Author + information
- Received April 8, 1993
- Revision received November 8, 1993
- Accepted November 17, 1993
- Published online April 1, 1994.
- Albert Schömig, MDa,∗,
- Adnan Kastrati, MDa,1,
- Rainer Dietz, MD∗,
- Bernhard Rauch, MD∗,
- Franz-Josef Neumann, MDa,
- Hugo H. Katus, MD∗ and
- Ulrich Busch, MDa
- ↵∗Address for correspondence: Dr. A. Schömig, I. Medizinische Klinik, Klinikum rechts der Isar, Ismaningerstrasse 22, 81675 München, Germany.
Objectives. The purpose of this study was to assess the angiographic results after emergency coronary Stenting and after repeat angioplasty for restenosis within the stent.
Background. There is still little angiographic information about lumen renarrowing and its correlates after emergency stenting, and data with regard to the angiographic outcome of repeat angioplasty within the stent are almost nonexistent.
Methods. This study was based on the quantitative evaluation of angiograms performed before and immediately after intervention and at 6-month follow-up. The study included 164 of the 183 eligible patients with emergency Palmaz-Schatz stact implantation and 31 of those with restenosis within the stent who had repeat angioplasty.
Results. Stenting produced an improvement in minimal lumen diameter from 0.82 ± 0.41 to 2.76 ± 0.47 mm (mean ± SD) and in diameter stenosis from 74.9 ± 11.5% to 18.3 ± 8.1%. Elastic recoil was 0.51 ± 0.34 mm, or 16%. At 6-month follow-up, 32.3% of the patients had restenosis (≥50% stenosis). Minimal lumen diameter decreased to 1.84 ± 0.78 mm, and diameter stenosis increased to 41.7 ± 21.0%. The degree of lumen loss correlated significantly with the length of the original stenosis and the initial lumen gain achieved by stenting. Thirty-one patients with in-stent restenosis underwent repeat angioplasty. The primary success rate was 100%, and no abrupt vessel closure was verified. Minimal lumen diameter increased from 0.85 ± 0.35 to 2.18 ± 0.39 mm, and diameter stenosis decreased from 69.7 ± 12.9% to 28.6 ± 9.4%. Elastic recoil was 0.82 ± 0.38 mm, or 27%. At follow-up, 38.5% of the patients had restenosis. Minimal lumen diameter was reduced to 1.72 ± 0.67 mm, and diameter stenosis increased to 42.4 ± 18.1%.
Conclusions. Angiographic results of emergency coronary stenting compare favorably with those of conventional angioplasty. In-stent balloon redilation in patients with restenesis is associated with excellent short-term results and a restenosis rate not different from that reported for nonstented vessels.
↵1 Dr. Kastrati was the recipient of a research fellowship from the Alexander von Humboldt Foundation, Bonn, Germany.
☆ This study was presented in part at the 65th Annual Scientific Sessions of the American Heart Association, New Orleans, Louisiana, November 1992 and the 42nd Annual Scientific Session of the American College of Cardiology, Anaheim, California, March 1993.
- Received April 8, 1993.
- Revision received November 8, 1993.
- Accepted November 17, 1993.