PERCUTANEOUS TRANSRADIAL CORONARY PALMAZ-SCHATZ STENT IMPLANTATION, GUIDED BY INTRAVASCULAR ULTRASOUND

Intravascular ultrasound (IVUS) allows accurate assessment of stent st ent deployment, its use being confined to the use of 8 French (F) guid ing catheters. We evaluated the feasibility of combining transradial a rtery Palmaz-Schatz stent implantation through 6F guiding catheters wi th IVUS for assessment of stent diameter after delivery at moderate in flation pressures (10-12 atmospheres [atm]) with compliant balloons an d after high pressure dilatations with balloons of intermediate compli ance. In 8 consecutive patients, 12 stents were delivered with Scimed( R) Express(TM) balloon catheters at 10-12 atm followed by IVUS (EndoSo nics(R) CathScanner; Visions(R) FX 3.5F 20 MHz transducer). An ultraso und study was repeated after high pressure dilatations (16-20 atm) wit h Schneider(R) Magical Speedy(TM) balloon catheters. The balloon diame ters were derived from manufacturer provided specifications. In all pa tients the transducer could easily be advanced through the guiding cat heters. Reference diameter of the stented segment was 3.7 +/- 0.5 mm ( 2.7-4.5) and the diameter of Scimed(R) Express(TM) balloons during inf lation was 4.0 +/- 0.3 mm (3.6-4.7). Stent diameter was 3.0 +/- 0.1 mm (2.8-3.2) (P < 0.001 compared to the reference and the balloon diamet er). The diameter of the Schneider(R) Magical Speedy(TM) balloons at s econdary dilatations with 16 +/- 3 atm (14-20) was 4.1 +/- 0.4 mm (3.3 -4.5) (P = 0.50 compared to the initial balloon diameter). Final stent diameter was 3.3 +/- 0.4 mm (2.9-4.1) (P = 0.02 compared to the initi al stent diameter). All stents were symmetrically deployed and well ap posed. No damage to vessel or stents was detected after passage of the transducer. Thus ultrasound guided stenting via 6F guiding catheters is feasible, and high pressure dilatations with balloons of intermedia te compliance results in better stent expansion than after 10-12 atm i nflations with compliant balloon catheters. (C) 1995 Wiley-Liss, Inc.