CORONARY STENTING IN CARDIAC ALLOGRAFT VASCULOPATHY

Objective. The purpose of this study was to evaluate acute angiographi c success, in-hospital complications and long-term outcome after intra coronary stenting in patients with cardiac allograft vasculopathy. Bac kground. The application of conventional interventional modalities to treat discrete lesions in patients with cardiac allograft vasculopathy is associated with higher procedural morbidity, mortality and higher restenosis compared to atherosclerotic coronary artery disease. Electi ve coronary stenting has been shown to lower restenosis rates and impr ove long-term outcome in selected patients with native coronary artery disease; however, its safety and efficacy in reducing restenosis in p atients with cardiac allograft vasculopathy is unknown. Methods. Ten p atients with 19 discrete lesions in a major coronary artery without di ffuse distal disease underwent intracoronary stenting using Palmaz-Sch atz stents. The average stent size was 3.4 mm, and the stent/artery ra tio was 0.99 +/- 0.07. Eight of ten (80%) patients received antiplatel et therapy (aspirin plus ticlopidine) only. Results. Procedural succes s was 100% with no in-hospital stent thrombosis, Q-wave myocardial inf arction or death. Minimal luminal diameter increased from 0.83 +/- 0.3 8 mm to 3.23 +/- 0.49 mm after stenting. Diameter stenosis decreased f rom 74.91 +/- 11.52% to 5.90 +/- 4.09% after stenting. Follow-up angio graphy was performed in 8 of 10 (80%) patients and 16 of 19 (84%) lesi ons. Target lesion revascularization was required in 2 of 10 (20%) pat ients and 3 of 16 (19%) lesions. Allograft survival was 7 of 10 (70%) at the end of 22 +/- 11 months follow-up. Conclusions. Intracoronary s tenting can be performed safely with excellent angiographic success in selected patients with cardiac allograft vasculopathy. The restenosis rate appears to be low despite the aggressive nature of the disease. A multi-center study with a larger number of patients is required to a ssess its efficacy in reducing restenosis and improving allograft surv ival. (J Am Coll Cardiol 1998;32:1656-40) (C)1998 by the American Coll ege of Cardiology.