Experience with the Gianturco-Roubin stent for abrupt vessel closure complicating percutaneous transluminal coronary angioplasty.
BACKGROUND
Emergency coronary artery bypass grafting (CABG) has previously been the only option in the treatment of refractory abrupt vessel closure complicating percutaneous transluminal coronary angioplasty (PTCA), and has been associated with high rates of morbidity and mortality. Intracoronary stenting now provides an alternative to emergency CABG.


OBJECTIVE
To assess our initial experience with emergency coronary artery stenting as a new technique.


METHODS
Retrospective case study review with clinical and angiographic follow-up.


RESULTS
The Gianturco-Roubin (GR) stent was deployed in 13 patients in whom PTCA was complicated by abrupt vessel closure refractory to standard balloon techniques. Indications for PTCA were unstable angina (six), stable angina (six) and acute myocardial infarction (MI) (one). The arteries stented included left anterior descending (LAD) artery lesions (eight) and right coronary artery lesions (five). Two patients required urgent CABG, one due to failed stent deployment and one for inadequate control of vessel dissection. In seven of the stented patients the creatine kinase rose to greater than twice the upper limit or normal. Three patients had subacute thrombotic occlusion at seven to 19 days post stent deployment, managed with intravenous thrombolysis or repeat PTCA. At seven months follow-up, 11 patients were free of angina, two patients had Canadian Heart Association class II angina and there were no deaths. Eleven patients had repeat angiography at mean six months post stent. Five patients had evidence of restenosis managed with repeat PTCA in four and CABG in one.


CONCLUSIONS
The GR stent is an effective alternative to urgent CABG in the treatment of refractory abrupt vessel closure complicating PTCA.
Carey
L
L
Department of Cardiology, Prince Charles Hospital, Brisbane, Qld.
Cameron
J
J
Aroney
C
C
Bett
N
N
Holt
G
G
Mahononda
N
N
McEniery
P
P
D015906:Angioplasty, Balloon, Coronary; D003251:Constriction, Pathologic / Q000453:epidemiology / Q000628:therapy; D017023:Coronary Angiography; D003327:Coronary Disease / Q000453:epidemiology / Q000628:therapy*; D003331:Coronary Vessels; D004630:Emergencies; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015607:Stents; D013997:Time Factors; D014654:Vascular Patency / Q000502:physiology