Plamaz-Schatz Coronary Stenting without Anticoagulation

Kim, Han Soo; Tahk, Seung Jea; Kim, Won; Shen, Jing Song; Kim, Dong Jin; Shin, Joon Han; Choi, Byung Il

Abstract

BACKGROUND
Recent randomized studies have shown a reduction of restenosis rate after denovo coronary stenting as compared to classical PTCA. The purpose of this study was to evaluate a new medication protocol using antiplatelet therapy(ticlodipine, aspirin) and heparin in conjunction with routine high pressure ballooning after stenting.
METHODS AND RESULTS
Seventy two patients(47 males and 25 females, mean age : 58+/-11 years) underwent Palmaz-Schatz coronary stenting in 76 coronary lesions. Their clinical characeristice were ; 38 cases(63%) of unstable angina, 14 cases(19%) of stable angina and 20 cases(28%) of acute myocardial infarction(MI, Q : 16 cases, non-Q : 4 cases). In 15 out of 20 acute MI cases, stents were implanted in the infarct-related arteries. Primary elective stenting was indicated for 40 lesions(53%) ; 34 for de novo and 6 for restenosis after PTCA. Stents were implanted in 27 lesions(35%) with suboptimal result after PTCA and 9 lesions(12%) as a bailout procedure ; 8 threatened closures and 1 acute closure. All patients were treated with heparin for 48 hours and antiplatelet agents(aspirin 100-200mg/day and ticlopidine 200-500mg/day) after the procedure. All stents were greater than 3.0mm in size. Postdilatation was obtained with a max balloon diameter of 3.5+/-0.6mm(balloon-to-vessel ratio of 1.12+/-0.20) at a max inflation pressure of 14.4+/-2.8 atm. Percent diameter stenosis decreased from 70.4+/-15.5% to -1.2+/-4.8%(p<0.0001), and minimal luminal diameter increased from 0.94+/-0.57mm to 3.15+/-0.51mm(p<0.0001) after stenting. During mean follow-up duration of 5.1+/-3.0 months there were 3 cases(4.2%) of myocardial infarction, 2(2.7%) of repeat angioplasty, 1(1.4%) of CABG and 1(1.4%) of death.
CONCLUSION
Palmaz-Schatz coronary stenting with poststenting routine high pressure ballooning appears to be safe and feasibile without anticoagulation and without use of intravascular ultrasound in selected patients.