INTRACORONARY STENT IMPLANTATION VIA THE BRACHIAL APPROACH - A TECHNIQUE TO REDUCE VASCULAR BLEEDING COMPLICATIONS

To reduce the incidence of vascular complications of intracoronary ste nt implantation, we used the brachial approach. We attempted implantat ion of the Palmaz-Schatz stent via the brachial artery approach at 10 lesions in 9 patients. Stent delivery was successful at 8 lesions. Bal loon angioplasty was successfully performed in the 2 failed cases, 1 o f whom required surgical repair of the brachial artery. Intravenous an ticoagulation was uninterrupted from the time of stent placement until therapeutic prothrombin times from oral warfarin therapy were obtaine d. Neither acute nor long-term major bleeding occurred in the 9 patien ts. There were no embolic events, myocardial infarctions, or deaths. O ne subacute thrombosis occurred, and the patient underwent bypass surg ery. To evaluate the risks and benefits of the brachial approach, we c ompared these 9 patients with 41 who had stent placement by the femora l approach during the same period. Lesion characteristics were similar in these 2 groups. There were no significant differences in the succe ss rate or angiographic outcome between the 2 groups. Seven (17%) pati ents in the femoral group had vascular access complications requiring surgery, compared with 1 (11%) in the brachial group. No patient in th e brachial group required transfusion, compared with all 7 of the pati ents who had femoral vascular complications. The potential reduction i n bleeding complications makes the brachial approach to stent implanta tion attractive in selected patients.