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Successful coronary stenting without warfarin or intravascular ultrasound
M F Warner1, C Nathaniel, J C Missri
1Cardiac Catheterization Laboratory, St. Francis Hospital and Medical Center, Hartford, CT 06105, USA.
Insights
Subacute stent thrombosis was not observed in patients treated with high-pressure balloon angioplasty post-stent deployment, even without warfarin or intravascular ultrasound guidance. This suggests optimal stent results are achievable without these interventions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Devices
Background:
- Warfarin is standard post-coronary stent implantation, but ticlopidine may reduce subacute thrombosis.
- High-pressure balloon angioplasty is common after stent deployment.
- The role of intravascular ultrasound (IVUS) in assessing stent expansion and deployment adequacy remains debated.
Purpose of the Study:
- To evaluate the efficacy of empiric high-pressure balloon angioplasty in achieving optimal stent deployment without warfarin or IVUS.
- To determine if subacute stent thrombosis can be avoided using this strategy.
Main Methods:
- Retrospective study of 100 consecutive patients undergoing coronary stent implantation.
- Patients received no warfarin or IVUS guidance.
- All patients were followed for at least six weeks post-procedure.
Main Results:
- No instances of subacute stent thrombosis were reported in any of the 100 patients.
- The study demonstrated excellent outcomes in stented patients.
Conclusions:
- Optimal coronary stent deployment and excellent clinical results can be achieved without the routine use of intravascular ultrasound.
- Empiric high-pressure balloon postdilatation appears to be a safe and effective strategy for stenting, obviating the need for warfarin and IVUS in select patients.
Abstract:
Although warfarin is typically recommended in the management of patients following coronary stent implantation, several studies have suggested a reduced incidence of subacute thrombosis if the antiplatelet drug ticlopidine is employed instead. Postdilatation with a high pressure balloon catheter is now commonly performed following stent deployment. However, there is uncertainty whether intravascular ultrasound is important in assessing adequacy of stent expansion. Some investigators have proposed a set of ultrasound criteria that need to be met in order to achieve optimal stent deployment. Others have reported low rates of subacute stent thrombosis using empiric high pressure postdilatation rather than an ultrasound-guided strategy. We retrospectively studied 100 consecutive patients in a single institution who received coronary stents for a variety of indications. No patient received warfarin or intravascular ultrasound, and all were followed for a minimum of six weeks. Subacute stent thrombosis did not occur in any patient. We conclude that an excellent result can be routinely obtained in stented patients without the use of intravascular ultrasound.