EXPERIENCE WITH THE GIANTURCO-ROUBIN STENT FOR ABRUPT VESSEL CLOSURE COMPLICATING PERCUTANEOUS TRANSLUMINAL CORONARY ANGIOPLASTY

Background: Emergency coronary artery bypass grafting (CABG) has previ ously been the only option in the treatment of refractory abrupt vesse l closure complicating percutaneous transluminal coronary angioplasty (PTCA), and has been associated with high rates of morbidity and morta lity. Intracoronary stenting now provides an alternative to emergency CABG. Aim: To assess our initial experience with emergency coronary ar tery stenting as a new technique. Methods: Retrospective case study re view with clinical and angiographic follow-up. Results: The Gianturco- Roubin (GR) stent was deployed in 13 patients in whom PTCA was complic ated by abrupt vessel closure refractory to standard balloon technique s. Indications for PTCA were unstable angina (six), stable angina (six ) and acute myocardial infarction (MI) (one). The arteries stented inc luded left anterior descending (LAD) artery lesions (eight) and right coronary artery lesions (five). Two patients required urgent CABG, one due to failed stent deployment and one for inadequate control of vess el dissection. In seven of the stented patients the creatine kinase ro se to greater than twice the upper limit or normal. Three patients had subacute thrombotic occlusion at seven to 19 days post stent deployme nt, managed with intravenous thrombolysis or repeat PTCA. At seven mon ths follow-up, 11 patients were free of angina, two patients had Canad ian Heart Association class II angina and there were no deaths. Eleven patients had repeat angiography at mean six months post stent. Five p atients had evidence of restenosis managed with repeat PTCA in four an d CABG in one. Conclusions: The GR stent is an effective alternative t o urgent CABG in the treatment of refractory abrupt vessel closure com plicating PTCA.