Outcomes following interventions in small coronary arteries with the use of hand-crimped Palmaz-Schatz stents

Although coronary stenting has been shown to be effective, retrospective st udies have suggested that stents do not provide better results than angiopl asty in smell coronary arteries. We sought to examine procedural, in-hospit al, and long-term outcomes of patients undergoing small-vessel stenting wit h Palmaz-Schatz stents hand-crimped on a balloon catheter <3 mm in diameter . We retrospectively analyzed the outcomes of 117 patients who underwent th is type of coronary stent implantation at Duke University Medical Center be tween January 1, 1997 and May 30, 1998. The clinical indications for percut aneous revascularization included unstable angina in 67.5% of patients, acu te myocardial infarction in 4.3%, postinfarct angina in 3.4%, silent ischem ia in 3.4%, and stable angina in 1% of patients. Quantitative angiographic analysis was performed immediately before angioplasty and after stent impla ntation. Stents were used for elective indications in 24%, for suboptimal a ngiographic result in 61.5%, and for abrupt and/or threatened closure in 14 .5% of patients. Reference vessel diameter was similar before and after the procedure. Minimum luminal diameter increased from 0.63 to 2.35 mm, an acu te gain of 1.72 +/- 0.43 mm. Percent stenosis decreased from 74.2% to 4.7%. The clinical composite of death (n = 1, 1%), nonfatal myocardial infarctio n (n = 6, 5.1%), and revascularization (n = 1, 1%) occurred in-hospital in only 8 patients (6.8%), resulting in clinical procedure success in 109 pati ents (93%). Our data suggest that stents designed for vessels >3.0 mm can b e deployed in small vessels, with a low in-hospital event rate. However, ta rget lesion revascularization in small vessels remains high. Development of antiproliferative strategies could improve long-term outcomes for small-ve ssel interventions. (C) 2000 by Excerpta Medica, Inc.