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Experience with the Gianturco-Roubin stent for abrupt vessel closure complicating percutaneous transluminal coronary
Insights
Emergency coronary artery stenting effectively treats abrupt vessel closure after angioplasty, offering an alternative to bypass surgery. This study shows promising results for stenting in complex coronary artery interventions.
Area of Science:
- Interventional Cardiology
- Cardiovascular Surgery
Background:
- Emergency coronary artery bypass grafting (CABG) was the standard for abrupt vessel closure post-percutaneous transluminal coronary angioplasty (PTCA), but carried high risks.
- Intracoronary stenting has emerged as a viable alternative to emergency CABG.
Purpose of the Study:
- To evaluate the initial clinical experience and outcomes of emergency coronary artery stenting.
- To assess stenting as a novel technique for managing PTCA complications.
Main Methods:
- Retrospective review of 13 patients undergoing Gianturco-Roubin (GR) stent deployment for abrupt vessel closure refractory to balloon angioplasty.
- Clinical and angiographic follow-up was performed.
Main Results:
- GR stent was deployed in 13 patients with PTCA complications (unstable angina, stable angina, acute MI).
- Two patients required urgent CABG; 7 had elevated creatine kinase levels.
- Three patients experienced subacute stent thrombosis, managed successfully. At 7 months, 11 patients were angina-free, with no deaths. Restenosis occurred in 5 patients.
Conclusions:
- The Gianturco-Roubin stent is an effective alternative to urgent CABG for abrupt vessel closure complicating PTCA.
- Coronary stenting offers a less invasive option for managing complex PTCA outcomes.
Background:
Emergency coronary artery bypass grafting (CABG) has previously been the only option in the treatment of refractory abrupt vessel closure complicating percutaneous transluminal coronary angioplasty (PTCA), and has been associated with high rates of morbidity and mortality. Intracoronary stenting now provides an alternative to emergency CABG.
Aim:
To assess our initial experience with emergency coronary artery stenting as a new technique.
Methods:
Retrospective case study review with clinical and angiographic follow-up.
Results:
The Gianturco-Roubin (GR) stent was deployed in 13 patients in whom PTCA was complicated by abrupt vessel closure refractory to standard balloon techniques. Indications for PTCA were unstable angina (six), stable angina (six) and acute myocardial infarction (MI) (one). The arteries stented included left anterior descending (LAD) artery lesions (eight) and right coronary artery lesions (five). Two patients required urgent CABG, one due to failed stent deployment and one for inadequate control of vessel dissection. In seven of the stented patients the creatine kinase rose to greater than twice the upper limit or normal. Three patients had subacute thrombotic occlusion at seven to 19 days post stent deployment, managed with intravenous thrombolysis or repeat PTCA. At seven months follow-up, 11 patients were free of angina, two patients had Canadian Heart Association class II angina and there were no deaths. Eleven patients had repeat angiography at mean six months post stent. Five patients had evidence of restenosis managed with repeat PTCA in four and CABG in one.
Conclusions:
The GR stent is an effective alternative to urgent CABG in the treatment of refractory abrupt vessel closure complicating PTCA.