967–16 Preliminary Experience of Coronary Stenting with the Micro Stent™ (original) (raw)
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Catheterization and Cardiovascular Interventions, 1999
To evaluate the results of long Micro Stent II (MS-XL) implantations, 119 MS-XLs were implanted in 102 patients (age, 62.83 years). Nineteen stents (16%) were implanted in saphenous vein grafts; 100 stents (84%) were implanted in native coronary arteries. Twenty-five patients (25%) were treated because of acute myocardial infarction (AMI); 30 patients (29%) because of unstable angina or angina class IV, and 47 patients (46%) because of stable angina. Eighty-six de novo lesions (84%) and 16 restenotic lesions (16%) were treated. Indications for stent implantation include elective, 61 patients (60%); suboptimal balloon angioplasty result, 22 patients (21%); and bailout after balloon angioplasty, 19 patients (19%). Because of residual thrombus after stenting, 27 patients (26%) received abciximab. All patients received ticlopidin for 28 days and acetylsalicylic acid. One hundred and seventeen MS-XLs (98%) were implanted successfully. Additional (shorter) MS-II were implanted in 40 patients (39%). The stented segment length was 45 ؎ 20 mm. The minimum lumen diameter increased from 0.5 ؎ 0.5 mm before to 2.7 ؎ 0.5 mm after stent implantation. The acute gain was 2.2 ؎ 0.4 mm. Early clinical events (F4 weeks) include death, 3 (3%); subacute stent thrombosis, 1 (1%); non-Q-wave infarction, 2 (2%); CABG, 1 (1%); vascular complications, 2 (2%). Late clinical events (F6 months) include acute myocardial infarction, 5 (5%); reintervention, 6 (6%); CABG, 1 (1%). The procedural success rate was 88%, and the event free survival at 6 months was 76%. Stenting of long lesions with the MS-XL was successful and associated with an acceptable complication rate. Cathet.
Objectives. Stent implantation reduces restenosis in vessels > 3 mm compared with balloon angioplasty, but few data are available for stents implanted in vessels <3 mm. The aim of this study was to evaluate immediate and follow-up patient outcomes after stent implantation in vessels <3 mm compared to stent implantation in vessels > 3 mm. Methods. Between March 1993 and May 1996, a total of 1,298 consecutive patients (1,673 lesions) underwent coronary stenting. The study population was divided into two groups based on angiographic vessel diameter. In case of multivessel stenting, patients were randomly assigned only one lesion. Group I included 696 patients (696 lesions) in whom stents were implanted in vessels > 3 mm, and group II included 602 patients (602 lesions) in whom stents were implanted in vessels <3 mm. Results. There was no difference in procedural success (95.4% in group I and 95.9% in group II), or subsequent subacute stent thrombosis (1.5% in group I and 1.4% in group II, p NS). The postprocedure residual diameter stenosis was 3.31 12.4% in group I and 2.45 16.2% in group II. Angiographic follow-up was performed in 75% of patients, restenosis occurred in 19.9% of patients in group I and 32.6% in group II (p <0.0001). Absolute lumen gain was significantly higher in group I compared to group II, but absolute late lumen loss was similar in the two groups (1.05 0.91 mm in group I vs. 1.11 0.85 mm in group II, p NS). Subsequently, the loss index was more favorable in group I (0.45 vs. 0.56; p 0.0006). Independent predictors of freedom from restenosis by multivariate logistic regression in the total population were: larger baseline reference diameter (odds ratio 2.032 p 0.006), larger postprocedure minimal stent cross-sectional area (odds ratio 1.190, p 0.0001) and shorter lesions (odds ratio 1.037, p 0.01). At long-term clinical follow-up, patients with small vessels had a lower rate of event-free survival (63% vs. 71.3%, p 0.007). Conclusions. Coronary stenting can be performed in small vessels with a high success rate and low incidence of stent thrombosis. However, the long-term angiographic and clinical outcome of patients undergoing stent implantation in small vessels is less favorable than that of patients with large vessels. (J Am Coll Cardiol 1998;32:1610 – 8) ©1998 by the American College of Cardiology
Angiographic and clinical outcome following coronary stenting of small vessels
Journal of the American College of Cardiology, 1998
Objectives. Stent implantation reduces restenosis in vessels > ؊ 3 mm compared with balloon angioplasty, but few data are available for stents implanted in vessels <3 mm. The aim of this study was to evaluate immediate and follow-up patient outcomes after stent implantation in vessels <3 mm compared to stent implantation in vessels > ؊ 3 mm.
Peri-procedural Outcome of Small Vessel Coronary Stenting
Bangladesh Heart Journal, 2016
Background: Among all percutaneous coronary interventions (PCIs), 30 to 40% involve small coronary arteries. Small vessel PCI has historically been associated with poor outcome in terms of coronary artery dissection, acute vessel closure, myocardial infarction, emergent coronary bypass grafting, and restenosis, but the scenario has been changing in recent years. The outcome of small vessel coronary intervention in Bangladeshi population is largely unknown. Objectives: The study was carried out to assess and compare the immediate outcome of PCI in small vessels with that in large vessels. Methods: This prospective, comparative study involved 100 patients undergoing PCI with stent implantation; group I constituted 50 patients having target vessel diameter of <3.0 mm, whereas group II constituted 50 patients having target vessel diameter of >3.0 mm. Immediate outcome of PCI was compared between the two groups. Angiographic, procedural and clinical successes were assessed. Acute complications e.g. major adverse cardiac events (MACE), arrhythmia, hemorrhage, pericardial tamponade, coronary dissection, no flow, vessel rupture and shock were observed. Results: No statistically significant differences in baseline clinical characteristics existed between the two groups. Favourable outcomes were observed in both groups. Angiographic success was 100% in group I, as well as, in group II; procedural and clinical success was 94% vs. 98%, and 90% vs. 94% in small and large vessel groups respectively (p> 0.05). Complications were infrequent in both groups. Also, no statistically significant difference was found in duration of hospital stay post-procedure between group I and group II. Conclusion: Small vessel coronary stenting may be safe and effective. However, these findings require further study involving larger population and long term follow up.
