We studied 100 patients who had coronary implantation of Palmaz-Schatz stents in our institution from November 1989 until March 1991. A total of 126 standard and 6 short stents were implanted. The patients' mean age was 58±5 years, and 97 were males. The indications were lesions with high risk of restenosis (29 patients), restenosis (27 patients), suboptimal result of angioplasty (24 patients), dissection (16 patients), and recanalized chronic total occlusion (6 patients). In 17 patients a brachial cut-down approach was used. Stents were correctly placed in 98 patients. Stent related complications occurred in 9 patients: major ischemic complications in 7 patients (acute myocardial infarction in 2 patients, emergency bypass surgery in 3 patients and emergency angioplasty in 2 patients); in 3 of these patients there was a subacute closure of the stent and in 2 patients there were delivery problems. Vascular complications at the site of arterial puncture occurred in 3 patients (some patients had more than one complication). A learning curve was observed. There was a decrease in the complication rate with the higher number of patients treated: 28% for the first 50 patients and 6% for the last 50 patients. Clinical follow-up was available in all patients. Of the 92 patients eligible for follow-up (7 ± 2 months), 69 patients were asymptomatic and 23 had recurrence of angina: 19 patients for stent restenosis and 4 patients for coronary artery disease progression. Follow-up angiogram was done in 79/92 (86%) patients: 21 had restenosis (27%). Restenosis rate was higher in patients with multiple stents 40% (6/15) than with the single stent 23% (15/64), and when the indications were for dissection 35% (6/17). These differences did not reach statistical significance. The global incidence of restenosis appears to be lower when compared to balloon coronary angioplasty, although there is no guarantee these populations are comparable. Stenting seems to be a good alternative to coronary angioplasty in lesions which are not considered ideal for the balloon dilatation and to treat occlusive dissections. The use of multiple and partial overlapping stents is associated with a high restenosis rate. These impressions need to be tested in a large, randomized, multicenter study.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine