title: Clinical outcome of patients undergoing endoluminal coronary artery reconstruction with three or more stents.
abstract: OBJECTIVE
  We sought to evaluate the outcome of patients undergoing multiple (three or more), contiguous stent implantation within a single native coronary artery.
  
  
  BACKGROUND
  The implantation of multiple stents within a single coronary artery is increasing in frequency, although the outcome of such patients is not well described.
  
  
  METHODS
  Forty-five patients without previous coronary artery bypass graft surgery (CABG) undergoing multiple, contiguous stent implantation in a single coronary artery were identified. Clinical and angiographic characteristics and outcomes were analyzed.
  
  
  RESULTS
  The angiographic success rate was 97.8%. The procedural success rate was 91.1%; stent occlusion during the initial hospital period occurred in four patients (8.9%). Death, myocardial infarction (MI), CABG, repeat target vessel intervention or severe angina occurred in 10 (23.3%) of 43 hospital survivors at 6-months follow-up. The indication for stent placement was threatened or abrupt closure in 30 patients (66.7%). Of the 25 patients with abrupt or threatened closure whose clinical and angiographic data would have indicated emergent CABG had stents not been available, the frequency of in-hospital death and Q wave MI was similar to that of a matched consecutive series of patients at our institution who underwent emergent CABG after failed angioplasty. At 1 year, the frequency of death, Q wave MI, CABG and severe angina at 1 year was similar in the two groups; the need for repeat percutaneous intervention was more common in the stent group (25% vs. 0%, p = 0.01).
  
  
  CONCLUSIONS
  Implantation of multiple, contiguous intracoronary stents was associated with a high initial success rate, although the incidence of early stent closure was relatively high. Adverse events at 6 months of follow-up were more frequent than previously reported for elective single-stent implantation; however, adverse angiographic characteristics such as dissection and thrombus were frequent in this group. In addition, the strategy of multiple stent implantation in the setting of failed angioplasty is a reasonable alternative to emergent CABG, although the need for further percutaneous intervention must be anticipated.
authors.affiliation: Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
authors.forename: V
authors.initials: V
authors.lastname: Mathew
authors.forename: D
authors.initials: D
authors.lastname: Hasdai
authors.forename: D R
authors.initials: DR
authors.lastname: Holmes
authors.forename: K N
authors.initials: KN
authors.lastname: Garratt
authors.forename: M R
authors.initials: MR
authors.lastname: Bell
authors.forename: A
authors.initials: A
authors.lastname: Lerman
authors.forename: S
authors.initials: S
authors.lastname: Melby
authors.forename: D E
authors.initials: DE
authors.lastname: Grill
authors.forename: P B
authors.initials: PB
authors.lastname: Berger
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000401:mortality; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D003331:Coronary Vessels / Q000293:injuries; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome