Bailout Palmaz-Schatz coronary stenting in 39 patients with occlusive dissection complicating conventional angioplasty.
The purpose of this study was to evaluate feasibility, safety, and efficacy of bailout Palmaz-Schatz stenting in a series of 39 patients with coronary dissection associated with acute or unequivocal threatened closure complicating conventional angioplasty. No anatomical characteristics other than reference vessel diameter < 3 mm were considered as contraindications for bailout coronary stenting. Stringent criteria were adopted in defining optimal results (< 10% residual stenosis, no angiographic evidence of residual dissection), suboptimal results (> 10% residual stenosis or angiographic evidence of residual dissection), deployment failure (failure to deploy the stent because of poor trackability or persistent occlusion despite stent deployment). A total of 49 stents and 7 half-stents were implanted in 36 patients (range 1-5; mean 1.45 +/- 0.84). Successful stenting without in-hospital death, urgent or semielective coronary surgery, stent thrombosis, or Q-wave myocardial infarction was achieved in 33/39 patients (85%). A suboptimal result was associated with an increased risk of in-hospital recurrence of ischemia and other related major adverse events (2/5 patients with suboptimal results vs. 1/31 patients with complete deployment success; P < 0.05). Multiple stents implantation did not carry a significant risk of major cardiac adverse events. The results of this study suggest that bailout Palmaz-Schatz stenting may be considered a stand-alone treatment of coronary dissection if an optimal acute angiographic result is achieved.
Antoniucci
D
D
Division of Cardiology, Careggi Hospital, Florence, Italy.
Santoro
G M
GM
Bolognese
L
L
Leoncini
M
M
Buonamici
P
P
Fazzini
P F
PF
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D003251:Constriction, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D003331:Coronary Vessels / Q000293:injuries*; D004630:Emergencies; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D015607:Stents / Q000009:adverse effects