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Autoperfusion balloon versus stent for acute or threatened closure during percutaneous transluminal coronary
E D de Muinck1, P den Heijer, R B van Dijk
1Department of Cardiology, Groningen University Hospital, The Netherlands.
Insights
Palmaz-Schatz stents showed higher procedural success and lower emergency bypass rates compared to autoperfusion balloons for coronary angioplasty complications. However, stents had higher subacute reclosure rates, with no significant long-term differences in restenosis or survival.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Surgery
Background:
- Acute or threatened closure during coronary angioplasty presents a significant challenge.
- Autoperfusion balloons and Palmaz-Schatz stents are used to manage these complications.
- Comparative data on their efficacy and safety are crucial for clinical decision-making.
Purpose of the Study:
- To compare the efficacy and clinical outcomes of autoperfusion balloons versus Palmaz-Schatz stents in patients with acute or threatened coronary closure.
- To evaluate procedural success, need for emergency surgery, reclosure rates, and long-term restenosis.
Main Methods:
- A comparative study involving 61 patients treated with autoperfusion balloons and 36 patients treated with Palmaz-Schatz stents.
- Assessment of procedural success, emergency bypass surgery, in-hospital reclosure, and 3-month angiographic follow-up for restenosis.
- Comparison of event-free survival between the two groups.
Main Results:
- Procedural success was higher with stents (94%) compared to autoperfusion balloons (70%) (p < 0.02).
- Emergency bypass surgery was significantly lower in the stent group (0%) versus the autoperfusion balloon group (21%) (p < 0.001).
- Stent group had higher subacute reclosure rates (22%) during hospitalization, while the autoperfusion balloon group required more emergency surgery.
Conclusions:
- Both autoperfusion balloons and Palmaz-Schatz stents are effective in treating acute or threatened coronary closure, with comparable 3-month event-free survival.
- Stents offer higher procedural success and reduced need for emergency surgery, but carry a risk of subacute reclosure.
- The choice between interventions should consider the trade-offs between procedural success and reclosure rates.
Abstract:
Efficacy and major clinical end points were compared in 61 patients treated with a Stack autoperfusion balloon versus 36 patients who received a Palmaz-Schatz stent for acute or threatened closure during coronary angioplasty. The groups were comparable regarding baseline clinical characteristics. Procedural success was achieved in 43 patients (70%) treated with an autoperfusion balloon versus 34 patients (94%) who received a stent (p < 0.02). Emergency bypass surgery was performed in 13 patients (21%) with the autoperfusion balloon versus none of the patients with a stent (p < 0.001). In the stent group, 3 patients (8%) died (p < 0.05); 2 deaths were caused by thrombotic reclosure, and 1 patient died after unsuccessful stent delivery. Subacute reclosure during hospitalization occurred in none of the patients with autoperfusion versus 8 patients with the stent (22%) (p < 0.0002). Therefore, the number of patients with successful stent implantation at discharge decreased to 26 (72%). At 3-month follow-up in all patients with a successful intervention, reclosure or angiographic restenosis (> 50%) occurred in 13 patients with autoperfusion (30%) versus 3 patients with stents (12%) (p = NS). There was no difference in event-free survival during follow-up. Thus, both interventions were equally successful in the treatment of acute and threatened closure. More emergency surgery was performed in the autoperfusion balloon group, whereas a higher subacute reclosure rate was seen in the stent group. At 3-month follow-up, there were no significant differences regarding reclosure, restenosis, and event-free survival.