INTRACORONARY EMERGENCY STENTING - COMPLI CATIONS AND EXPERIENCES WITH 124 PATIENTS

From January 1990 to February 1993, 88 patients (group 1) received an emergency stent implantation with threatening vascular occlusion withi n the framework of an elective PTCA or a second emergency PTCA after u p to 5 days following a primary successful PTCA. In addition, 36 patie nts (group 2) received an intracoronary stent during emergency PTCA of instable angina pectoris or acute myocardial infarction. The attempte d stent implantation was not successful in 6 other patients. All patie nts were anticoagulated with heparin, aspirin (100 to 500 mg), and phe nprocoumon. Since October 1991, 3 x 75 mg dipyridamol was given and he parinization was stopped after measuring the anticoagulation factor II (prothrombin time < 40%). Main complications within the first 2 to 3 weeks were acute and subacute stent thrombosis (21.8%) and complicatio ns of the puncture site (bleeding 19.3%, a. spurium/av-fistula 1.6%). The risk of acute stent thrombosis was significantly higher in patient s of group 2 (instable angina pectoris despite of drug therapy or acut e myocardial infarction) compared with group 1 (42.4 versus 14.8%). Im plantation of multiple stents to stabilize extended dissections had a lower occlusion rate (6.3%). Acute myocardial infarctions were registe red in group 1 in 25% (11.4% following implantation, 13.6% following s tent Occlusion, CK 153 to 3380 U/l, average 826 U/l) and in 58,3% of t he high risk patients in group 2 (50% just before or following implant ation, 36.1% infarctions or re-infarctions caused by stent occlusion, CK 152 to 1950 U/l, average 657 U/l). The risk of infarction could be limited to approximately 58% of the patients of group 2. Concerning th e bleeding complications, there was no difference between the two grou ps. Emergency bypass surgery was necessary in 6 patients as well as in 3 other patients with failed emergency stent implantation. Three of s ix deaths occurred in coherence with the emergency stent implantation. Emergency stent implantation is an effective alternative to emergency bypass surgery. The risk of acute and subacute stent thrombosis is de pendent on the implantation indication. In some cases it is neccesary to implant multiple stents in extended dissections to reduce the risk of acute stent occlusion. The major complication is bleending which ma kes a definitive indication necessary.