NO SUBACUTE THROMBOSIS AND FEMORAL BLEEDING COMPLICATIONS UNDER FULL ANTICOAGULATION IN 150 CONSECUTIVE PATIENTS RECEIVING NON-HEPARIN-COATED INTRACORONARY PALMAZ-SCHATZ STENTS

Intracoronary stenting has been shown to have better immediate and lon g-term clinical outcomes and less restenosis than standard balloon ang ioplasty. However, the benefit was achieved at the cost of higher rate s of coronary thrombosis, bleeding complications, the need for anticoa gulation, and longer hospital stay. For the latter reasons there is a tendency to replace the anticoagulants by antiplatelet agents alone af ter stenting. However, we prospectively monitored 150 consecutive pati ents (133 men, 17 women, mean age 58.5 years) from two centers since F ebruary 1993. They all had coronary artery disease and underwent percu taneous implantation of non-heparin-coated Palmaz-Schatz coronary sten ts under a full but lower dose of anticoagulation. The femoral approac h was used in all patients except one. In the 150 patients, 200 stents were implanted in 165 target arteries with 172 lesions. Stenting was performed without the guidance of intravascular ultrasonography; high- pressure poststenting inflation was used in only 17.3% of patients wit h less than optimal angiographic results. Coronary angiography was per formed at baseline, immediately after the procedure, and after 6 month s (mean 207 +/- 53.6 days SD) of stenting. The mean (+/-SD) coronary m inimum luminal diameter increased from 0.52 0.31 mm to 3.13 +/- 0.42 m m immediately after stenting was performed and was 2.12 +/- 0.91 mm at 6 months. There was a 0% subacute thrombosis rate and a 0% femoral bl eeding complication rate in the whole series. Only three (2%) major ev ents occurred: one Q-wave myocardial infarction from closure of an ang ioplasty site distal to the stent on a very long lesion, one cerebrova scular accident, and one noncoronary-related death. The only patient w ho underwent the brachial approach had hematoma; otherwise no other mi nor event occurred. The mean hospital stay was 4.5 days in one of the two study centers. The long-term clinical follow-up rate was 97.3%. Th e mean (+/-SD) clinical follow-up period was 589 +/- 363 days. Clinica l symptoms improved; the percentage of patients who had angina accordi ng to the Canadian Cardiovascular Society functional class II, III, an d IV was 31.3%, 44.7%, and 4%, respectively, before stenting was perfo rmed and was reduced to 4.7%, 3.7%, and 0%, respectively at 6-month fo llow-up after stenting was performed. The B-month angiographic restudy rate was 90.6%, and the restenosis rate was 18.3%. In contrast to oth er reported series, these results support the idea that with careful p uncture technique and meticulous postoperative wound care, intracorona ry stenting can be successfully performed with the patient under full anticoagulation without major risks of bleeding and femoral vascular c omplications. Furthermore with a full but comparatively lower dose of anticoagulation, subacute thrombotic complications can be reduced to 0 % even with non-heparin-coated stents without the use of intravascular ultrasound guidance and without the use of adjunctive high-pressure p oststenting inflation in most patients. The restenosis rate and long-t erm clinical outcomes remained very favorable.