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Long-term follow-up study of coronary reconstruction with multiple stents
1Interventional Cardiology, University of Alabama at Birmingham, Alabama, USA.
Insights
Multiple intracoronary stents effectively treat very long coronary lesions and dissections, showing high success rates and acceptable long-term outcomes for patients undergoing complex coronary interventions.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Vascular Surgery
Background:
- Conventional balloon angioplasty has limitations for very long coronary lesions or dissections.
- High complication rates and low success are associated with traditional angioplasty for these complex cases.
Purpose of the Study:
- To evaluate the efficacy and safety of using multiple intracoronary stents.
- To assess outcomes for patients with very long de novo coronary lesions or post-angioplasty dissections.
Main Methods:
- Retrospective analysis of 47 consecutive patients from June 1993 to December 1995.
- Patients received 4 or more intracoronary stents covering at least two diseased segments.
- Gianturco Roubin I and Palmaz-Schatz stents were utilized.
Main Results:
- 100% angiographic success rate was achieved.
- In-hospital complications included one death and seven non-Q-wave myocardial infarctions.
- At long-term follow-up (430 days), 76% of patients were asymptomatic, with 28% undergoing repeat angioplasty.
Conclusions:
- Multiple intracoronary stenting is a viable option for treating very long coronary lesions and dissections.
- The procedure demonstrates acceptable immediate and long-term clinical outcomes.
Background:
Conventional balloon angioplasty of very long de novo coronary lesions or very long coronary dissection caused by angioplasty is associated with low success and high complication rates. Multiple intracoronary stents have been used to treat both conditions, although long-term efficacy has not been defined.
Methods And Results:
Between June 1993 and December 1995, 47 consecutive patients underwent native coronary angioplasty and stenting with 4 or more stents covering at least 2 consecutive diseased coronary segments. Preangioplasty and poststenting diameter stenoses were 81% +/- 13% and 21% +/- 12%, respectively. Reference vessel diameters were 3.53 +/- 0.55 mm proximal to the stents and 2. 95 +/- 0.62 mm distal to the stents. Average lesion length was 63 +/- 20 mm. The number of stents used was 4.5 +/- 1 per vessel (from 4 to 7). Gianturco Roubin I stents were used in all patients. Coronary Palmaz-Schatz stents were used as supplementary stents in 3 patients. Angiographic success was 100%. In-hospital outcomes include 1 death, 1 coronary bypass surgery, no Q-wave myocardial infarction, and 7 non-Q-wave myocardial infarctions. Long-term follow-up at 430 +/- 199 days was completed in all patients. Thirty-five (76%) patients were asymptomatic, 8 (17%) had class 1 or 2 angina, 1 had a myocardial infarction, 13 (28%) underwent repeat angioplasty, 2 patients had subsequent elective bypass surgery, and 3 died during follow-up.
Conclusions:
Multiple intracoronary stents for very long lesions or dissection can be performed with acceptable immediate and long-term outcomes.