The avantgarde carbostent in patients scheduled for undelayable noncardiac surgery

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Managing patients requiring coronary revascularization before urgent non-cardiac surgery presents significant clinical challenges.
• Percutaneous coronary intervention (PCI) is a key revascularization strategy, but its timing relative to surgery requires careful consideration.

Purpose of the Study:

• To evaluate the safety and efficacy of the Avantgarde(TM) Carbostent for PCI in patients undergoing subsequent undelayable non-cardiac surgery.
• To assess major adverse cardiac events (MACE) and major bleeding in this high-risk patient cohort.

Main Methods:

• A pilot study analyzed 42 consecutive patients who received PCI with the Avantgarde(TM) stent before non-cardiac surgery.
• Residual platelet reactivity was monitored using a point-of-care Multiplate analyzer.
• Outcomes included major adverse cardiac events (death, myocardial infarction, stent thrombosis) and major bleeding.

Main Results:

• One patient (2.4%) experienced a fatal myocardial infarction 12 days post-stenting and 3 days post-surgery.
• No major bleeding complications were observed in the postoperative period.
• The study involved complex PCI procedures, including long stent lengths and multivessel stenting in a significant proportion of patients.

Conclusions:

• The Avantgarde(TM) stent appears to be a viable option for patients requiring PCI before urgent non-cardiac surgery.
• A minimum of 10-14 days of dual antiplatelet therapy remains a mandatory requirement post-PCI.
• Further research is warranted to confirm these findings in larger patient populations.