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Bailout Palmaz-Schatz coronary stenting in 39 patients with occlusive dissection complicating conventional
D Antoniucci1, G M Santoro, L Bolognese
1Division of Cardiology, Careggi Hospital, Florence, Italy.
Insights
Bailout Palmaz-Schatz stenting is a feasible and safe treatment for coronary dissection following angioplasty. Achieving optimal results with this technique significantly reduces adverse cardiac events.
Area of Science:
- Interventional Cardiology
- Vascular Surgery
Background:
- Coronary dissection can occur during angioplasty, potentially leading to threatened closure.
- Bailout stenting is a strategy to manage such complications.
Purpose of the Study:
- To assess the feasibility, safety, and efficacy of Palmaz-Schatz stenting as a bailout strategy for coronary dissection.
- To identify factors influencing outcomes in patients undergoing bailout stenting.
Main Methods:
- Retrospective analysis of 39 patients with coronary dissection treated with Palmaz-Schatz stents.
- Defined criteria for optimal, suboptimal, and deployment failure.
- Monitored in-hospital outcomes including death, urgent surgery, stent thrombosis, and myocardial infarction.
Main Results:
- Successful stenting was achieved in 85% (33/39) of patients without major in-hospital complications.
- Suboptimal stenting results were linked to a higher risk of recurrent ischemia and adverse events (P < 0.05).
- Multiple stent implantation did not increase the risk of major adverse cardiac events.
Conclusions:
- Bailout Palmaz-Schatz stenting is a viable treatment for coronary dissection when optimal angiographic results are obtained.
- Careful assessment and achievement of optimal results are crucial for successful bailout stenting.
Abstract:
The purpose of this study was to evaluate feasibility, safety, and efficacy of bailout Palmaz-Schatz stenting in a series of 39 patients with coronary dissection associated with acute or unequivocal threatened closure complicating conventional angioplasty. No anatomical characteristics other than reference vessel diameter < 3 mm were considered as contraindications for bailout coronary stenting. Stringent criteria were adopted in defining optimal results (< 10% residual stenosis, no angiographic evidence of residual dissection), suboptimal results (> 10% residual stenosis or angiographic evidence of residual dissection), deployment failure (failure to deploy the stent because of poor trackability or persistent occlusion despite stent deployment). A total of 49 stents and 7 half-stents were implanted in 36 patients (range 1-5; mean 1.45 +/- 0.84). Successful stenting without in-hospital death, urgent or semielective coronary surgery, stent thrombosis, or Q-wave myocardial infarction was achieved in 33/39 patients (85%). A suboptimal result was associated with an increased risk of in-hospital recurrence of ischemia and other related major adverse events (2/5 patients with suboptimal results vs. 1/31 patients with complete deployment success; P < 0.05). Multiple stents implantation did not carry a significant risk of major cardiac adverse events. The results of this study suggest that bailout Palmaz-Schatz stenting may be considered a stand-alone treatment of coronary dissection if an optimal acute angiographic result is achieved.