MULTIPLE STENT IMPLANTATION IN SINGLE CORONARY-ARTERIES - ACUTE RESULTS AND 6-MONTH ANGIOGRAPHIC FOLLOW-UP

A total of 147 stents were implanted (in overlapping manner in 76% of vessels) in a single coronary artery in 59 patients (60 vessels, 97 le sions, 2.45 stents/vessel) over a period of 18 mo using high pressure stent deployment without ultrasound guidance. The indications for sten ting were suboptimal percutaneous transluminal coronary angioplasty (P TCA) result (45%), primary prevention of restenosis (44%), acute closu re (10%), and restenosis after plain balloon angioplasty (1%). One pat ient required emergency coronary artery bypass grafting (CABG) (extens ive dissection), and one required early intervention with plain balloo n angioplasty and intracoronary urokinase for stent thrombosis. There were no deaths. Thirteen patients had recurrence of angina within 6 mo and angiograms were performed in all. These showed intrastent resteno sis in nine (all had successful repeat plain balloon angioplasty), dev elopment of new disease in other vessels along with restenosis close t o the stent in the target vessel in one (underwent elective CABG) and normal angiograms with widely patent stents in three. Forty-five patie nts (77%) remained free of recurrent angina and 25 of these had follow -up angiograms (56%) at a mean of 172 days, two showing restenosis. Th us, the restenosis rate per patient in the symptomatic group (angiogra phic follow-up in 100%) was 77% and in the asymptomatic group (angiogr aphic follow-up in 56%) was 8%. The restenosis rate in the subgroup wi th bailout stenting (n = 6) was 20% (angiographic follow-up in 83%). T he overall restenosis rate per patient was 32% (overall angiographic f ollow-up in 66%). During the 6-mo follow-up period, one patient underw ent elective CABG (1.7%), one sustained a non-Q myocardial infarction (1.7%), nine had repeat PTCA to the target vessel (15.5%), and there w ere no deaths. The event-free survival rate was 77%. Multiple stent im plantation aided by high pressure stent deployment without ultrasound guidance and with adjunctive optimal antiplatelet therapy without oral anticoagulation seems to be a useful and effective revascularisation strategy to deal with long lesions and acute dissections with a high p rocedural success rate. The restenosis rate is acceptable and is not a ppreciably high as reported in previous studies from the ''warfarin er a.'' (C) 1997 Wiley-Liss, Inc.