LATE CLINICAL OUTCOME AFTER INTRACORONARY PALMAZ-SCHATZ STENTING WITHHIGH-PRESSURE BALLOON DILATION WITHOUT ANTICOAGULATION

In recent studies, the technique of high pressure balloon dilation for stent optimization has been shown to improve procedural success and t o reduce subacute closure after stenting. The late clinical outcome, h owever, is still uncertain after stenting with high pressure balloon d ilation. Therefore, we evaluated the effect of high pressure balloon d ilation on the subsequent clinical course in patients after intracoron ary stenting. One hundred ninety patients with 197 lesions were treate d with Palmaz-Schatz stent implantation. Intracoronary stenting withou t high pressure balloon dilation and with anticoagulation was performe d in 55 patients with 55 lesions (phase 1), whereas intracoronary sten ting with high pressure balloon dilation, without anticoagulation was done in 135 patients with 142 lesions (phase 2). We compared the angio graphic and clinical results immediately and at follow-up in both phas e 1 and phase 2. Coronary angiography was repeated at 6 months in 147 patients (79%) and 150 lesions (77%). The overall incidence of angiogr aphic restenosis was 24% (31% in phase 1 and 21% in phase 2). Angiogra phic restenosis occurred in 18% of elective stenting on ne novo lesion s (23% in phase 1 and 15% in phase 2). The target lesion revasculariza tion rate was 19% (26% in phase 1 and 16% in phase 2). The restenosis rate was significantly reduced with high pressure balloon dilation in the infarct-related artery and for a stent size of greater than or equ al to 4.0 mm (p < 0.05). In conclusion, intracoronary stenting using h igh pressure balloon dilation technique without anticoagulation has go od immediate results, negligible stent thrombosis and may have a tende ncy towards lower rates of restenosis.