Intracoronary Stenting Without Anticoagulation Accomplished With Intravascular Ultrasound Guidance

The experience of this study showed that indentations in the balloon profile or angiographic mismatch between the measured and chosen balloon diameters correspond to inadequate stent expansion as documented by intravascular ultrasound

Antonio Colombo; Patrick Hall; Shigeru Nakamura; Yaron Almagor; Luigi Maiello; Giovanni Martini; Antonio Gaglione; Steven L. Goldberg; Jonathan M. Tobis

2012

Scholarcy highlights

  • Introduction to Coronary Artery Stents andTheir Pharmacotherapeutic Management Ann Pharmacother. 1997;31:1490-1498, Abstract PDFCirculation. 1997;96:2997-3005, Abstract Full TextDisturbed Intracoronary Hemodynamics in Myocardial Bridging : Early Normalization by Intracoronary Stent Placement Circulation. 1997;96:2905-2913, Abstract Full TextIntravascular Ultrasound Image System for Experimental Implantation of Various Stents: Part 1 Interv Neuroradiol. 1997;3:82-85, Abstract PDFAntithrombotic Therapy in Patients Undergoing Coronary Angioplasty or Coronary Stent Placement CLIN APPL THROMB HEMOST. 1997;3:S24-S31, PDFGene therapy for arterial thrombosis Cardiovasc Res. 1997;35:459-469, Abstract Full Text PDFSustained Platelet Glycoprotein IIb/IIIa Blockade With Oral Xemilofiban in 170 Patients After Corona ry Stent Deployment Circulation. 1997;96:1117-1121, Abstract Full TextCirculation. 1997;96:491-499, Abstract Full TextCoronary Stenting After Rotational Atherectomy in Calcified and Complex Lesions : Angiographic and Clinical Follow-Up ResultsCirculation. 1997;96:128-136, Abstract Full TextDrug Information Rounds Ann Pharmacother. 1997;31:770-778, PDF
  • Stents decrease morbidity of acute closure, lower the incidence of major hospital or early events, and reduce restenosis rates compared with angioplasty-treated groups, the potential benefit of stent implantation is, unquestionably, lost in patients with stent thrombosis
  • The experience of this study showed that indentations in the balloon profile or angiographic mismatch between the measured and chosen balloon diameters correspond to inadequate stent expansion as documented by intravascular ultrasound
  • On the basis of these observations, it is reasonable to conclude that the Palmaz-Schatz stent can be deployed in coronary arteries with a low rate of thrombosis provided that stent expansion is adequate and there are no other flow-limiting lesions present
  • If high-pressure stent dilatation, treatment of the entire lesion, and intravascular ultrasound documentation of optimal stent expansion and lesion coverage are used, anticoagulation can be safely omitted after the procedure
  • The tightest intrastent lumen area relative to the reference area expanded from 49±13% at the initial intravascular ultrasound to 66±13% at the final intravascular ultrasound
  • This strategy should facilitate the expanded use of stents to provide the benefit of decreased restenosis while simultaneously reducing the cost and complications associated with stent insertion

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