Single bailout stenting for threatened coronary closure complicating balloon angioplasty: acute and mid-term outcome

Abstract

Background: Emergency stent implantation for the treatment of failed balloon angioplasty has been limited by a 3-33% incidence of early stent thrombosis and a paucity of information on restenosis. Accordingly, the objective of this study is to determine both the acute and midterm results following single bailout stenting for threatened closure after failed balloon angioplasty.

Methods: Single stent placement with either a Gianturco-Roubin or Palmaz-Schatz stent for the treatment of threatened closure complicating conventional single-vessel balloon angioplasty of de novo native coronary lesions was carried out in 16 and 24 patients, respectively.

Results: Successful stent implantation was achieved in 39 patients (97.5%), reducing the diameter stenosis from 90 +/- 7% before 6 +/- 8% after the procedure. No early stent closure, myocardial infarction, or need for emergency coronary bypass surgery was observed. Furthermore, except for one death due to massive intracranial hemorrhage 1 1/2 weeks after a successful stent implantation, there was no mortality directly related to the procedure. Repeat angiographic study performed at a mean of 5 +/- 3 months after stenting in 30 (86 %) eligible patients revealed in-stent restenosis (> 50% diameter stenosis) in six patients (20%). Five had successful repeat balloon angioplasty. Restenosis rate was significantly higher in patients with diabetes mellitus (83 versus 21% in nondiabetics, P = 0.0047), who had small (< 3 mm diameter) stent (reflecting small vessel diameters) implanted (40 versus 10% for > or = 3 mm stents, P = 0.0528) and those who had received stents to rectify vessel recoil (60 versus 12% for dissection, P = 0.0264). During a follow-up period of 12 +/- 8 months, clinical benefits were maintained in most patients, with none requiring bypass surgery, and no myocardial infarction or death encountered.

Conclusion: Our study suggests that single bailout stenting for threatened closure in selected patients is associated with a favorable short and mid-term outcome, with minimal risk of early stent closure and a low restenosis rate. Restenosis rate, however, remains high in diabetic patients, stent placement for vessel recoil indication and those receiving < 3 mm diameter stents.