Circulation, Vol 87, 1498-1505, Copyright © 1993 by American Heart Association
A Kastrati, A Schomig, R Dietz, FJ Neumann and G Richardt
BACKGROUND. Prevention of abrupt vessel closure after percutaneous
transluminal coronary angioplasty (PTCA) represents one of the current
indications for intracoronary stent implantation. After the procedure, the
stented segment undergoes luminal changes that may lead to late restenosis.
This study was undertaken to assess the time course of luminal changes
during the first year after emergency placement of coronary stents. METHODS
AND RESULTS. Coronary stenting was indicated in patients with present or
threatened vessel closure secondary to large dissections after PTCA. From
June 1989 to May 1991, 82 patients who received Palmaz-Schatz stents and
did not have early vessel occlusion after stenting were enrolled into a
serial angiographic follow-up study. Coronary normal reference diameter and
minimal luminal diameter were measured with an automated edge detection
technique. Patients who underwent repeat PTCA for restenosis were excluded
from further serial angiography. The restudy rate at 3, 6, and 12 months
was 96%, 81%, and 90% of the eligible patients, respectively. The incidence
of restenosis (defined as a diameter stenosis > or = 50%) was 22.0% at 3
months, 31.9% at 6 months, and 33.2% at 12 months. Minimal luminal diameter
was increased from 0.66 +/- 0.32 mm before to 2.85 +/- 0.43 mm immediately
after stenting. It was 0.46 +/- 0.31 mm smaller than the diameter of the
maximally inflated balloon during the procedure. The reduction in minimal
luminal diameter was 0.80 +/- 0.69 mm (p = 0.0001) for the first 3 months,
0.29 +/- 0.52 mm (p = 0.0001) between 3 and 6 months, and 0.13 +/- 0.32 mm
(p = 0.01) for the last 6 months. The percentage of patients who presented
a significant change in minimal luminal diameter (defined as > 0.60 mm)
declined from 50.6% during the first 3 months and 18.9% between 3 and 6
months to 6.5% for the period between 6 and 12 months. CONCLUSIONS. The
incidence and the time course of restenosis after emergency coronary
stenting are similar to that reported for conventional PTCA. Coronary lumen
dimensions demonstrated a peak change at 3 months and remained mostly
stable after the first 6 months.
ARTICLES
Time course of restenosis during the first year after emergency coronary stenting
I. Medizinische Klinik, Technical University of Munich, Germany.
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