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Early outcome after placement of a metallic intracoronary stent: initial Mayo Clinic experience
K N Garratt1, D R Holmes, G S Roubin
1Division of Cardiovascular Diseases and Internal Medicine, University of Alabama, Birmingham, Alabama.
Insights
Coronary stents effectively treat abrupt coronary closure after angioplasty, reducing the need for bypass surgery. This metallic coil stent shows promise for high-risk and restenotic lesions, though long-term outcomes are still unknown.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) carries a risk of in-hospital coronary closure (3-7%) and subsequent myocardial infarction.
- Disrupted coronary integrity, especially large dissections, increases the risk of acute coronary closure.
- Coronary vascular stents offer a potential solution to alleviate acute or threatened coronary closure and reduce patient morbidity.
Purpose of the Study:
- To evaluate the efficacy and safety of the Gianturco-Roubin coronary stent in treating acute or threatened coronary closure post-angioplasty.
- To assess the feasibility of elective stent placement for high-risk or restenotic coronary lesions.
- To determine the complication rates associated with coronary stent placement.
Main Methods:
- A prospective study involving 15 patients at Mayo Clinic between October 1989 and June 1990.
- Attempted placement of 16 balloon-expandable, flexible metallic coil (Gianturco-Roubin) coronary stents.
- Stent placement was performed for actual/threatened abrupt closure (10 patients), high-risk lesions (1 patient), and restenotic lesions (5 patients).
Main Results:
- Successful stent placement in 15 out of 16 attempts (94% success rate).
- No early deaths or need for coronary artery bypass grafting.
- Complications were uncommon and comparable to those after balloon angioplasty.
- Stents were successfully deployed in native arteries and vein grafts for various lesion types.
Conclusions:
- The Gianturco-Roubin metallic coil stent is effective in managing vascular disruption causing or threatening coronary closure after angioplasty.
- Elective coronary stent placement is safe for patients with high-risk or recurrent restenotic lesions.
- Long-term outcomes for patients receiving coronary stents remain to be determined.
Abstract:
After percutaneous transluminal coronary angioplasty, 3 to 7% of patients have in-hospital coronary closure, and the risk of subsequent myocardial infarction is high, even with an urgent bypass operation. Disrupted coronary morphologic integrity, particularly with large dissections, may be associated with an increased risk of acute coronary closure. A percutaneously placed coronary vascular stent may rapidly alleviate acute or threatened coronary closure and could reduce morbidity. Between October 1989 and June 1990, placement of a balloon-expandable, flexible metallic coil (Gianturco-Roubin) coronary stent was attempted 16 times in 15 Mayo Clinic patients--for treatment of actual or threatened abrupt coronary closure in 10 patients, for primary treatment of a lesion judged to be at high risk for dissection with conventional balloon angioplasty in 1, and for elective treatment of restenotic lesions in 5. Placement of the stent was successful in 15 attempts (94%). Associated complications, which were uncommon, were similar to those noted after balloon angioplasty. No early deaths occurred, and no patient required coronary artery bypass grafting. Stents were successfully placed in both urgent and elective circumstances in native coronary arteries and saphenous vein grafts, and they were used in primary atheromatous and restenotic lesions. Our initial experience with this metallic coil stent indicates that it is efficacious for vascular disruption that is threatening or causing coronary closure after angioplasty. Furthermore, elective placement of a stent may be safely undertaken in patients with high-risk coronary lesions or recurrent restenotic lesions. The long-term outcome in all groups of patients who receive coronary stents is unknown.