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Transradial Palmaz-Schatz coronary stenting on an outpatient basis: results of a prospective pilot study
F Kiemeneij1, G J Laarman, T Slagboom
1Amsterdam Department of Interventional Cardiology (ADIC)-OLVG, the Netherlands.
Insights
Outpatient coronary stenting using the Palmaz Schatz stent is feasible. This pilot study found no complications in the first 24 hours, supporting same-day discharge for select patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Palmaz Schatz coronary stent implantation is associated with bleeding risks and extended hospital stays.
- Outpatient coronary stenting offers a potential strategy to reduce healthcare costs.
- Previous observations showed infrequent complications in ambulatory patients undergoing radial artery stenting.
Purpose of the Study:
- To assess the feasibility of outpatient coronary stenting.
- To evaluate same-day discharge criteria for patients undergoing Palmaz Schatz stent implantation.
- To determine the safety and efficacy of same-day discharge after radial artery stenting.
Main Methods:
- Patients received Palmaz Schatz stents via radial artery approach with adequate anticoagulation (INR > 2.5).
- Same-day discharge was considered for patients meeting specific clinical and procedural criteria, with 4-6 hours observation.
- Heparin was administered only during the procedure; arterial sheaths were removed immediately post-procedure.
Main Results:
- Twenty patients (17 CCS-class III/IV) underwent stenting and were discharged same-day.
- No cardiac or bleeding events occurred within 24 hours post-discharge.
- One patient was readmitted at 4 days for a bleeding abdominal aortic aneurysm; no other complications were noted at 1-month follow-up.
Conclusions:
- Outpatient coronary stenting is a feasible option for selected patients.
- No complications were observed in the first 24 hours for patients meeting discharge criteria.
- A larger feasibility study is warranted to further investigate outpatient coronary stenting.
Background:
The applicability of Palmaz Schatz coronary stent implantation is limited by bleeding complications and prolonged hospitalization. Coronary stenting on an outpatient basis, may be the ultimate means to reduce costs of this treatment. Since bleeding and stent occlusion were infrequent complications in a group of 100 ambulatory patients who underwent stent implantation via the radial artery in our department, we performed a pilot study to determine the feasibility of using coronary stenting on an outpatient basis.
Methods:
Patients selected for Palmaz Schatz stent implantation, were adequately adjusted on coumadin. At an INR > 2.5, stenting was performed via the radial approach. Based on pre-, post- and procedural criteria, considering clinical status, procedural course and outcome, absence of predictors for stent occlusion and of events during 4 to 6 hours observation, patients were considered candidates for same-day discharge. Heparin was administered only during the procedure. Immediately after the procedure, the arterial sheath was removed. Patients were mobilized and were discharged with a pressure dressing over the puncture site. Follow-up was performed on the next day, at 2 weeks and at one month.
Results:
Between May and September 1994, 47 patients underwent Palmaz Schatz stent implantation via the radial artery. Of these, 27 remained hospitalized for reasons, considered to be incompatible with outpatient treatment. Twenty patients (CCS-class III and IV; n = 17 (85%)) received 29 stents for 23 lesions, distributed in 21 vessels and were discharged the day of treatment. No cardiac or bleeding events were encountered within 24 hours. At 2 weeks follow-up, one patient was readmitted (day 4) because of a bleeding abdominal aortic aneurysm, requiring surgery. At 1 month follow-up, no bleeding, entry-site and cardiac complications were noted.
Conclusion:
Since no complications were encountered (95% confidence interval; 0-17%) in the first 24 hours after optimal coronary stent implantation in patients with an adequate preprocedural level of anticoagulation, a larger feasibility study of outpatient coronary stenting will be undertaken.