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Effects of stenting of recent or chronic coronary occlusions on late vessel patency and left ventricular function
E Van Belle1, P Blouard, E P McFadden
1Department of Cardiology, University of Lille, France.
Insights
Stent implantation after balloon angioplasty for coronary occlusions prevents reocclusion and improves heart function. This procedure significantly enhances left ventricular ejection fraction and reduces cardiac volumes, potentially improving patient survival.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- Balloon angioplasty for coronary occlusions often leads to late vessel reocclusion, limiting sustained improvement in left ventricular function.
- Recent research indicates that stent implantation can substantially decrease late vessel occlusion rates.
Purpose of the Study:
- To evaluate the impact of stent implantation on the patency of coronary arteries with recent or chronic occlusions.
- To assess the effect of stent implantation on left ventricular function in patients with coronary occlusions.
Main Methods:
- A study involving 24 patients who underwent successful stent implantation for coronary occlusions.
- A 6-month angiographic follow-up program including quantitative angiography and contrast left ventricular cineangiography.
- Analysis of preprocedural, postprocedural, and follow-up data for 22 patients.
Main Results:
- No instances of late vessel reocclusion were observed at the 6-month follow-up.
- A restenosis rate of 32% was noted, defined as >50% diameter stenosis.
- Significant improvements were observed in global left ventricular function, including decreased left ventricular end-diastolic volume index and end-systolic volume index, and increased left ventricular ejection fraction.
- Regional wall motion in the affected arterial territory improved, alongside a reduction in left ventricular filling pressure.
Conclusions:
- Stent implantation following balloon angioplasty for coronary occlusions is associated with a low rate of late reocclusion.
- The procedure leads to favorable changes in left ventricular volumes, including reduced cardiac volume and increased ejection fraction.
- These positive effects on left ventricular function may have significant implications for patient survival.
Abstract:
Due to high rates of late vessel reocclusion, balloon angioplasty of recent or chronic coronary occlusions is not associated with a sustained improvement in left ventricular function. Recent studies have suggested that stent implantation at coronary occlusions significantly reduces late vessel occlusion. We thus designed a study to analyze the effect of stent implantation at coronary occlusions on late vessel potency and left ventricular function. Twenty-four consecutive patients with recent or chronic coronary occlusions had successful stent implantation and were enrolled in a 6-month angiographic follow-up program. Contrast left ventricular cineangiography, at baseline and 6-month follow-up, as well as preprocedural, postprocedural, and follow-up angiograms analyzed with quantitative angiography were available in 22 of the patients (92%). At follow-up, no vessel reocclusion was observed and 32% of the patients, as analyzed by the >50% diameter stenosis criterion, had restenosis. There was a significant improvement in global left ventricular function with a decrease in both left ventricular end-diastolic volume index (LVEDVI, p <0.01) and left ventricular end-systolic volume index (LVESVI, p <0.0001) and an increase in left ventricular ejection fraction (LVEF, p <0.0001). Similarly, regional wall motion in the territory of the recanalized artery was also significantly improved (p <0.05). These effects were associated with a reduction in left ventricular filling pressure (p <0.0001). Stent implantation following balloon angioplasty of recent or chronic coronary occlusion is associated with a low rate of late vessel reocclusion, a reduction in cardiac volume, and an increase in ejection fraction. Such effects on left ventricular volumes could have a significant impact on patient survival.