SINGLE BAILOUT STENTING FOR THREATENED CORONARY CLOSURE COMPLICATING BALLOON ANGIOPLASTY - ACUTE AND MIDTERM OUTCOME

Background Emergency stent implantation for the treatment of failed ba lloon angioplasty has been limited by a 3-33% incidence of early stent thrombosis and a paucity of information on restenosis. Accordingly, t he objective of this study is to determine both the acute and midterm results following single bailout stenting for threatened closure after failed balloon angioplasty. Methods Single stent placement with eithe r a Gianturco-Roubin or Palmaz-Schatz stent for the treatment of threa tened closure complicating conventional single-vessel balloon angiopla sty of de novo native coronary lesions was carried out in 16 and 24 pa tients, respectively. Results Successful stent implantation was achiev ed in 39 patients (97.5%), reducing the diameter stenosis from 90 +/- 7% before to 6 +/- 8% after the procedure, No early stent closure, myo cardial infarction, or need for emergency coronary bypass surgery was observed. Furthermore, except for one death due to massive intracrania l hemorrhage 1 1/2 weeks after a successful stent implantation, there was no mortality directly related to the procedure. Repeat angiographi c study performed at a mean of 5 +/- 3 months after stenting in 30 (86 %) eligible patients revealed in-stent restenosis ( > 50% diameter ste nosis) in six patients (20%), Five had successful repeat balloon angio plasty. Restenosis rate was significantly higher in patients with diab etes mellitus (83 versus 21% in nondiabetics, P = 0.0047), who had sma ll ( < 3 mm diameter) stents (reflecting small vessel diameters) impla nted (40 versus 10% for greater than or equal to 3 mm stents, P = 0.05 28) and those who had received stents to rectify vessel recoil (60 ver sus 12% for dissection, P = 0.0264), During a follow-up period of 12 /- 8 months, clinical benefits were maintained in most patients, with none requiring bypass surgery, and no myocardial infarction or death e ncountered. Conclusion Our study suggests that single bailout stenting for threatened closure in selected patients is associated with a favo rable short and mid-term outcome, with minimal risk of early stent clo sure and a low restenosis rate. Restenosis rate, however, remains high in diabetic patients, stent placement for vessel recoil indication an d those receiving < 3 mm diameter stents.