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. 1991 Nov;66(5):337–345. doi: 10.1136/hrt.66.5.337

Short and long term results after intracoronary stenting in human coronary arteries: monocentre experience with the balloon-expandable Palmaz-Schatz stent.

M Haude 1, R Erbel 1, U Straub 1, U Dietz 1, J Meyer 1
PMCID: PMC1024770  PMID: 1747292

Abstract

OBJECTIVE--Intracoronary stenting was designed to overcome acute complications after percutaneous transluminal coronary angioplasty and to achieve a reduced rate of restenosis, both of which are major limitations of this well accepted method for treating coronary heart disease. This report describes the experience at one centre with the implantation of balloon-expandable Palmaz-Schatz stents and focuses on device related complications and the short and long term angiographic outcome. DESIGN--A retrospective data analysis. PATIENTS--Stenting was attempted in 50 patients. Restenosis after an initially successful angioplasty procedure, inadequate postangioplasty results, saphenous coronary bypass stenoses, and bail-out situations were regarded as indications. MAIN OUTCOME MEASURES AND RESULTS--In 49 of 50 attempted patients 61 stents (1-4 per patient) were implanted. Delivery problems occurred in three patients and were successfully overcome in two patients. Bail-out situations were successfully managed in 16 patients. Complications included acute thrombus formation within the stent immediately after implantation in one patient, which was successfully treated by thrombolysis. One patient was sent for bypass surgery the day after implantation; another died 10 days after implantation for unknown reasons. Subacute stent thrombosis occurred in seven patients 5-9 days after implantation and was successfully treated by thrombolysis or balloon angioplasty in five patients. Bleeding complications occurred in nine patients, five of whom required blood transfusions. Angiography showed long term vessel patency after 4-6 months in 31 (76%) of the 41 patients who were followed up, restenosis in six (14%), and reocclusion in four (10%). Late restenosis or reocclusion was found in five (15%) of 33 patients with a single stent in contrast to five (63%) of eight patients with multiple stents. CONCLUSIONS--Balloon-expandable intracoronary stenting is a feasible method for treating the acute complications of balloon angioplasty. It reduced the rate of restenosis for single stent implantation. Subacute thrombotic events must be regarded as previously unknown and serious complications.

