Palmaz-Schatz Coronary Stent Implantation Without Intravascular Ultrasound and Without Subsequent Anticoagulation:...

OBJECTIVES: To determine the safety and efficacy of antiplatelet therapy alone in a selected group of patients following coronary stenting. BACKGROUND: Coronary stent implantation is an effective treatment for abrupt closure, and can also reduce the restenosis rate following percutaneous transluminal coronary angioplasty. However, anticoagulation therapy following stent implantation is associated with a significant incidence of vascular complications and subacute stent thrombosis. METHODS: Between February and November 1994 we implanted 62 Palmaz-Schatz stents in 50 patients with an optimal angiographic result following stent deployment. In these patients, intravascular ultrasound was not used, and a regimen of aspirin 100 mg daily indefinitely and ticlopidine 250 mg twice daily for 3 months was started without anticoagulation. RESULTS: Of these 50 patients (10 females : 40 males, mean age 63 +/- 12 years, LVEF 64 +/- 10%), 39 (78%) were stented for a suboptimal angiographic result post angioplasty, 2 (4%) received stents as a bailout procedure, and 9 (18%) were stented electively. Average hospital stay following stent implantation was 3.7 +/- 3.0 days. After a mean follow-up period of 140 +/- 70 days, there were no instances of stent occlusion, death, stroke, need for coronary bypass surgery, Q-wave myocardial infarction or femoral artery pseudoaneurysm. There was 1 case (2%) of significant puncture site hemorrhage. CONCLUSIONS: Immediate angiographic appearance after stent implantation can be used to define patients at low risk of stent thrombosis who do not require anticoagulation and can safely be discharged early from the hospital.