Coronary stent immobilization during angioplasty by transcoronary ventricular pacing via a guidewire.
OBJECTIVE
In some patients, cardiac contractions cause the coronary artery segment adjacent to a stent to move in such a way that accurate stent positioning is difficult. A number of techniques have been described for immobilizing the stent at the target site by inducing periods of either asystole or tachycardia. This study shows how pulsatile motion can be controlled by means of rapid ventricular pacing via an angioplasty guidewire.


METHODS
The study involved 27 consecutive patients in whom excessive stent movement during angioplasty complicated accurate stent implantation. In these selected patients, myocardial tachycardia was induced by transcoronary ventricular pacing via an angioplasty guidewire with the aim of reducing the pulsatile motion of the stent.


RESULTS
At baseline, the median displacement was 4.08 mm (interquartile range 2.75 mm). During pacing at 100 and 150 beats per minute, the median displacement was 1.39 mm and 0.54 mm, respectively (interquartile range 1.66 mm and 0.54 mm, respectively). Transcoronary myocardial pacing was effective in 96% of cases. No complications associated with pacing were reported.


CONCLUSIONS
Transcoronary ventricular pacing via an angioplasty guidewire was an effective and safe method for achieving stent immobilization in cases where there was excessive pulsatile motion.
Lasa
Garikoitz
G
Servicio de Hemodinámica y Cardiología Intervencionista, Policlínica Gipuzkoa, 20009 San Sebastián, Guipúzcoa, Spain. glasa@med.policlinicagipuzkoa.com
Larman
Mariano
M
Gaviria
Koldo
K
Sanmartín
Juan Carlos
JC
Sádaba
Mario
M
Rumoroso
José Ramón
JR
D017130:Angioplasty; D002304:Cardiac Pacing, Artificial / Q000379:methods*; D003327:Coronary Disease / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents; D016896:Treatment Outcome