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Clinical Evaluation of Current Stent Deployment Strategies
Insights
Coronary stenting with ticlopidine/aspirin reduces complications and costs. Radial artery access combined with ticlopidine/aspirin offers the most cost-effective strategy, eliminating access-site issues.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary stenting reduces abrupt closure and restenosis.
- Intensive anticoagulation increases vascular complications and costs.
- Reduced anticoagulation and alternative access sites are being evaluated.
Purpose of the Study:
- To analyze access-site and anticoagulation strategies in coronary stenting.
- To compare outcomes and cost-effectiveness of different approaches.
Main Methods:
- 377 patients undergoing coronary stenting were analyzed.
- Four groups compared: femoral/warfarin, radial/warfarin, femoral/ticlopidine+aspirin, radial/ticlopidine+aspirin.
- Outcomes included success rates, complications, length of stay, and hospital charges.
Main Results:
- Primary success was similar across all groups.
- Subacute closure occurred only with warfarin.
- Access-site complications occurred only with femoral access.
- Ticlopidine groups had significantly shorter hospital stays and lower charges.
- The radial/ticlopidine group was most cost-effective.
Conclusions:
- Ticlopidine/aspirin therapy reduces hospital stay and charges without subacute closure.
- Radial access eliminates access-site complications.
- The radial/ticlopidine strategy is the most cost-effective, reducing complications and costs.
Abstract:
BACKGROUND: Coronary stenting has been demonstrated to reduce the incidence of abrupt closure and restenosis. However, intensive anticoagulation regimens have increased the number of vascular complications and hospital length of stay. Consequently, the potential long-term cost effectiveness of stenting has been jeopardized by a significant increase in procedural and hospital costs. These drawbacks have resulted in evaluation of reduced anticoagulation programs and alternative access sites. METHODS: Access-site and anticoagulation strategies were analyzed in 377 patients who had undergone coronary stenting. Four groups were compared: 114 patients stented from the femoral artery and treated with warfarin, 87 patients stented from the radial artery and treated with warfarin, 88 patients stented from the femoral artery and treated with ticlopidine and aspirin anticoagulation, and 88 patients stented from the radial artery and treated with ticlopidine and aspirin. RESULTS: Primary success was similar in all groups. Subacute closure occurred only in the groups managed with warfarin. Access-site complications occurred only in the groups with femoral access. Total hospital and post-procedure length of stay and total hospital charge were significantly less in the ticlopidine groups. The radial/ticlopidine group was the most cost-effective. CONCLUSIONS: Ticlopidine/aspirin therapy following coronary stenting from either the femoral or radial approach reduced hospital length of stay and hospital charge without subacute closure. Access-site complications were not reduced by femoral/ticlopidine strategy but were eliminated by the radial approach with either anticoagulation regimen. The radial/ticlopidine strategy eliminated access-site complications and significantly reduced hospital length of stay and hospital charge as compared to femoral/ticlopidine and was the most cost-effective strategy.