CORONARY STENTING FOR TREATMENT OF OSTIAL STENOSES OF NATIVE CORONARY-ARTERIES OR AORTOCORONARY SAPHENOUS VENOUS GRAFTS

This study examines the procedural success, complication, and restenos is rates in patients undergoing Palmaz-Schatz stenting of native coron ary and saphenous vein graft ostial stenoses. All patients undergoing Palmaz-Schatz stent placement of ostial lesions (greater than or equal to 70% diameter stenosis within 3 mm from the arterial ostium) betwee n November 1989 and February 1992 were included in this study. Patient s were treated with aspirin, dipyridamole, low molecular weight dextra n, and heparin during the procedure and received systemic anticoagulat ion with warfarin for 1 month after the procedure. Angiographic measur ements were obtained using electronic calipers. Coronary stents were p laced in 41 ostial lesions of 41 patients. The target ostial stenosis was in a saphenous vein graft in 54% and a native coronary artery in 4 6% of lesions. The mean pre- and postprocedural minimal luminal diamet ers were 0.8 +/- 0.7 and 3.3 +/- 0.8 mm, respectively (p <0.0001), cor responding to a mean diameter stenosis of 83.5 +/- 10.0% and 1.0 +/- 4 .2%. Two patients had subacute stent thrombosis related to premature d iscontinuation of antithrombotic medications. Two patients died, 1 bec ause of stent thrombosis and 1 because of progressive renal failure an d sepsis. Angiographic follow-up was obtained at a mean of 5.8 +/- 1.8 months in 95% of patients with a successful stent procedure. The over all restenosis rate (>50% diameter stenosis at follow-up) was 27.8%. T hus, stenting of ostial native coronary and vein graft stenoses can be performed with excellent angiographic and procedural success rates. R estenosis rates appear to be lower than expected using historical cont rol subjects. The effectiveness of stenting for these patients, howeve r, may be limited by significant procedural complications.