Intracoronary stent insertion after balloon angioplasty of chronic total occlusions
Author + information
- Steven L. Goldberg, MDa,*,
- Antonio Colombo, MD, FACC*,
- Luigi Maiello, MD*,
- Massimo Borrione, MD*,
- Leo Finci, MD* and
- Yaron Almagor, MD‡
- ↵*Address for correspondence: Dr. Steven L. Goldberg, Division of Cardiology, Harbor-UCLA Medical Center, 1000 West Carson Street, RB2, Torrance, California 90509.
Abstract
Objectives This retrospective analysis was performed to assess the medium-term effectiveness of implanting intracoronary stents into chronic total occlusions that are successfully opened by balloon angioplasty.
Background The value of percutaneous transluminal coronary angioplasty of chronic total occlusions is limited by a very high restenosis rate of 50% to 68%. Intravascular stents have been shown to reduce restenosis in a subset of patients with subtotal stenoses. It has not been demonstrated that the placement of stents into successfully opened chronic total coronary artery occlusions leads to lower rates of restenosis.
Methods A consecutive series of patients with chronic total coronary occlusions successfully opened by balloon angioplasty received Palmaz-Schatz stents. Patients underwent clinical and angiographic follow-up at a mean of 6 months after stent insertion. Angiographic and clinical results were retrospectively analyzed.
Results Fifty-nine patients underwent stenting of 60 chronic total coronary occlusions, with a 98% rate of successful stent deployment. Complications occurred in 5% of cases, all with subacute thrombosis. Angiographic follow-up was obtained in 88% of patients at a mean of 6 months and demonstrated an angiographic restenosis rate of 20%, with only one reocclusion. Among several variables examined, only the presence of a procedurerelated moderate to severe dissection was associated with higher follow-up percent diameter stenoses and clinical events. At a mean of 14 months after stent insertion, 77% of patients remained free of symptoms or clinical events.
Conclusions The implantation of intracoronary stents into vessels with opened chronic total coronary occlusions is associated with favorable rates of angiographic restenosis and relief of symptoms. A randomized clinical trial comparing balloon angioplasty with stent-assisted balloon angioplasty in the treatment of chronic total coronary occlusions is indicated.
- Received July 17, 1994.
- Revision received January 20, 1995.
- Accepted April 12, 1995.
- American College of Cardiology
