Coronary stenting without anticoagulation

Abstract

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.

Stenting with the half (disarticulated) palmaz‐schatz stent

“…A total of 17 patients who received half stents in our series received no anticoagulation other than 100 mg aspirin daily following stenting. Criteria for not using anticoagulation [7] included: (1) vessel size 2 3 mm, (2) excellent angiographic result, and (3) good peripheral runoff. There were no acute or subacute stent thrombosis using this strategy.…”

“…Most patients received anticoagulation (aspirin and heparin/coumadin) following the procedure. Seventeen patients received no anticoagulation other than aspirin following stenting [7].…”

“…This has invoked increasing use of half (disarticulated) Palmaz-Schatz coronary stents for localized dissections, relapsing stenoses, ostial stenoses, discrete venous graft stenoses, and restenotic lesions. Additionally, with the use of half stents, we have been encouraged to stent in high-risk situations, e.g., thrombus containing lesions [ 121, multiple stenoses, and without subsequent heparin and oral anticoagulation [7]. This article describes our experience with use of the half (disarticulated) Palmaz-Schatz stent.…”

“…As experience with stents has grown, some of the old rules of stenting, e.g., the need for rigorous anticoagulation, requirement to cover the entire ballooned segment with stent, and apprehension against using multiple stents, have been challenged. Reports of stenting without anticoagulation [7,8], use of multiple stents [9], and short stents to cover only the target lesion [ 10,111 indicate this changing attitude.…”

Editorial comment: Bare-mounted stents: A bare necessity?

“…This implies that bare stenting in its present form may not provide the most idyllic solution to overcome the difficulties we encounter with the standard stent delivery system. The ''stent saddle technique'' as utilized by Levine et al [5] was originally described by Mehan et al [6]. This technique incorporates inflation at a pressure sufficient to inflate each end of the balloon beyond the stent's boundaries for the creation of a ''saddle.''…”