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Selected References

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  1. Bredlau C. E., Roubin G. S., Leimgruber P. P., Douglas J. S., Jr, King S. B., 3rd, Gruentzig A. R. In-hospital morbidity and mortality in patients undergoing elective coronary angioplasty. Circulation. 1985 Nov;72(5):1044–1052. doi: 10.1161/01.cir.72.5.1044. [DOI] [PubMed] [Google Scholar]
  2. Brown B. G., Bolson E., Frimer M., Dodge H. T. Quantitative coronary arteriography: estimation of dimensions, hemodynamic resistance, and atheroma mass of coronary artery lesions using the arteriogram and digital computation. Circulation. 1977 Feb;55(2):329–337. doi: 10.1161/01.cir.55.2.329. [DOI] [PubMed] [Google Scholar]
  3. Ellis S. G., Roubin G. S., King S. B., 3rd, Douglas J. S., Jr, Shaw R. E., Stertzer S. H., Myler R. K. In-hospital cardiac mortality after acute closure after coronary angioplasty: analysis of risk factors from 8,207 procedures. J Am Coll Cardiol. 1988 Feb;11(2):211–216. doi: 10.1016/0735-1097(88)90082-4. [DOI] [PubMed] [Google Scholar]
  4. Erbel R., Meyer J., Schmitz H. J., Kiesslich T., Effert S. Percutaneous transluminal coronary angioplasty in patients with unstable angina. Postgrad Med J. 1983;59 (Suppl 3):22–25. [PubMed] [Google Scholar]
  5. Erbel R., Schatz R., Dietz U., Nixdorff U., Haude M., Aichinger S., Pop T., Meyer J. Ballondilatation und koronare Gefässstützenimplantation. Z Kardiol. 1989 Feb;78(2):71–77. [PubMed] [Google Scholar]
  6. Galan K. M., Deligonul U., Kern M. J., Chaitman B. R., Vandormael M. G. Increased frequency of restenosis in patients continuing to smoke cigarettes after percutaneous transluminal coronary angioplasty. Am J Cardiol. 1988 Feb 1;61(4):260–263. doi: 10.1016/0002-9149(88)90927-7. [DOI] [PubMed] [Google Scholar]
  7. Gruentzig A. R., King S. B., 3rd, Schlumpf M., Siegenthaler W. Long-term follow-up after percutaneous transluminal coronary angioplasty. The early Zurich experience. N Engl J Med. 1987 Apr 30;316(18):1127–1132. doi: 10.1056/NEJM198704303161805. [DOI] [PubMed] [Google Scholar]
  8. Gruentzig A. R. Percutaneous transluminal coronary angioplasty: six years' experience. Am Heart J. 1984 Apr;107(4):818–819. doi: 10.1016/0002-8703(84)90351-x. [DOI] [PubMed] [Google Scholar]
  9. Haude M., Erbel R., Straub U., Dietz U., Schatz R., Meyer J. Results of intracoronary stents for management of coronary dissection after balloon angioplasty. Am J Cardiol. 1991 Apr 1;67(8):691–696. doi: 10.1016/0002-9149(91)90523-n. [DOI] [PubMed] [Google Scholar]
  10. Heusch G. Alpha-adrenergic mechanisms in myocardial ischemia. Circulation. 1990 Jan;81(1):1–13. doi: 10.1161/01.cir.81.1.1. [DOI] [PubMed] [Google Scholar]
  11. Kaltenbach M., Kober G., Scherer D. Mechanische Dilatation von Koronararterienstenosen (Transluminale Angioplastie). Z Kardiol. 1980 Jan;69(1):1–10. [PubMed] [Google Scholar]
  12. Kaltenbach M., Kober G., Schmidt-Moritz A., Scherer D. Rezidivhäufigkeit nach erfolgreicher transluminaler Koronarangioplastie. Dtsch Med Wochenschr. 1983 Sep 16;108(37):1387–1390. doi: 10.1055/s-2008-1069754. [DOI] [PubMed] [Google Scholar]
  13. Leimgruber P. P., Roubin G. S., Anderson H. V., Bredlau C. E., Whitworth H. B., Douglas J. S., Jr, King S. B., 3rd, Greuntzig A. R. Influence of intimal dissection on restenosis after successful coronary angioplasty. Circulation. 1985 Sep;72(3):530–535. doi: 10.1161/01.cir.72.3.530. [DOI] [PubMed] [Google Scholar]
  14. Matthews B. J., Ewels C. J., Kent K. M. Coronary dissection: a predictor of restenosis? Am Heart J. 1988 Mar;115(3):547–554. doi: 10.1016/0002-8703(88)90802-2. [DOI] [PubMed] [Google Scholar]
  15. Meyer J., Erbel R., Pop T., Rupprecht H. J. Derzeitiger Stand der intrakoronaren Ballondilatation. Internist (Berl) 1987 Nov;28(11):736–746. [PubMed] [Google Scholar]
  16. Meyer J., Schmitz H., Erbel R., Kiesslich T., Böcker-Josephs B., Krebs W., Braun P. C., Bardos P., Minale C., Messmer B. J. Treatment of unstable angina pectoris with percutaneous transluminal coronary angioplasty (PTCA). Cathet Cardiovasc Diagn. 1981;7(4):361–371. doi: 10.1002/ccd.1810070408. [DOI] [PubMed] [Google Scholar]
  17. Palmaz J. C., Kopp D. T., Hayashi H., Schatz R. A., Hunter G., Tio F. O., Garcia O., Alvarado R., Rees C., Thomas S. C. Normal and stenotic renal arteries: experimental balloon-expandable intraluminal stenting. Radiology. 1987 Sep;164(3):705–708. doi: 10.1148/radiology.164.3.2956628. [DOI] [PubMed] [Google Scholar]
