Coronary stenting during rescue angioplasty after failed thrombolysis

Compared with primary angioplasty [percutaneous transluminal coronary angio plasty (PTCA)], rescue PTCA is associated with lower angiographic success a nd higher reocclusion rates, especially after thrombolysis with tissue-type plasminogen activator (tPA). Although stent placement during primary PTCA has been demonstrated to be safe and even to improve the angiographic resul ts achieved by balloon-alone PTCA, there are few data on stent placement du ring rescue PTCA after failed thrombolysis. This study sought to assess the feasibility and safety of stent implantation during rescue angioplasty in myocardial infarction after failed thrombolysis. The study population consi sted of 20 patients with acute myocardial infarction referred for rescue PT CA after failed thrombolysis consecutively treated with coronary stenting. The thrombolytic agent was tPA in 15 patients (75%), streptokinase in 1 (5% ), and anisoylated streptokinase plasminogen activator complex (APSAC) in 1 (5%); 3 patients (15%) were included in the INTIME II study (tPA vs. lanot eplase). After stenting, aspirin 200 mg daily plus ticlopidine 250 mg b.i.d . were administered. Thirty stents (1.5 +/- 1.0 per patient) were implanted . Angiographic success was achieved in 19 patients (95%). Two patients (10% ) died, both because of severe bleeding complications. One patient (5%) suf fered a reinfarction, but no patients suffered postinfarction angina or nee ded new target vessel revascularization. Eighteen patients (90%) were disch arged alive and free of events. All these patients remained asymptomatic an d free of target vessel revascularization at 6-month follow-up. Stent place ment during rescue PTCA after failed thrombolysis is feasible and safe and is associated with a good angiographic result and clinical outcome. Bleedin g complications seem to be, however, the main limitation of this reperfusio n strategy. Cathet. Cardiovasc. Intervent. 47:1-5, 1999. (C) 1999 Wiley-Lis s, Inc.