CLINICAL AND ANGIOGRAPHIC OUTCOME AFTER PALMAZ-SCHATZ STENT IMPLANTATION GUIDED BY INTRAVASCULAR ULTRASOUND

Intracoronary stents can be implanted with a low incidence of stent th rombosis (< 1%) when the stent procedure is guided by intravascular ul trasound. The long-term clinical and angiographic effects, however, ha ve not been reported. This study assesses the 6 month clinical and ang iographic results of a consecutive series of patients with intravascul ar ultrasound guided Palmaz-Schatz stent deployment that were not trea ted with subsequent anticoagulation after a successful stent implantat ion procedure. From March, 1993 to April 1994, 411 patients underwent Palmaz-Schatz stent implantation. There were 26 patients that had unco mplicated Palmaz-Schatz stent implantation that were treated with a st andard anticoagulation regimen that are not evaluated in this study. T hus, this study includes an assessment of 385 patients that had either a successful intravascular ultrasound guided stent implantation proce dure and did not receive post procedure anticoagulation or had a proce dural complication. Procedural success was achieved in 369 patients (9 6%). Clinical success (procedure success without early post procedure event) was achieved in 363 patients (94%). There were 2 acute stent th rombosis events (0.5%) and 1 subacute stent thrombosis (0.3%) in the g roup of 369 patients with 454 lesions treated without anticoagulation. At 6 month clinical follow-up the incidence of myocardial infarction was 4.9% and the rate of coronary bypass surgery was 6.2%. There was a 2.1% incidence of death. Emergency intervention (emergency angioplast y or bailout stent implantation was necessary in 3 patients (0.8%). Th e total incidence of repeat percutaneous intervention was 11.4%. By 6 months clinical follow-up, major events had occurred in 19.2% of patie nts. The angiographic lesion restenosis rate, according to 50% diamete r stenosis criteria, was 19%. The incidence of restenosis per patient was 22%. In conclusion, intravascular ultrasound guided Palmaz-Schatz can be performed without subsequent anticoagulation with a low inciden ce of stent thrombosis and acceptable clinical and angiographic outcom e at 6 month. clinical follow-up.