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Intracoronary Stent Placement without Coumadin or Intravascular Ultrasound
1Division of Cardiology, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, USA.
Insights
Coronary stenting with high-pressure balloon angioplasty, aspirin, and ticlopidine, without intravascular ultrasound, resulted in a short hospital stay and no subacute stent thrombosis in 322 patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary stenting traditionally requires intravascular ultrasound (IVUS) and prolonged anticoagulation, leading to increased hospital stays.
- High-pressure balloon angioplasty is often used with stenting, but its impact on outcomes without IVUS is less understood.
Purpose of the Study:
- To evaluate the safety and efficacy of coronary stenting using high-pressure balloon angioplasty without IVUS.
- To assess the outcomes of a simplified post-stent anticoagulation regimen with aspirin and ticlopidine.
Main Methods:
- A consecutive series of 322 patients underwent intracoronary stenting with adjunctive high-pressure balloon angioplasty (mean peak 15.9 ATM).
- Intravascular ultrasound was not used. Post-stent anticoagulation included overnight heparin, followed by aspirin and ticlopidine for 4-6 weeks.
- A total of 575 stents were implanted in 338 coronary vessels; 7% of patients had multi-vessel stenting.
Main Results:
- The average length of stay post-stenting was 1.6 days, with 71% of patients discharged the next day.
- During 30-day follow-up, only one patient (0.3%) experienced acute stent thrombosis, and no subacute thrombosis occurred.
- The study included patients with a high prevalence of unstable coronary syndrome (66%).
Conclusions:
- Coronary stent implantation with routine high-pressure balloon post-dilatation, without intravascular ultrasound, and a combination of aspirin and ticlopidine is safe and effective.
- This approach is associated with a significantly short length of hospital stay and a low rate of thrombotic complications.
- The findings suggest a potential simplification of the coronary stenting procedure, reducing resource utilization and patient inconvenience.
Abstract:
Coronary stenting has been associated with the need for intravascular ultrasound, increased anticoagulation, and increased length of stay. We evaluated the use of ticlopidine and aspirin without ultrasound in 322 consecutive patients from February 1995 through January 1996 who underwent intracoronary stenting with adjunctive high pressure balloon angioplasty [mean peak atmospheres (ATM) = 15.9; mean post-dilating balloon size = 3.4 mm]. Unstable coronary syndrome was the admitting diagnosis in 66% of these patients. Post-stent anticoagulation consisted of overnight heparin, followed by aspirin (325 mg daily) and ticlopidine (250 mg twice daily) for 4 to 6 weeks. Among the 322 patients, 575 stents (Palmaz-Schatz Coronary Stents = 530; Palmaz-Schatz Biliary Stents = 33; Gianturco-Roubin Stents = 12) were implanted in 338 coronary vessels (native arteries = 316; saphenous vein grafts = 22). Twenty-three patients (7%) had multi-vessel stenting. Average length of stay following stenting was 1.6 days (average overall hospital length of stay was 2.3 days), and 71% of patients were discharged the next day. Follow-up of all 322 patients was performed by telephone contact at least 30 days after discharge. During this period 1 (0.3%) acute thrombosis and no subacute thrombosis occurred. In this series of patients, coronary stent implantation using routine high pressure balloon post-dilatation Ñ without intravascular ultrasound Ñ and a combination of aspirin and ticlopidine was performed with no subacute thrombosis and a short length of stay.