zmudka
1Kliniki Chorób Serca i Naczyń, Instytutu Kardiologii Collegium Medicum, Uniwersytetu Jagiellońskiego w Krakowie.
Insights
Coronary stenting effectively treats obstructive dissections after percutaneous transluminal coronary angioplasty (PTCA), significantly reducing the need for emergency bypass grafting (CABG). This bailout stenting approach shows a high success rate with favorable short-term outcomes.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
- Medical Device Technology
Background:
- Obstructive dissections are serious complications following percutaneous transluminal coronary angioplasty (PTCA).
- Historically, emergency coronary artery bypass grafting (CABG) was often required for these dissections.
- The introduction of coronary stenting aimed to provide an alternative treatment modality.
Purpose of the Study:
- To evaluate the initial results of coronary stenting in bailout situations after PTCA.
- To assess the efficacy and safety of stent implantation for managing obstructive dissections.
- To compare complication rates before and after the introduction of stenting.
Main Methods:
- Retrospective analysis of 38 patients undergoing bailout stent implantation for obstructive dissections post-PTCA.
- Evaluation of procedural success rates, deployment pressures, and residual stenosis.
- Assessment of clinical and angiographic outcomes at six-month follow-up.
Main Results:
- Stent deployment success rate was 95% with an average residual stenosis of -0.81%.
- Emergency CABG rates decreased significantly from 1.8% to 0.5% after stent introduction (p < 0.05).
- Six-month follow-up showed no deaths or Q-MI, but a 43% restenosis rate, particularly in patients pre-treated with prolonged balloon inflations.
Conclusions:
- Coronary stenting is an excellent non-surgical option for treating acute vascular closure complicating coronary angioplasty.
- Bailout stenting significantly reduces the need for emergency CABG.
- Further research is needed to optimize stenting strategies, especially regarding pre-stenting interventions.
Unlabelled:
This study describes initial results of stent implantation in bailout situations in 38 patients with obstructive dissection after percutaneous transluminal coronary angioplasty (PTCA). Before stent introduction 1.8% of all patients after PTCA required emergency bypass grafting (CABG) because of postprocedural complications. In 1997 the rate of such emergency operations decreased to only 0.5% (p < 0.05). The success rate of stent deployment in patients included in the study was 95%. Mean final inflation pressure used for stent deployment was 12.0 +/- 2.3 atm. After stent implantation average residual stenosis was -0.81 +/- 5.75%. Of the 38 patients, 15 (40%) were treated before stent implantation with prolonged inflations with perfusion catheter. Bailout stenting was performed in 10 (25%) patients undergoing PTCA for restenotic lesions. The stents were placed in the left anterior descending coronary artery in 26 patients (69%), left circumflex coronary artery in 3 patients (8%), and in the right coronary artery in 9 patients (23%). Before bailout stenting 28 patients (75%) presented with type C and D dissection. One patient (2.5%) developed acute stent thrombosis. No episodes of subacute stent thrombosis were noted. During six-months clinical follow up no death and no Q-MI were observed. Angiographic follow up restenosis rate was 13/30 (43%), predominantly in patients treated with prolonged perfusion balloon inflations before stent implantation. The incidence of repeated PTCA and elective CABG due to restenosis was 12/30 (40%) and 1/30 (3%), respectively. There were no vascular complication at the puncture site.
In Conclusion:
the introduction of coronary stenting has provided an excellent non-surgical modality for treatment of imminent or acute vascular closure complicating coronary angioplasty.