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Single bailout stenting for threatened coronary closure complicating balloon angioplasty: acute and mid-term outcome
Insights
Emergency bailout stenting after failed angioplasty shows good short-term results with low stent closure rates. However, restenosis remains a concern in diabetic patients and those receiving smaller stents.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Emergency stent implantation for failed balloon angioplasty is limited by stent thrombosis and restenosis.
- Limited data exists on midterm outcomes of bailout stenting for threatened closure.
Purpose of the Study:
- To evaluate acute and midterm outcomes of single bailout stenting after failed balloon angioplasty.
- To assess the safety and efficacy of bailout stenting in native coronary lesions.
Main Methods:
- Single stent placement (Gianturco-Roubin or Palmaz-Schatz) in 40 patients with threatened closure after balloon angioplasty.
- Analysis of procedural success, early complications, and midterm angiographic restenosis.
Main Results:
- Successful stent implantation in 97.5% of patients, significantly reducing stenosis.
- No early stent closure, myocardial infarction, or need for emergency bypass surgery.
- Midterm restenosis (>50% diameter stenosis) observed in 20% of patients, higher in diabetics, small stents, and for vessel recoil indications.
Conclusions:
- Single bailout stenting offers favorable short- and midterm outcomes with minimal early risks.
- Restenosis rates are higher in diabetic patients, those receiving small stents (<3 mm), and for vessel recoil indications.
- Clinical benefits are maintained long-term, with no reported bypass surgery, MI, or death related to the procedure.
Background:
Emergency stent implantation for the treatment of failed balloon angioplasty has been limited by a 3-33% incidence of early stent thrombosis and a paucity of information on restenosis. Accordingly, the objective of this study is to determine both the acute and midterm results following single bailout stenting for threatened closure after failed balloon angioplasty.
Methods:
Single stent placement with either a Gianturco-Roubin or Palmaz-Schatz stent for the treatment of threatened closure complicating conventional single-vessel balloon angioplasty of de novo native coronary lesions was carried out in 16 and 24 patients, respectively.
Results:
Successful stent implantation was achieved in 39 patients (97.5%), reducing the diameter stenosis from 90 +/- 7% before 6 +/- 8% after the procedure. No early stent closure, myocardial infarction, or need for emergency coronary bypass surgery was observed. Furthermore, except for one death due to massive intracranial hemorrhage 1 1/2 weeks after a successful stent implantation, there was no mortality directly related to the procedure. Repeat angiographic study performed at a mean of 5 +/- 3 months after stenting in 30 (86 %) eligible patients revealed in-stent restenosis (> 50% diameter stenosis) in six patients (20%). Five had successful repeat balloon angioplasty. Restenosis rate was significantly higher in patients with diabetes mellitus (83 versus 21% in nondiabetics, P = 0.0047), who had small (< 3 mm diameter) stent (reflecting small vessel diameters) implanted (40 versus 10% for > or = 3 mm stents, P = 0.0528) and those who had received stents to rectify vessel recoil (60 versus 12% for dissection, P = 0.0264). During a follow-up period of 12 +/- 8 months, clinical benefits were maintained in most patients, with none requiring bypass surgery, and no myocardial infarction or death encountered.
Conclusion:
Our study suggests that single bailout stenting for threatened closure in selected patients is associated with a favorable short and mid-term outcome, with minimal risk of early stent closure and a low restenosis rate. Restenosis rate, however, remains high in diabetic patients, stent placement for vessel recoil indication and those receiving < 3 mm diameter stents.