Pk. Haager et al., Long term angiographic and clinical follow up in patients with stent implantation for symptomatic myocardial bridging, HEART, 84(4), 2000, pp. 403-408
Citations number
44
Categorie Soggetti
Cardiovascular & Respiratory Systems","Cardiovascular & Hematology Research
Objective-To assess long term results of coronary stent implantation in pat
ients with symptomatic myocardial bridging.
Methods-Intracoronary stent implantation was performed within the intramura
l course of the left anterior descending coronary artery in 11 patients wit
h objective signs of myocardial ischaemia and absence of other cardiac diso
rders. All had myocardial bridging of the central portion of the left anter
ior descending coronary artery. Quantitative coronary angiography was perfo
rmed before and after stent deployment, and again at seven weeks and six mo
nths. Clinical evaluation was done at two years.
Results-After stent deployment, quantitative coronary angiography showed ab
sence of systolic compression along the left anterior descending coronary a
rtery; the minimum luminal diameter (mean (SD)) increased from 0.6 (0.3) mm
before stent implantation to 1.9 (0.3) mm after implantation (p < 0.05). I
ntravascular ultrasound showed an increase in cross sectional area from 3.3
(1.3) mm(2) at baseline to 6.8 (0.9) mm(2) (p < 0.005) after stent deploym
ent. Coronary flow reserve was normalised from 2.6 (0.5) at baseline to 4.0
(0.5) (p < 0.005) after stent implantation. At seven weeks, quantitative c
oronary angiography showed mild to moderate or severe in-stent stenosis in
five of the 11 patients; four of these underwent repeat target vessel revas
cularisation (percutaneous transluminal coronary angioplasty in two; corona
ry artery bypass grafting in two). At six months, all patients (n = 9) show
ed good angiographic results, including those who had target vessel revascu
larisation. On clinical evaluation at two years, all patients (including th
ose with target vessel revascularisation) remained free of angina and cardi
ac events.
Conclusions-Intracoronary stent implantation prevents external compression
of bridged coronary artery segments, with increase in luminal diameter and
alleviation of symptoms. The incidence of in-stent stenosis requiring targe
t vessel revascularisation (36%) is comparable with that of lesions of 25 m
m length in coronary artery disease. The symptom free and event free two ye
ar follow up data suggest that stent implantation is a useful way of treati
ng symptomatic patients with myocardial bridges.