title: Experience of immediate stenting, perfusion balloon and secondary stenting in failed angioplasty.
abstract: OBJECTIVE
  To present a comparative analysis of the immediate and short term experience of stent implantation as the initial treatment for failed angioplasty (immediate stenting) with the staged approach of prolonged inflation with a perfusion balloon followed by stent implantation if prolonged inflation was unsuccessful (secondary stenting).
  
  
  METHODS
  Retrospective analysis of the outcome of 90 consecutive patients from a single institution undergoing one of these treatment strategies for failed angioplasty.
  
  
  RESULTS
  The initial treatment for failed angioplasty was prolonged inflation with a perfusion balloon in 59 and immediate stent implantation in 31 patients. Angiographic success (less than 50% residual and normal flow) was achieved in 24 of 59 (41%) with the perfusion balloon (mean duration of inflation 12.2 +/- 8.3 mins) and in 30 of 31 (97%) with immediate stent implantation (P = 0.0001). Of the 35 patients in whom the perfusion balloon was unsuccessful secondary stenting was attempted in 27, with angiographic success in 24 (89%). Stent thrombosis occurred in four (13%) of the immediate stent group and in three (13%) of the secondary stent group. Acute ischemia compatible with vessel occlusion occurred in one (4%) of the perfusion balloon alone group following an initially successful result. One month following the procedure, 23 (72%) of the patients treated with perfusion balloon alone, 26 (84%) of the immediate stent group and 21 (78%) of the secondary stent group had a successful outcome and were free from major complications.
  
  
  CONCLUSIONS
  Immediate stent implantation and the staged approach of prolonged inflation with a perfusion balloon followed by secondary stent implantation if prolonged inflation was unsuccessful yielded similar results.
authors.affiliation: Victoria Hospital, University of Western Ontario, London.
authors.forename: J B
authors.initials: JB
authors.lastname: Foley
authors.forename: C
authors.initials: C
authors.lastname: Pilon
authors.forename: R I
authors.initials: RI
authors.lastname: Brown
authors.forename: I M
authors.initials: IM
authors.lastname: Penn
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects*; D002404:Catheterization; D001026:Coronary Artery Bypass; D003327:Coronary Disease / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D015425:Myocardial Reperfusion; D015607:Stents / Q000009:adverse effects; D013927:Thrombosis / Q000209:etiology