Abstract
Although a decade of experience has resulted in improved initial success of percutaneous transluminal coronary angioplasty (PTCA) even in the presence of more difficult anatomic problems (1, 2), the technique fails to yield lasting results in a significant percentage of patients. Early failures occur due to abrupt coronary artery closure in approximately 5%–7% of all patients (3, 4), and it is in these patients that most of the procedure related morbidity is encountered (3, 5). Restenosis appears in approximately a quarter of all patients within six months and in over one half of the patients undergoing vein graft PTCA (7, 8). Although a number of clinical, angiographic and procedural factors have been identified which appear to be associated with an increased risk of acute occlusion (3, 4, 9, 10, 11) and restenosis (6, 7, 8), the occurrence of these events in individual patients remains unpredictable. If one assumes that the results obtained in 14 experienced American centers participating in the 1985–86 NHLBI registry are similar to those in current practice, performance of 250 000 procedures annually world-wide would be expected to result in 19 000 acute closures (a 7.7% incidence) and 2 750 in-hospital deaths (a 1.1% incidence). Restenosis would be expected in at least 75 000 patients (assuming a 30% incidence). The enormous cost and morbidity related to these major limitations of PTCA have fostered innovative new invasive approaches aimed at maintenance of coronary luminal integrity. Placement of intracoronary stenting devices, a concept introduced by Dotter two decades ago (12), has been performed in several animal models and a number of different stent designs are currently undergoing clinical trials. Although still in an embryonic stage with respect to design features, determination of clinical utility and indications, and optimal adjunctive therapy, these new techniques have stimulated intense interest and may provide a method for treatment of patients who are now failures of PTCA or they may even become a routine component of angioplasty in some specific patient subgroups. The place of intravascular stenting in our therapeutic armamentarium will be determined by critical analysis of ongoing laboratory and clinical evaluations and technological improvements.
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References
Anderson H, Roubin G, Leimgruber P et a1. (1985) Primary angiographie success rates of percutaneous transluminal coronary angioplasty. Am J Cardiol 56: 712
Holmes DR, Vlietstra RE, Kelsey S and Detre K (1987) Comparison of current and earlier complications of angioplasty: NHLBI PTCA Resistry: J Am Coll Cardiol 9: 19A
Bredlau CE, Roubin G, Leimgruber P et al. (1985) In-hospital morbidity and mortality in patients undergoing elective coronary angioplasty. Circulation 72: 1044
Cowley MJ, Kelsey SF, Holubkov MS et al. (1988) Factors influencing outcome with coronary angioplasty: 1985–1986 NHLBI PTCA Registry. J Am Coll Cardiol 11: 148A
Ellis SG, Roubin GS, King SB et al. (1988) In-hospital cardiac mortality after acute closure after coronary angioplasty:Analysis of risk factors from 8207 procedures. J Am Coll Cardiol 11: 211–6
Leimgruber PP, Roubin GS, Hollman J et al. (1986) Restenosis after successful coronary angioplasty in patients with single vessel disease. Circulation 73: 710–717
Douglas JS Jr, Grüntzig AR, King SB III et al. (1983) Percutaneous transluminal coronary angioplasty in patients with prior coronary bypass surgery. J Am Coil Cardiol 2: 745–754
Douglas J, King S, Roubin G et al. (1986) Percutaneous angioplasty of venous aortocoronary graft stenoses: Late angiographic and clinical outcome. Circulation 74, Suppl II: 281
Cowley M, Dorros G, Kelsey S et al. (1984) Acute coronary events associated with percutaneous transluminal coronary angioplasty. Am J Cardiol 53: 12C
Sugrue DD, Holmes DR, Smith HC et al. (1986) Coronary artery throbus as a risk factor for acute vessel occlusion during percutaneous transluminal coronary angioplasty: improving results. Br Heart J 56: 62
Ellis SG, Roubin GS, King SB et al. (1988) Angiographic and clinical predictors of acute closure after native vessel coronary angioplasty. Circulation 77: 372
Dotter CT (1969) Transluminally-placed coilspring endarterial tube grafts. Long-term patency in canine popliteal artery. Inves Radiol 4: 329
Sigwart U, Puel J, Mirkovitch V et al. (1987) Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty. N Eng J Med 12: 701
Schatz R, Palmaz J, Garcia F et al. (1986) Balloon expandable intracoronary stents in dogs. Circulation 74, Suppl 11: 458
Palmaz JC, Sibbitt RR, Tio FO et al. (1986) Expandable intraluminal graf: a feasibility study. Surgery 99: 199
Palmaz JC, Windeler SA, Garcia F et al. (1986) Atherosclerotic rabbit aortas: expandable intraluminal grafting. Radiology 160: 723
Roubin GS, Robinson KA, King SB et al. (1987) Early and late results of intracoronary arterial stenting after coronary angioplasty in dogs. Circulation 76: 891
Robinson KA, Roubin GS, Apkarian RP et al. (1987) Short-term effects of intracoronary stenting in the canine: A descriptive scanning electron microscopic analysis. Circulation 76 Suppl IV: 26
Palmaz JC, Garcia OJ, Kopp DT et al. (1987) Balloon expandable intra-arterial stents: Effect of anticoagulation on thronbus formation. Circulation 76, Suppl IV: 186
Robinson KA, Siegel RJ, Brown JE et al. (1987) Effects of intra-arterial stenting on the progression of atherosclerosis in the rabbit. Circulation 76 Suppl IV: 186
Puel J, Rousseau H, Joffre F et al. (1987) Intravascular stents to prevent restenosis after transluminal coronary angioplasty. Circulation 76 Suppl IV: 27
Sigwart U, Golf S, Urs K et al. (1988) Analysis of complications associated with coronary stenting. J Am Coll Cardiol 11: 66A
Surreys PW, Juilliere Y, Bertrand ME et al. (1987) Additional improvement in stenosis geometry by stenting human coronary arteries after angioplasty. Circulation 76 Suppl IV: 232
Sigwart U, Kaufmann U, Goy JJ et al. (1987) Suppression of residual transstenotic pressure gradients after PTCA by implantation of self-expanding stents. Circulation 76, Suppl IV: 186
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© 1989 Springer-Verlag Berlin Heidelberg
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Douglas, J.S. (1989). Current status of intracoronary stents. In: Höfling, B., v. Pölnitz, A., Erdmann, E., Steinbeck, G., Strauer, B.E. (eds) Interventional Cardiology and Angiology. Steinkopff, Heidelberg. https://doi.org/10.1007/978-3-662-12114-6_23
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DOI: https://doi.org/10.1007/978-3-662-12114-6_23
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