Related Experiment Videos
Intracoronary stenting for thrombus-containing lesions in the setting of acute ischemic syndromes
A Ramondo1, E Bertaglia, G Isabella
1Servizio di Emodinamica e Cardiologia, Interventistica e U.C.I.C., Cattedra di Cardiologia, Università degli Study, Padova.
Insights
Palmaz-Schatz stents are safe and effective for treating thrombus-containing lesions, even in acute myocardial infarction (AMI). This study found successful deployment and good long-term outcomes in patients with acute ischemic syndromes.
Area of Science:
- Interventional Cardiology
- Cardiovascular Research
- Medical Device Technology
Background:
- Intracoronary thrombus historically contraindicated stent deployment.
- Recent evidence suggests safety and efficacy of stenting for thrombus-laden lesions.
- Acute myocardial infarction (AMI) management has evolved with interventional techniques.
Purpose of the Study:
- To evaluate the safety and effectiveness of Palmaz-Schatz stent implantation in thrombus-containing coronary lesions.
- To assess outcomes in patients with acute ischemic syndromes, including AMI.
- To determine the utility of stenting for suboptimal results and complications during percutaneous transluminal coronary angioplasty (PTCA).
Main Methods:
- Palmaz-Schatz stents were implanted in 41 patients with thrombus-containing lesions.
- Indications included suboptimal PTCA results (n=27), dissection (n=13), and abrupt closure (n=1).
- Clinical presentations included unstable angina (n=24) and AMI (n=17).
Main Results:
- Successful angiographic deployment was achieved in 98% of lesions.
- In-hospital complications occurred in 9.8% of patients (3 non-fatal non-Q wave AMI, 1 death).
- Six-month follow-up showed low rates of re-infarction (2.6%) and repeat angioplasty (5.1%).
Conclusions:
- Adequately dilated Palmaz-Schatz stents are safe and effective for thrombus-containing lesions.
- Stenting is a viable option for acute ischemic syndromes, including AMI.
- This approach avoids the need for emergency bypass surgery or repeat PTCA in most cases.
Aim:
The presence of intracoronary thrombus was considered a contraindication for stent deployment. Recently, many investigators have demonstrated that the use of stents for thrombus-laden lesions under both elective and bail-out conditions is effective and safe, even in the setting of acute myocardial infarction (AMI).
Methods And Results:
In this study Palmaz-Schatz stents were implanted to treat suboptimal results and complications of percutaneous transluminal coronary angioplasty (PTCA) in 41 thrombus-containing lesions. Clinical presentation was unstable angina in 24 and AMI in 17 patients. Stents were deployed because of suboptimal result (n = 27), coronary dissection with threatening occlusion (n = 13) or abrupt closure (n = 1). An angiographic successful deployment was obtained in all but one lesions (98%). Four patients (9.8%) suffered from in-hospital complications: three developed a non fatal non-Q wave AMI and one died. There was no need for emergency coronary artery bypass graft surgery, repeat PTCA or blood transfusion for vascular complications. At six-months follow-up one patient (2.6%) developed a non-Q wave AMI and two (5.1%) underwent a repeat coronary angioplasty.
Conclusions:
Our experience confirms that adequately dilated Palmaz-Schatz stent might be safe and effective for thrombus-containing lesions in the setting of acute ischemic syndromes.