TRANSRADIAL PALMAZ-SCHATZ CORONARY STENTING ON AN OUTPATIENT BASIS - RESULTS OF A PROSPECTIVE PILOT-STUDY

Background: The applicability of Palmaz Schatz coronary stent implanta tion is limited by bleeding complications and prolonged hospitalizatio n. Coronary stenting on an outpatient basis, may be the ultimate means to reduce costs of this treatment. Since bleeding and stent occlusion were infrequent complications in a group of 100 ambulatory patients w ho underwent stent implantation via the radial artery in our departmen t, we performed a pilot study to determine the feasibility of using co ronary stenting on an outpatient basis. Methods: Patients selected for Palmaz Schatz stent implantation, were adequately adjusted on coumadi n. At an INR > 2.5, stenting was performed via the radial approach. Ba sed on pre-, post- and procedural criteria, considering clinical statu s, procedural course and outcome, absence of predictors for stent occl usion and of events during 4 to 6 hours observation, patients were con sidered candidates for same-day discharge. Heparin was administered on ly during the procedure. Immediately after the procedure, the arterial sheath was removed. Patients were mobilized and were discharged with a pressure dressing over the puncture site. Follow-up was performed on the next day, at 2 weeks and at one month. Results: Between May and S eptember 1994, 47 patients underwent Palmaz Schatz stent implantation via the radial artery. Of these, 27 remained hospitalized for reasons, considered to be incompatible with outpatient treatment. Twenty patie nts (CCS-class III and IV; n=17 {85%}) received 29 stents for 23 lesio ns, distributed in 21 vessels and were discharged the day of treatment . No cardiac or bleeding events were encountered within 24 hours. At 2 weeks follow-up, one patient was readmitted (day 4) because of a blee ding abdominal aortic aneurysm, requiring surgery. At 1 month follow-u p, no bleeding, entry-site and cardiac complications were noted. Concl usion: Since no complications were encountered (95% confidence interva l; 0-17%) in the first 24 hours after optimal coronary stent implantat ion in patients with an adequate preprocedural level of anticoagulatio n, a larger feasibility study of outpatient coronary stenting will be undertaken.