PRIMARY CORONARY STENTING AFTER SUCCESSFUL BALLOON ANGIOPLASTY OF CHRONIC TOTAL OCCLUSIONS - A SINGLE-CENTER EXPERIENCE

Coronary angioplasty of chronic total occlusions has been limited by a relatively low success rate and a high average restenosis rate of 53% . We prospectively assessed the immediate and long-term outcome of pri mary stenting after performing successful recanalization of chronic to tal occlusions in 38 consecutive patients. Thirty-three men and five w omen (mean age 56 +/- 11 years) in whom 39 total occlusions were stent ed with a successful stent delivery of 97% were evaluated. After stent deployment quantitative angiography demonstrated the mean reference d iameter to be 3.42 +/- 0.44 mm with a mean residual stenosis of 6% +/- 9%. Immediately after the stent was implanted, no major complications occurred. Patients underwent clinical and angiographic follow-up at a mean of 6 +/- 1 months after stent implantation. At 6 months after st ent implantation 74% of the patients had no symptoms and remained free of death, myocardial infarction, or target lesion revascularization. Quantitative follow-vp angiography was performed in 90% of the patient s. The angiographic restenosis rate (>50% diameter stenosis) was 40% ( 14 of 35 lesions). In eight (23%) of these lesions a reocclusion was n oted. Repeat uneventful angioplasty was performed in five (14%) patien ts with symptomatic restenosis at the stent site, and two (5%) patient s had elective coronary artery bypass graft surgery, in conclusion, in tracoronary stent implantation is a safe and effective technique in pa tients with chronic total coronary occlusions, The angiographic resten osis rate of 40% after stenting compares favorably with that in histor ical balloon angioplasty control series. However, further improvement of this technique is required to reduce the relatively high restenosis rate in patients with chronic total occlusions.