Intracoronary stenting compared with conventional therapy for abrupt vessel closure complicating coronary angioplasty. A matched case-control study

Abstract

Although early treatment of established vessel closure by intracoronary stenting was associated with a low incidence of both myocardial infarction and emergency bypass surgery, the likelihood or severity of infarction was not reduced among those in whom stents were implanted later. Patients with threatened vessel closure could not be shown to benefit from stent treatment. These data provide preliminary indications for stent placement in the acute period to be validated in larger randomized studies.

A Call for Provisional Stenting

“…Although the usefulness of emergency stent implantation over that of repeat balloon inflations has never been documented in a randomized trial, multiple observational reports have consistently illustrated the advantages of coronary stents as "bailout" devices (Table 1). [3][4][5][6][7][8][9][10] In the largest case series, George et al 4 reported successful deployment of the Gianturco-Roubin stent in 95.4% of 494 patients with abrupt or threatened abrupt closure during angioplasty. Only 4.3% of patients in this series required emergency bypass surgery, a clear improvement compared with rates typically of Ͼ20% in the prestent era.…”

“…Only 4.3% of patients in this series required emergency bypass surgery, a clear improvement compared with rates typically of Ͼ20% in the prestent era. Lincoff et al, 5 using a matched case-control approach, compared the results of Gianturco-Roubin stent implantation in 61 patients with threatened or actual abrupt closure with those for patients after conventional (balloonbased) therapy in 61 historical control subjects treated before the availability of stents. Stent placement was associated with less residual stenosis (26% versus 49%; PϽ.001), increased restoration of TIMI grade 3 flow (97% versus 72%; PϽ.001), and reduced need for emergency bypass surgery (4.9% versus 18%; Pϭ.02), although the rates of subsequent Q-wave myocardial infarction or death did not differ among the treatment groups.…”

“…[3][4][5][6][7][8][9][10][11][12] Based on these advantages, stent implantation is used in approximately half of all percutaneous interventions in the United States. However, despite their proven benefits, coronary stents continue to be accompanied by several theoretical and practical limitations: they are costly, typically associated with a more marked degree of neointimal formation than balloon angioplasty, and difficult to use with some lesion subsets such as bifurcation stenoses, and they have engendered the new and difficult-to-treat entity of in-stent restenosis.…”

Practice of Coronary Angioplasty in California in 1995

“…Because only in-hospital mortality is presented, the effect of stent placement would appear to be due to the prevention or expedient treatment of coronary dissections, reducing the incidence of abrupt vessel closure, prolonged ischemia, and myocardial infarction. 11,12 The reduction in the rate of emergency CABG, from 3.3% with PTCA to 2.2% with stent placement, also supports such a mechanism of benefit. Although the patients treated with stents may have been at slightly lower risk, it is unlikely that their baseline characteristics accounted for all the reduction in mortality.…”

Inibição do receptor plaquetário glicoproteína (GP) IIb/IIIa em síndromes isquêmicas agudas e intervenções coronárias

“…Apesar de que as razões para implante de stents sejam bastante dependentes do médico executando o procedimento, stents são geralmente utilizados em pacientes que, após angioplastia com balão, apresentam lesões residuais que limitam o fluxo sangüíneo ou dissecções complexas [94][95][96][97] . Stents também são utilizados quando um resultado obtido com o balão é inadequado (>30% de estenose residual) 98 e para lesões com morfologia desfavorável, nas quais a angioplastia com o balão torna-se improvável de produzir resultados adequados, como em pontes safenas [99][100][101] ou oclusões crônicas [102][103][104][105] .…”