USE OF BARE-MOUNTED PALMAZ-SCHATZ STENTS EMPLOYING THE STENT SADDLE TECHNIQUE ON THE DELIVERY BALLOON - A SINGLE-CENTER EXPERIENCE

The major limitations of the Palmaz-Schatz stent stem from the design of its stent delivery system (SDS). The SDS is bulky and has poor trac kability in lesions with proximal tortuosity and/or vessel calcificati on. The use of bare-mounted Palmaz-Schatz stents on low profile balloo ns represents an alternate approach for lesions that are not accessibl e for stenting with the SDS, Thus we evaluated the indications, proced ural success rate, and in-hospital complications of patients undergoin g bare stenting at a single center between 1 October 1995 through 30 S eptember 1996. A total of 363 coronary interventions were performed du ring this period, including coronary stenting in 194 vessels. In 18 of these 194 vessels, bare-mounted Palmaz-Schatz stents were used. The i ndications for bare stenting were: inability to deliver the Palmaz-Sch atz stent on SDS for suboptimal angioplasty results or acute/threatene d abrupt closure; use of half stents; stenting in vessels < 3.0 mm; in termediate disease in the proximal segment that would have precluded o ptimal visualization of stent placement; and use of guides 7 French or smaller. Bare stenting was successful in 15 of the 18 patients (vesse ls) in whom it was attempted, There were no deaths, myocardial infarct ions, stent thrombosis, repeat interventions, or significant bleeding in patients with successful bare stent delivery, The stents were succe ssfully retrieved in the three patients in whom the stent could not be advanced into the target coronary segment, One of these patients had a propagated spiral dissection prior to attempts at bare stenting and required emergent bypass surgery. The remaining two patients with fail ed deployment had suboptimal angioplasty results but had an uncomplica ted hospital course, Thus bare stenting represents an alternate percut aneous approach to tackle suboptimal procedural results and/or complic ations in patients who have failed stent deployment with the standard sheathed stent delivery system currently available in the United State s. (C) 1997 Wiley-Liss, Inc.