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Utilization of the coronary balloon-expandable coil stent without anticoagulation or intravascular ultrasound
C M Goods1, K F Al-Shaibi, S S Yadav
1Division of Cardiovascular Diseases, University of Alabama at Birmingham, 35294, USA.
Insights
Discontinuing anticoagulation after coronary balloon-expandable coil stenting, when optimal angiographic results are achieved, is safe. This approach reduces comorbidity without increasing stent thrombosis risk.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Balloon-expandable coil stents are effective for coronary artery stenting, reducing restenosis.
- Coronary stenting complications include stent thrombosis and anticoagulation-related comorbidities.
- The study aimed to evaluate omitting anticoagulation post-stenting to minimize risks.
Purpose of the Study:
- To determine the safety and efficacy of a post-stenting protocol without anticoagulation.
- To assess the incidence of stent thrombosis and other complications when anticoagulation is omitted.
- To evaluate the feasibility of managing patients with aspirin and ticlopidine alone.
Main Methods:
- A cohort of 369 patients receiving balloon-expandable coil stents was analyzed.
- 216 patients were enrolled in a protocol using aspirin and ticlopidine for 1 month, excluding anticoagulation.
- Eligibility required optimal procedural and angiographic results, including TIMI grade 3 flow.
Main Results:
- Stent thrombosis occurred in 0.9% of patients (2/216) within 30 days.
- Major adverse events included 1 death (0.5%) and 2 coronary bypass surgeries (0.9%).
- Access-site complications and bleeding requiring transfusion each occurred in 1.9% of patients.
Conclusions:
- Patients with optimal angiographic results after coil stenting can be safely managed without anticoagulation.
- A regimen of aspirin and ticlopidine is sufficient for these patients.
- This strategy reduces comorbidity associated with anticoagulation without compromising safety.
Background:
The balloon-expandable coil stent has been proved effective in the management of acute and threatened closure after coronary balloon angioplasty and has been shown to reduce restenosis in patients with suboptimal results after coronary balloon angioplasty. Coronary artery stenting has been limited by the occurrence of stent thrombosis and comorbidity related to anticoagulation. This study was undertaken to determine whether anticoagulation may be removed from poststenting protocols, thus reducing comorbidity without increasing stent thrombosis.
Methods And Results:
Between September 1994 and May 1995, 369 patients received balloon-expandable coil stents in native coronary arteries at our institution. Of these patients, 216 were selected for a protocol of aspirin and ticlopidine (for 1 month) without anticoagulation. Eligibility for this protocol followed satisfaction of certain procedural and angiographic criteria. These criteria included adequate coverage of intimal dissections, absence of residual filling defects, and normal (TIMI grade 3) flow in the stented vessel after high-pressure balloon inflations. Intravascular ultrasound was not used to guide stent deployment. The stenting procedure was planned in 37% of patients and unplanned in 63% of patients, including 25 (12%) for acute or threatened closure. During the 30-day follow-up period, stent thrombosis occurred in 2 patients (0.9%), there was 1 death (0.5%), and 2 patients (0.9%) underwent coronary bypass surgery. Vascular access-site complications occurred in 4 patients (1.9%), and bleeding that required blood transfusion occurred in 4 patients (1.9%).
Conclusions:
Patients who receive the coronary balloon-expandable coil stent with optimal angiographic results without intravascular ultrasound guidance can be managed safely with a combination of aspirin and ticlopidine without anticoagulation.