Outcome of urgent coronary stent implantatino in the treatment of acute complications of percutaneous coronary angioplasty
Med Sci Monit 1999; 5(3): CR474-478
The aim of the study was to evaluate the results of stent implantation in the cases of acute occlusion and dissection of dilated coronary artery, with disturbed blood flow as well as clinical and electrocardiographic symptoms of myocardial ischaemia. The study group consisted of 69 patients aged 50±8 years, including 60% men.Although 55% subjects had the history of myocardial infarction, left ejection fraction was 58±12%. Critical stenosis affected one coronary artery in 60% patients, two coronary arteries - in 30% patients, and three coronary arteries - in 10% patients. Diameter of dilated arteries was 3.02±0.14 mm and the length of stenosis -12±7 mm. The stents were urgently implanted to the following coronary arteries: anterior descending branch (adb) in 29 patients (42%), circumflex branch (cx) in 27 patients (39%) and right coronary artery (rca) in 13 patients (19%). In total, 45 stents PS153, 10 'WIKTORs' and 16 GRII were used. In order to stabilise long dissection, the insertion of two overlapping stents was necessary in 2 subjects. All the stents were effectively implanted, which resulted in the return of normal flow in the artery (TIMI3) and the withdrawal of symptoms of myocardial ischaemia. None of the patients displayed either the symptoms of subacute thrombosis in the stent or general and topical haemorrhagic complications. During the procedure, all the patients received i.v. bolus of 10000 IU heparin, 250 mg/day oral aspirin as well as 250 mg ticlopidine b.i.d. for 30 days following stent implantation. Symptoms of restenosis occurred in 12 patients (18%) during mean period of 8-month clinical follow-up. Stent implantation in the cases of sudden or threatening occlusion of dilated coronary artery allows for an effective control of blood flow disorders and the withdrawal of ailments related to ischaemia. The use of combined antiplatelet therapy prevents the occurrence of thrombotic complications associated with stent implantation in patients with high risk of death.
Keywords: complications after coronary angioplasty, coronary stents