INTRACORONARY STENT INSERTION AFTER BALLOON ANGIOPLASTY OF CHRONIC TOTAL OCCLUSIONS

Objectives. This retrospective analysis was performed to assess the me dium-term effectiveness of implanting intracoronary stents into chroni c total occlusions that are successfully opened by balloon angioplasty . Background. The value of percutaneous transluminal coronary angiopla sty of chronic total occlusions is limited by a very high restenosis r ate of 50% to 68%. Intravascular stents have been shown to reduce rest enosis in a subset of patients with subtotal stenoses. It has not been demonstrated that the placement of stents into successfully opened ch ronic total coronary artery occlusions leads to lower rates of resteno sis. Methods. A consecutive series of patients with chronic total coro nary occlusions successfully opened by balloon angioplasty received Pa lmaz-Schatz stents. Patients underwent clinical and angiographic follo w-up at a mean of 6 months after stent insertion. Angiographic and cli nical results were retrospectively analyzed. Results. Fifty-nine patie nts underwent stenting of 60 chronic total coronary occlusions, with a 98% rate of successful stent deployment. Complications occurred in 5% of cases, all with subacute thrombosis. Angiographic follow-up was ob tained in 88% of patients at a mean of 6 months and demonstrated an an giographic restenosis rate of 20%, with only one reocclusion. Among se veral variables examined, only the presence of a procedure-related mod erate to severe dissection was associated with higher follow-up percen t diameter stenoses and clinical events. At a mean of 14 months after stent insertion, 77% of patients remained free of symptoms or clinical events. Conclusions. The implantation of intracoronary stents into ve ssels with opened chronic total coronary occlusions is associated with favorable rates of angiographic restenosis and relief of symptoms. A randomized clinical trial comparing balloon angioplasty with stent-ass isted balloon angioplasty in the treatment of chronic total coronary o cclusions is indicated.