Outpatient coronary stenting using the femoral approach with vascular sealing

Purpose. We report here the use of vascular sealing devices in conjunction with the use of small transfemoral guiding catheters to decrease time to am bulation, decrease cost associated with hospitalization and achieve early d ischarge. Methods. Fifty patients were enrolled in this pilot project from two busy i nterventional practices between May 1997 and February 1999. Patients with s table or unstable angina or positive ETT and with recent myocardial infarct ion greater than 24 hours from the time of the procedure were included. Exc luded patients included those who had received glycoprotein IIb/IIIa platel et inhibitors and those with intra-procedure access site complications. Results. Of the 50 patients originally recruited, 49 underwent vascular sea ling for hemostasis and 45 were discharged on the same day, as planned. Ear ly home telephone follow-up was available on 41 of the 45 same-day discharg e patients, of whom 30 noted no complaints. One patient, who had been re-ac cessed in the right femoral artery after a previous intervention, developed a pseudoaneurysm requiring surgical repair. One-month follow-up was availa ble an all patients. No patient suffered a late ischemic event or access si te complication requiring treatment. There were no instances of stent loss, acute closure or subacute thrombosis. Conclusion. Though limited by small numbers, this pilot study shows that se lected patients undergoing coronary stenting via the femoral approach can b e safely treated on an outpatient basis using vascular sealing devices. Cos t savings may be significant using this strategy.