Clinical and Angiographic Outcome Following Implantation of the New Less Shortening Wallstent in Aortocoronary Vein Grafts: Introduction of a Second Generation Stent in the Clinical Arena

Abstract

One of the factors felt to have contributed to the high rate of stent occlusion in the European registry of the coronary Wallstent in the 1980s was the frequent deployment of more than one stent to cover the target lesion. This resulted from a high degree of shortening of the Wallstent upon expansion. To overcome this limitation the design of the Wallstent was modified to reduce the degree of shortening. We report the results of a study of the first patients to undergo implantation of the new Less Shortening Wallstent. Thirty-five Wallstents were electively deployed in aortocoronary vein grafts in 29 patients. Stent deployment was successful in 35 of 36 attempts in 30 lesions. In five of the 30 lesions, a second stent was required to cover the proximal portion of the lesion. Angiographic success (< 50% residual diameter stenosis as determined by off-line quantitative coronary angiography) was achieved in all 29 patients. During the in-hospital phase, no major adverse cardiac event occurred (reintervention, re-CABG, myocardial infarction, or death) and five patients had hemorrhagic complications. Following hospital discharge, one patient had a subacute stent occlusion associated with symptoms and elevated cardiac enzymes at 11 days, another patient had symptoms and elevated cardiac enzymes (CK 300 U/I) at 22 days with a patent stent, five patients required balloon angioplasty within the 6 month follow-up period (four for restenosis and one for stent occlusion), one patient underwent re-CABG for a native artery stenosis distal to the anastomosis of the patent stented vein graft.(ABSTRACT TRUNCATED AT 250 WORDS)

ACC/AHA/SCAI 2005 Guideline Update for Percutaneous Coronary Intervention

“…The presence of prior MI places the patient in a higher-risk subset and should be considered in the PCI decision. (244,245,(562)(563)(564)(565)(566)(567)(568)(569) than with balloon angioplasty of SVG stenoses, long-term prognosis remains guarded, and late recurrent ischemic events may be due to both restenosis of the target lesion and diffuse vein graft disease (570)(571)(572). Final patency after PCI is greater for distal SVG lesions than for ostial or mid-SVG lesions (535), and stenosis location appears to be a better determinant of final patency than graft age or the type of interventional device used.…”

Retrograde embolization during saphenous vein graft angioplasty

“…It has been suggested that perhaps because of the tighter mesh of the Wallstent, it maybe more effective in trapping dislodged degenerative fragments of atheroma. Hence this stent may be particularly suited for vein graft implantation [19,20].…”

Stenting of long coronary artery lesions: Initial angiographic results and 6-month clinical outcome of the micro stent II-XL

“…Likewise, the balloon used for postdilatation can be positioned inside the stent to protect against dissections at the stent margins [7,8]. The clinical success rate is equal to or better than reported with other types of stents [15,[21][22][23] and only slightly lower than after stent implantations in shorter segments [5][6][7][8]. However, the extensive experience of the operators with all different Micro Stents (Ͼ700 implants until now, Ͼ200 implants during the study period) may have contributed to this favorable outcome [7,8].…”