American Heart Journal, 1997
This prospective study represents the initial assessment of the Micro Stent PL (Arterial Vascular Engineering, Inc.) coronary stent. From one to three radiopaque stainless steel stents, each measuring 4 mm long, were premounted onto specially designed balloon catheters. A total of 123 stents were implanted in 41 patients without procedural failure or complications. Stent dislodgment proved a concern, with 7 of 123 stents (5.7%) moving >3 mm from the site of placement and late downstream migration occurring in an additional patient. Subacute stent thrombosis occurred in two patients (5%). Six-month angiographic follow-up was available in 37 of 41 patients (90%). Minimal lumen diameter at baseline was 0.93 ± 0.51 mm, increasing to 2.74 ± 0.49 mm after stenting, and falling to 1.66 ± 0.89 mm at 6 months; this represents a late loss of 60% of the initial gain. Restenosis, based on a binary definition of >50% diameter stenosis, was documented in 18 patients (49%). Advantages of the Micro Stent PL include its radiopacity and marked ease of distal delivery. The potential for stent dislodgment has implications for future stent designs. The role of the Micro Stent PL in managing restenosis is unclear, but it appears useful in the management of dissection and threatened closure after balloon angioplasty. (Am Heart J 1997;133:369-74.)
Clinical and Angiographic Outcome of Micro Stent II Implantation in Native Coronary Arteries
The American Journal of Cardiology, 1998
To evaluate immediate success and 6-month restenosis rate, 70 Micro Stents II were implanted for 65 stenoses in 63 patients (age 59 ؎ 9 years). Stable angina pectoris was present in 47% of the patients (38% class I to III; 9% class IV), whereas 32% had postinfarction angina and 21% had unstable angina. Indications for stent implantation were elective in 62% and semi-elective in 38% of the patients. Sixty-two percent of the patients received ticlopidin and acetylsalicylic acid for 28 days, whereas 38% of the patients received only acetylsalicylic acid. All stents were deployed successfully at the target site. Subacute closure occurred in 2 patients (3%), both of whom were not treated with ticlopidin. Two other patients (3%) developed non-Q-wave infarction after side branch occlusion during the procedure. The minimum lumen diameter increased from 1.0 ؎ 0.5 mm to 2.8 ؎ 0.4 mm after stent implantation. At follow-up the loss in diameter was 0.9 ؎ 0.6 mm, indicating a net gain of 0.9 ؎ 0.8 mm. Late clinical events (4 weeks to 6 months) were coronary angioplasty of a stented segment (3%), coronary angioplasty of a nonstented segment (10%), and coronary artery bypass grafting (2%). No deaths or myocardial infarction occurred. The procedural success rate was 94% and the eventfree survival at 6-month follow-up was 79%. Micro Stent II implantation can be done with a high rate of immediate success and good 6-month outcome. The Micro Stent II has proven to be a versatile device that can also be used in patients with less favorable coronary anatomy or lesion characteristics. ᮊ1998 by
Stenting in small coronary arteries (SISCA) trial
Journal of the American College of Cardiology, 2001
The purpose of this study was to assess the clinical and angiographic benefits of elective stenting in coronary arteries with a reference diameter of 2.1 to 3.0 mm, as compared with traditional percutaneous transluminal coronary angioplasty (PTCA). BACKGROUND The problems related to small-vessel stenting might be overcome using modern stents designed for small vessels, combined with effective antiplatelet therapy.
Safety and effectiveness of stent implantation without predilation for small coronary arteries
Catheterization and Cardiovascular Interventions, 2003
The purpose of this study was to examine the safety and effectiveness of stenting without predilation (direct stenting) in small (< 2.5 mm) coronary arteries. Clinical and angiographic data from the multicenter randomized PREDICT trial was examined. Direct stenting was performed on 42 small and 158 large vessels. Predilation was performed prior to stenting for 37 small vessels. In the small-vessel group, mean reference vessel diameter was 2.24 ؎ 0.19 mm for direct stenting vs. 2.24 ؎ 0.22 mm for predilation (P ؍ NS). Mean reference vessel diameter was 3.17 ؎ 0.48 mm in the large-vessel group. Device success for direct stenting was similar for small vs. large vessels (90.5% vs. 92.4%; P ؍ NS). At 180 days, a trend toward increased MACE between small vs. large vessels in the direct-stenting group was observed (26.8% vs.16.7%; P ؍ NS), and significantly higher target lesion revascularizations (TLRs) in the small-vessel group (19.5% vs.7.7%; P ؍ 0.03) were observed. In small vessels, differences in device success rate (90.5% vs. 100 %; P ؍ NS) and lesion success rate (100% vs. 100%; P ؍ NS) for direct stenting vs. predilation were not significant. At 180 days, no differences between direct stenting and predilation for MACE (26.8% vs. 29.7%; P ؍ NS) or TLR (22.0% vs. 21.6%; P ؍ NS) were seen in small vessels, although binary angiographic restenosis rate tended to be higher in direct-stenting group (38.2% vs. 18.5%; P ؍ NS). Direct stenting of small vessels can be performed safely and successfully in selected cases. Restenosis rates may be higher for small vessel treated by direct stenting compared to predilation. Cathet Cardiovasc Intervent 2003;59:455-458.