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Stents are useful bail-out devices in coronary angioplasty. They are also used electively for situations associated with poor angioplasty results (e.g., restenotic lesions, venous grafts) and may reduce restenosis rates. However, the significant incidence of stent thrombosis necessitated aggressive anticoagulation with associated hemorrhagic complications. This remains a major limitation of stenting. We present our experience of stenting with half (disarticulated) Palmaz-Schatz coronary stents in eight consecutive patients, managed with aspirin alone. No patient experienced acute or subacute stent thrombosis.

A total of 110 half (disarticulated) Palmaz-Schatz coronary stents were implanted in 102 patients. Procedural success rate was 98%. Elective stenting was performed in five patients. The others received half stents for bail-out situations, including short dissections, relapsing stenoses, dissections not adequately covered by a full stent, ostial stenoses, and thrombus containing lesions. Seventeen patients received no anticoagulation except aspirin. Complications included one procedural death, three acute occlusions (resulting in one Q and two non-Q wave myocardial infarctions), and one non-Q wave infarction related to side branch closure. Stenting with the half Plamaz-Schatz coronary stent is an effective technique. It allows stenting in situations where a full stent may not be ideally suited. Use of only half a stent reduces thrombogenicity and halves costs.

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In 50 consecutive patients subjected to coronary angioplasty immediately following a 4 French (F) diagnostic study, the technical feasibility and economical aspects of angioplasty through 4F catheters of 54 lesions were assessed. The patients were selected, but multiple, eccentric, and long lesions were not a priori excluded. 4F diagnostic catheters (Cordis), and fixed-wire dilatation catheters (Ace, Scimed) were used in all cases. The procedure was successful in 43 lesions (80%) using 4F catheters. For 11 stenoses (20%), a change over to a larger French size was required. Two of these lesions could not be crossed with the balloon despite the larger sized guiding catheter. The final overall success rate was 96%, and there were no major complications. The use of diagnostic 4F catheters for angioplasty in these 50 patients resulted in the saving of 39 guiding catheters and 19 introducer sheaths. For 12 lesions (22%), an additional 4F catheter became necessary since the shape used for the diagnostic study was inadequate for angioplasty. In 7 cases, more than 1 balloon was used, but 5 of these balloon exchanges were independent of the use of 4F catheters. Three exchanges were performed through the 4F catheter (1 for need of a larger balloon to improve on an unsatisfactory angiographic result and 2 for a crimped guide wire tip of the Ace balloon). In the remaining 4, a larger catheter was used; in 2 of them, angioplasty eventually failed (failure to cross lesion) and in the remaining 2, a Monorail system solved the problem, which is incompatible with 4F catheters.(ABSTRACT TRUNCATED AT 250 WORDS)

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