Clinical Evaluation of Current Stent Deployment Strategies.
BACKGROUND: Coronary stenting has been demonstrated to reduce the incidence of abrupt closure and restenosis. However, intensive anticoagulation regimens have increased the number of vascular complications and hospital length of stay. Consequently, the potential long-term cost effectiveness of stenting has been jeopardized by a significant increase in procedural and hospital costs. These drawbacks have resulted in evaluation of reduced anticoagulation programs and alternative access sites. METHODS: Access-site and anticoagulation strategies were analyzed in 377 patients who had undergone coronary stenting. Four groups were compared: 114 patients stented from the femoral artery and treated with warfarin, 87 patients stented from the radial artery and treated with warfarin, 88 patients stented from the femoral artery and treated with ticlopidine and aspirin anticoagulation, and 88 patients stented from the radial artery and treated with ticlopidine and aspirin. RESULTS: Primary success was similar in all groups. Subacute closure occurred only in the groups managed with warfarin. Access-site complications occurred only in the groups with femoral access. Total hospital and post-procedure length of stay and total hospital charge were significantly less in the ticlopidine groups. The radial/ticlopidine group was the most cost-effective. CONCLUSIONS: Ticlopidine/aspirin therapy following coronary stenting from either the femoral or radial approach reduced hospital length of stay and hospital charge without subacute closure. Access-site complications were not reduced by femoral/ticlopidine strategy but were eliminated by the radial approach with either anticoagulation regimen. The radial/ticlopidine strategy eliminated access-site complications and significantly reduced hospital length of stay and hospital charge as compared to femoral/ticlopidine and was the most cost-effective strategy.
Mann
JT
Wake Heart Associates, Box 14427, Raleigh, NC, 27620, USA.
Cubeddu
G
Schneider
JE
Newman
WN
Rose
GC
Zellinger
MJ
Arrowood
M
Bowen