Coronary stenting: Single institution experience with the initial 100 cases using the Palmaz‐Schatz stent

Abstract

We studied 100 patients who had coronary implantation of Palmaz-Schatz stents in our institution from November 1989 until March 1991. A total of 126 standard and 6 short stents were implanted. The patients' mean age was 58 +/- 5 years, and 97 were males. The indications were lesions with high risk of restenosis (29 patients), restenosis (27 patients), suboptimal result of angioplasty (24 patients), dissection (16 patients), and recanalized chronic total occlusion (6 patients). In 17 patients a brachial cut-down approach was used. Stents were correctly placed in 98 patients. Stent related complications occurred in 9 patients: major ischemic complications in 7 patients (acute myocardial infarction in 2 patients, emergency bypass surgery in 3 patients and emergency angioplasty in 2 patients); in 3 of these patients there was a subacute closure of the stent and in 2 patients there were delivery problems. Vascular complications at the site of arterial puncture occurred in 3 patients (some patients had more than one complication). A learning curve was observed. There was a decrease in the complication rate with the higher number of patients treated: 28% for the first 50 patients and 6% for the last 50 patients. Clinical follow-up was available in all patients. Of the 92 patients eligible for follow-up (7 +/- 2 months), 69 patients were asymptomatic and 23 had recurrence of angina: 19 patients for stent restenosis and 4 patients for coronary artery disease progression. Follow-up angiogram was done in 79/92 (86%) patients: 21 had restenosis (27%).(ABSTRACT TRUNCATED AT 250 WORDS)

Angiographic follow-up and clinical experience with the flexible tantalum cordis stent

“…In addition to this, the stent was probably deployed in vessels with above-average tortuosity reflected by the fact that the right coronary artery was the target vessel of stenting in 45% of patients. Urgent CABG was required in 2 patients (1.9%), in keeping with other observational reports of similar-sized patient groups [14]. Two patients experienced subacute thrombotic stent occlusion on day 5.…”

Retrieval of undeployed intracoronary Palmaz‐Schatz stents

“…Successful delivery of this device has been reported in 95-98% of patients in various series [5,8,9]. Failure is often due to snagging of the stent before or at the lesion by mural plaques, or against a previously placed stent [5,8,9]. It is often possible to retrieve the stent from the coronary artery simply by withdrawing the stent-balloon assembly back to the tip of the guiding catheter and then pulling the whole system down to the descending aorta before at- tempted removal through the arterial sheath.…”

“…This design gives the stent a certain degree of longitudinal flexibility so that it can pass through the curves of the guiding catheters and coronary arteries to reach the target lesion. Successful delivery of this device has been reported in 95-98% of patients in various series [5,8,9]. Failure is often due to snagging of the stent before or at the lesion by mural plaques, or against a previously placed stent [5,8,9].…”

“…The use of this device, however, has added a new risk to percutaneous coronary revascularization, i.e., intracoronary embolization of undeployed stents. If it is not retrieved from the coronary artery, it may lead to thrombosis and subsequent myocardial infarction [5]. Coronary artery bypass surgery is necessary when this situation arises.…”

Retrieval of dislodged stents from left main during percutaneous coronary intervention by trapping technique

“…It was not rare when first generation stents were used [1][2][3]. The consequences could includecoronary thrombosis, myo cardial infarction, stroke, perforation and sudden death [4][5][6]. In the past, manual crimping of stents was associated with a significantly increased risk of stent dislodgement and embolisation.…”