Local Heparin Delivery Prevents Acute Stent Thrombosis, Bleeding Complications, and In-stent Restenosis

Jeong, Myung Ho; Park, Jong Cheol; Cha, Kwang Soo; Ahn, Young Keun; Cho, Jeong Gwan; Park, Jong Chun; Kang, Jung Chaee

Abstract

Stent thrombosis, bleeding complications and restenosis remain as major clinical concerns in coronary stenting despite high pressure inflation and intravascular ultrasound guidance. A new strategy may be local drug delivery, which maintain sustained local concentration and may limit systemic complications. To observe the effects of local heparin delivery on acute stent thrombosis in patients, local heparin delivery was performed in stented patients. Heparin was delivered (5,000 Units, 1.0 ml/min over 10 min) using the Dispatch Catheter, after predilation of target lesions in 10 patients (6 unstable angina, 4 acute myocardial infarction, mean age 52 +/- 7.0 year) without systemic heparin loading. After local heparin delivery, Palmaz-Schatz stents were placed using high pressure inflation. APTT and CK were checked at 1 hr, 3 hrs and 24 hrs after local heparin delivery and stenting. Follow-up coronary angiograms were done 48 hrs and 6 months after stenting. All patients had no ischemic symptoms or ECG changes during and after local heparin delivery. All APTT and CK values were unchanged at 3 hrs and 24 hrs after local heparin delivery and stenting. Follow-up quantitative coronary angiograms (QCA) at 48 hrs and 6 months showed all stents patent, with TIMI III distal flow, and without intra-stent thrombus (79.4 +/- 4.2% before predilation, 32.9 +/- 7.7% after predilation, 32.4 +/- 13.1% after local delivery, 14.2 ( 2.3% immediately after stenting, 13.9 +/- 2.5% at 48 hrs and 21.7 +/- 8.8% at 6 months after stenting). Local heparin delivery prior to stenting prevents acute stent thrombosis, systemic bleeding complications and in-stent restenosis.