S. Nakamura et al., HIGH-PRESSURE ASSISTED CORONARY STENT IMPLANTATION ACCOMPLISHED WITHOUT INTRAVASCULAR ULTRASOUND GUIDANCE AND SUBSEQUENT ANTICOAGULATION, Journal of the American College of Cardiology, 29(1), 1997, pp. 21-27
Objectives. The purpose of this study was to determine the efficacy of
treatment with antiplatelet therapy and no anticoagulation after high
pressure assisted coronary stent implantation performed, without intr
avascular ultrasound (IVUS) guidance. Background. Previous studies hav
e shown that during IVUS-guided Palmaz-Schatz coronary stenting, it is
safe to withhold anticoagulation when stent expansion has been optimi
zed by high pressure balloon dilation. Methods. Patients that had succ
essful coronary stenting without IVUS guidance mere treated with ticlo
pidine, 500 mg/day, and aspirin, 325 mg/day, for 1 month and then rece
ived only aspirin, 325 mg/day, indefinitely. Patients were not treated
with warfarin (Coumadin) or heparin after successful stenting. Clinic
al and angiographic events were assessed at 1 month. Results. A total
of 201 intracoronary stents were implanted in 127 patients with 137 le
sions. The average number of stents per lesion was 1.4 +/- 0.8, and th
e average number of stents per patient was 1.6 +/- 1.1. Stent deployme
nt was performed for elective indications in 79% of procedures and for
emergency indications in 21%. There were four stent thrombosis events
for a per patient event rate of 3.1% and a per lesion event rate of 2
.9%. Conclusions. After high pressure assisted stenting performed with
out IVUS guidance, there was an acceptable incidence of 3.1% of stent
thrombosis with the combination of short-term ticlopidine and aspirin
therapy and no anticoagulation. Although the study involved only 127 p
atients, the results support the relative safety of stenting without I
VUS guidance and with antiplatelet therapy only in comparison to histo
rical trials on stenting performed with postprocedure anticoagulation.