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Catheter-based Endovascular Angioplasty for Fibrosing Mediastinitis-associated Pulmonary Vein Stenosis
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Catheter-based Endovascular Angioplasty for Fibrosing Mediastinitis-associated Pulmonary Vein Stenosis

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Direct stenting with 3000 i.u. heparin

Christophe Caussin1, Abdelhamid Fsihi, Alice Ohanessian

  • 1Hôpital Marie Lannelongue, Le Plessis Robinson, France. caussin@ccml.fr

International Journal of Cardiovascular Interventions
|November 25, 2003
PubMed

Insights

This study found that direct stenting with 3000 IU heparin and immediate sheath removal is a safe percutaneous transluminal coronary angioplasty (PTCA) strategy, significantly reducing vascular complications in selected patients.

Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Vascular Medicine

Background:

  • Vascular complications are a concern during percutaneous transluminal coronary angioplasty (PTCA).
  • Predictive factors for these complications include heparin dosage, sheath dwell time, and use of anti-glycoprotein (GP) IIb/IIIa inhibitors.
  • A simplified PTCA approach may allow reduced heparinization and no anti-GP IIb/IIIa use in select cases.

Purpose of the Study:

  • To assess the safety and feasibility of a novel PTCA strategy.
  • This strategy involves direct stenting with a low heparin dose (3000 IU) and immediate sheath removal.
  • To evaluate the rate of vascular complications associated with this simplified PTCA technique.

Main Methods:

  • A prospective study screened 716 consecutive PTCA patients from April 1999 to April 2000.
  • 171 patients meeting specific inclusion criteria (excluding acute myocardial infarction and TIMI grade zero flow) were enrolled.
  • Patients received 3000 IU heparin before direct stenting, followed by immediate sheath removal via manual compression.

Main Results:

  • The study successfully completed the protocol in 150 patients (88%), with an average activated clotting time of 179 +/- 32 seconds.
  • No subacute thrombosis or creatine kinase elevation was observed before discharge.
  • Only minor vascular complications were reported: two uncomplicated groin hematomas and two false aneurysms (one requiring surgical repair).

Conclusions:

  • Direct stenting combined with 3000 IU heparin and immediate sheath removal is a safe PTCA strategy.
  • This simplified approach is feasible and associated with a low rate of major vascular complications.
  • This technique offers a potentially safer alternative for selected patients undergoing PTCA.

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