  18. Palmaz J. C., Sibbitt R. R., Tio F. O., Reuter S. R., Peters J. E., Garcia F. Expandable intraluminal vascular graft: a feasibility study. Surgery. 1986 Feb;99(2):199–205. [PubMed] [Google Scholar]
  19. Palmaz J. C., Windeler S. A., Garcia F., Tio F. O., Sibbitt R. R., Reuter S. R. Atherosclerotic rabbit aortas: expandable intraluminal grafting. Radiology. 1986 Sep;160(3):723–726. doi: 10.1148/radiology.160.3.2942964. [DOI] [PubMed] [Google Scholar]
  20. Puel J., Juilliere Y., Bertrand M. E., Rickards A. F., Sigwart U., Serruys P. W. Early and late assessment of stenosis geometry after coronary arterial stenting. Am J Cardiol. 1988 Mar 1;61(8):546–553. doi: 10.1016/0002-9149(88)90762-x. [DOI] [PubMed] [Google Scholar]
  21. Rupprecht H. J., Erbel R., Brennecke R., Pop T., Jung D., Kottmeyer M., Hering R., Meyer J. Aktuelle Komplikationsrate der perkutanen transluminalen Koronarangioplastie bei stabiler und unstabiler Angina. Dtsch Med Wochenschr. 1988 Mar 18;113(11):409–413. doi: 10.1055/s-2008-1067653. [DOI] [PubMed] [Google Scholar]
  22. Schatz R. A. A view of vascular stents. Circulation. 1989 Feb;79(2):445–457. doi: 10.1161/01.cir.79.2.445. [DOI] [PubMed] [Google Scholar]
  23. Schatz R. A., Palmaz J. C., Tio F. O., Garcia F., Garcia O., Reuter S. R. Balloon-expandable intracoronary stents in the adult dog. Circulation. 1987 Aug;76(2):450–457. doi: 10.1161/01.cir.76.2.450. [DOI] [PubMed] [Google Scholar]
  24. Serruys P. W., Beatt K. J., van der Giessen W. J. Stenting of coronary arteries. Are we the sorcerer's apprentice? Eur Heart J. 1989 Sep;10(9):774–782. doi: 10.1093/oxfordjournals.eurheartj.a059570. [DOI] [PubMed] [Google Scholar]
  25. Serruys P. W., Strauss B. H., Beatt K. J., Bertrand M. E., Puel J., Rickards A. F., Meier B., Goy J. J., Vogt P., Kappenberger L. Angiographic follow-up after placement of a self-expanding coronary-artery stent. N Engl J Med. 1991 Jan 3;324(1):13–17. doi: 10.1056/NEJM199101033240103. [DOI] [PubMed] [Google Scholar]
  26. Shiu M. F., Silverton N. P., Oakley D., Cumberland D. Acute coronary occlusion during percutaneous transluminal coronary angioplasty. Br Heart J. 1985 Aug;54(2):129–133. doi: 10.1136/hrt.54.2.129. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. Sigwart U., Puel J., Mirkovitch V., Joffre F., Kappenberger L. Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Engl J Med. 1987 Mar 19;316(12):701–706. doi: 10.1056/NEJM198703193161201. [DOI] [PubMed] [Google Scholar]
  28. Sigwart U., Urban P., Golf S., Kaufmann U., Imbert C., Fischer A., Kappenberger L. Emergency stenting for acute occlusion after coronary balloon angioplasty. Circulation. 1988 Nov;78(5 Pt 1):1121–1127. doi: 10.1161/01.cir.78.5.1121. [DOI] [PubMed] [Google Scholar]
  29. Steffenino G., Meier B., Finci L., Velebit V., von Segesser L., Faidutti B., Rutishauser W. Acute complications of elective coronary angioplasty: a review of 500 consecutive procedures. Br Heart J. 1988 Feb;59(2):151–158. doi: 10.1136/hrt.59.2.151. [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Swars H., Hafner G., Erbel R., Ehrenthal W., Rupprecht H. J., Prellwitz W., Meyer J. Prothrombin fragments and thrombotic occlusion of coronary stents. Lancet. 1991 Jan 5;337(8732):59–60. doi: 10.1016/0140-6736(91)93385-m. [DOI] [PubMed] [Google Scholar]
  31. Urban P., Sigwart U., Golf S., Kaufmann U., Sadeghi H., Kappenberger L. Intravascular stenting for stenosis of aortocoronary venous bypass grafts. J Am Coll Cardiol. 1989 Apr;13(5):1085–1091. doi: 10.1016/0735-1097(89)90265-9. [DOI] [PubMed] [Google Scholar]
  32. Vandormael M. G., Deligonul U., Kern M. J., Harper M., Presant S., Gibson P., Galan K., Chaitman B. R. Multilesion coronary angioplasty: clinical and angiographic follow-up. J Am Coll Cardiol. 1987 Aug;10(2):246–252. doi: 10.1016/s0735-1097(87)80003-7. [DOI] [PubMed] [Google Scholar]
  33. de Feyter P. J., DeScheerder I., van den Brand M., Laarman G., Suryapranata H., Serruys P. W. Emergency stenting for refractory acute coronary artery occlusion during coronary angioplasty. Am J Cardiol. 1990 Nov 1;66(15):1147–1150. doi: 10.1016/0002-9149(90)90522-3. [DOI] [PubMed] [Google Scholar]

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