Intracoronary Stent Placement without Coumadin or Intravascular Ultrasound.
Coronary stenting has been associated with the need for intravascular ultrasound, increased anticoagulation, and increased length of stay. We evaluated the use of ticlopidine and aspirin without ultrasound in 322 consecutive patients from February 1995 through January 1996 who underwent intracoronary stenting with adjunctive high pressure balloon angioplasty [mean peak atmospheres (ATM) = 15.9; mean post-dilating balloon size = 3.4 mm]. Unstable coronary syndrome was the admitting diagnosis in 66% of these patients. Post-stent anticoagulation consisted of overnight heparin, followed by aspirin (325 mg daily) and ticlopidine (250 mg twice daily) for 4 to 6 weeks. Among the 322 patients, 575 stents (Palmaz-Schatz Coronary Stents = 530; Palmaz-Schatz Biliary Stents = 33; Gianturco-Roubin Stents = 12) were implanted in 338 coronary vessels (native arteries = 316; saphenous vein grafts = 22). Twenty-three patients (7%) had multi-vessel stenting. Average length of stay following stenting was 1.6 days (average overall hospital length of stay was 2.3 days), and 71% of patients were discharged the next day. Follow-up of all 322 patients was performed by telephone contact at least 30 days after discharge. During this period 1 (0.3%) acute thrombosis and no subacute thrombosis occurred. In this series of patients, coronary stent implantation using routine high pressure balloon post-dilatation Ñ without intravascular ultrasound Ñ and a combination of aspirin and ticlopidine was performed with no subacute thrombosis and a short length of stay.
Lawrence
ME
Division of Cardiology, The Miriam Hospital, 164 Summit Avenue, Providence, RI, 02906, USA.
Burtt
DM
Shaftel
PA
Saunders
SE
Korr
KS
Gordon
PC