Angiographic follow-up after placement of a self-expanding coronary-artery stent.

BACKGROUND The placement of stents in coronary arteries after coronary angioplasty has been investigated as a way of treating abrupt coronary-artery occlusion related to the angioplasty and of reducing the late intimal hyperplasia responsible for gradual restenosis of the dilated lesion. METHODS From March 1986 to January 1988, we implanted 117 self-expanding, stainless-steel endovascular stents (Wallstent) in the native coronary arteries (94 stents) or saphenous-vein bypass grafts (23 stents) of 105 patients. Angiograms were obtained immediately before and after placement of the stent and at follow-up at least one month later (unless symptoms required angiography sooner). The mortality after one year was 7.6 percent (8 patients). Follow-up angiograms (after a mean [+/- SD] of 5.7 +/- 4.4 months) were obtained in 95 patients with 105 stents and were analyzed quantitatively by a computer-assisted system of cardiovascular angiographic analysis. The 10 patients without follow-up angiograms included 4 who died. RESULTS Complete occlusion occurred in 27 stents in 25 patients (24 percent); 21 occlusions were documented within the first 14 days after implantation. Overall, immediately after placement of the stent there was a significant increase in the minimal luminal diameter and a significant decrease in the percentage of the diameter with stenosis (changing from a mean [+/- SD] of 1.88 +/- 0.43 to 2.48 +/- 0.51 mm and from 37 +/- 12 to 21 +/- 10 percent, respectively; P less than 0.0001). Later, however, there was a significant decrease in the minimal luminal diameter and a significant increase in the stenosis of the segment with the stent (1.68 +/- 1.78 mm and 48 +/- 34 percent at follow-up). Significant restenosis, as indicated by a reduction of 0.72 mm in the minimal luminal diameter or by an increase in the percentage of stenosis to greater than or equal to 50 percent, occurred in 32 percent and 14 percent of patent stents, respectively. CONCLUSIONS Early occlusion remains an important limitation of this coronary-artery stent. Even when the early effects are beneficial, there are frequently late occlusions or restenosis. The place of this form of treatment for coronary artery disease remains to be determined.

[1]  L Schwartz,et al.  Aspirin and dipyridamole in the prevention of restenosis after percutaneous transluminal coronary angioplasty. , 1988, The New England journal of medicine.

[2]  F Joffre,et al.  Self-expanding endovascular prosthesis: an experimental study. , 1987, Radiology.

[3]  P. Serruys,et al.  Stenting of coronary arteries. Are we the sorcerer's apprentice? , 1989, European heart journal.

[4]  P W Serruys,et al.  Incidence of restenosis after successful coronary angioplasty: a time-related phenomenon. A quantitative angiographic study in 342 consecutive patients at 1, 2, 3, and 4 months. , 1988, Circulation.

[5]  J. J. Gerbrands,et al.  Assessment of short-, medium-, and long-term variations in arterial dimensions from computer-assisted quantitation of coronary cineangiograms. , 1985, Circulation.

[6]  E. Kaplan,et al.  Nonparametric Estimation from Incomplete Observations , 1958 .

[7]  W. J. Visser,et al.  Endothelialization of Intravascular Stents , 1988 .

[8]  P. Serruys,et al.  Early and late assessment of stenosis geometry after coronary arterial stenting. , 1988, The American journal of cardiology.

[9]  F Joffre,et al.  Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. , 1987, The New England journal of medicine.

[10]  M. P. Judkins,et al.  Transluminal Treatment of Arteriosclerotic Obstruction: Description of a New Technic and a Preliminary Report of Its Application , 1964, Circulation.

[11]  P J de Feyter,et al.  Change in diameter of coronary artery segments adjacent to stenosis after percutaneous transluminal coronary angioplasty: failure of percent diameter stenosis measurement to reflect morphologic changes induced by balloon dilation. , 1988, Journal of the American College of Cardiology.

[12]  U. Sigwart,et al.  Emergency stenting for acute occlusion after coronary balloon angioplasty. , 1988, Circulation.

[13]  U. Sigwart,et al.  Intravascular stenting for stenosis of aortocoronary venous bypass grafts. , 1989, Journal of the American College of Cardiology.

[14]  P. Serruys,et al.  Additional improvement of stenosis geometry in human coronary arteries by stenting after balloon dilatation. , 1988, The American journal of cardiology.