title: Patient selection reduces thrombotic complications of emergent stenting for failed PTCA.
abstract: A comparison of consecutive initial and later patients receiving emergent coronary artery stents to salvage failed PTCA procedures was made to determine whether experience with this procedure can improve patient outcome. Twenty-six consecutive patients underwent emergent, unplanned implantation of one or more Palmaz-Schatz coronary stents at our institution over a 3-1/2 year period. Indications for stent insertion included impending vessel closure (decrease in TIMI flow grade and clinical evidence of ischemia) or acute occlusion (TIMI flow grade 0 or 1 and > or = 99% stenosis) after PTCA. Immediate and final success (30 day) were determined, and the results in the first (Initial) 13 patients were compared to the remaining (Later) 13 patients. Baseline characteristics of the study population included a male predominance (69%) with a mean (+/- SD) age of 57 +/- 10 years. Conventional balloon PTCA was performed in all three native coronary arteries with an increase in mean percentage stenosis from 76 +/- 13 to 85 +/- 14% (P < 0.05). Twelve patients developed acute occlusion and 14 patients impending closure after PTCA due to the appearance of thrombus (12%), dissection (46%), or both (35%). Palmaz-Schatz stents were successfully inserted in all patients restoring TIMI grade 3 antegrade flow; however, major complications developed in almost 50% of patients. Comparison of initial and later patients showed no differences in demographic or pre-PTCA angiographic characteristics. Later patients had less severe stenoses post-PTCA (before stenting) and were less likely to have thrombus present at the angioplasty site (15% vs. 77%, P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Cardiovascular Division, University of Pennsylvania Medical Center, Philadelphia 19104, USA.
authors.forename: H C
authors.initials: HC
authors.lastname: Herrmann
authors.forename: S A
authors.initials: SA
authors.lastname: Malosky
authors.forename: S A
authors.initials: SA
authors.lastname: Guidera
authors.forename: D
authors.initials: D
authors.lastname: DeAngelo
authors.forename: J W
authors.initials: JW
authors.lastname: Hirshfeld
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000517:prevention & control; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D003323:Coronary Aneurysm / Q000000981:diagnostic imaging / Q000517:prevention & control; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging / Q000517:prevention & control*; D004630:Emergencies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000628:therapy*; D018579:Patient Selection; D012307:Risk Factors; D016879:Salvage Therapy; D015607:Stents; D016896:Treatment Outcome