Safety and Efficacy of Angiographic Guided Elective Palmaz‐Schatz Stent Implantation Without Coumadin: Comparison of Stent Implantation and Angioplasty

This study was designed to evaluate the safety and efficacy of routine high‐pressure Palmaz‐Schatz coronary stenting in patients with symptomatic coronary heart disease with only angiographic guidance without coumadin for poststenting treatment. Intracoronary stenting reduces restenosis rate after coronary angioplasty. High pressure stent deployment with intravascular ultrasound guidance reduces the incidence of stent thrombosis, despite reduction of anticoagulation. However, the feasibility of routine stent implantation with only angiographic guidance and without coumadin for poststenting treatment has not yet been determined. Patients undergoing coronary angioplasty for symptomatic coronary heart disease received stent implantation for abrupt or threatening vessel occlusion, vessel dissection without compromised antegrade blood flow (but at high risk for subacute occlusion and early restenosis), unsatisfactory angioplasty result with > 30% residual stenosis, and elective stent implantation in de novo lesions, restenotic lesions, and lesions in bypass grafts. Quantitative coronary analysis was performed before the procedure, immediately after, and at follow‐up 6 ± 1 (SD) months later. This patient group was matched for clinical and angiographic characteristics with those patients who underwent balloon angioplasty during the same period. Patients who underwent coronary stenting had larger net gain (1.95 ± 1.0 vs 1.42 ± 0.9; P < 0.001) resulting in a larger minimal luminal diameter (2.48 ± 1.19 vs 1.78 ± 1.01; P < 0.001) at follow‐up as compared with balloon angioplasty. Restenosis, defined as > 50% diameter stenosis at follow‐up, occurred in 35.0% in the PTCA group and in 16.1% in the stent group (P < 0.001). Subacute stent thrombosis occured in one patient (0.8%) due to angiographically evident suboptimal stent expansion. Routine coronary high pressure Palmaz‐Schatz stenting with angiographie guidance without coumadin for poststenting treatment represents a safe and effective option in patients with symptomatic coronary heart disease without increasing the incidence of (sub)acute stent thrombosis.