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741-3 Prevention of Subacute Occlusion After Coronary Stenting with Ticlopidine Regimen without Intravascular Ultrasound Guided Stenting

1995; Elsevier BV; Volume: 25; Issue: 2 Linguagem: Inglês

10.1016/0735-1097(95)92214-p

1558-3597

Paul Barragan, Marc Silvestri, Joël Sainsous, Jean-B. Siméoni, Gilles Bayet, Jean-L. Bouvier, B Comet,

Antiplatelet Therapy and Cardiovascular Diseases

Intravascular ultrasound (IVUS) guiding optimal coronary stent expansion has been proposed in the prevention of subacute stent thrombosis (SIT) wich remains the major limitation of coronary stenting. However this strategy, requiring high balloon pressure, enhances the risk of coronary rupture, and increases the time of procedure. We report our experience of coronary stenting using quantitative coronary analysis (OCA) and ticlopidine regimen (500 mg/day) initiated 3 days before PTCA and given for one month after stenting without any anticoagulation. From March 1994 to July 1994 among 587 consecutive PTCA, 208 patients (63 ± 11 yrs) were successfully stented on 235 lesions with 248 stents (223 Palmaz-Schatz, 25 Gianturco-Roubin). Femoral approach was used in 98% of cases with 8F (65%) or 6F guiding catheter (35%). Indications for stenting were elective (70%) or after failed PTCA(30%). The stents were expanded with a non compliant balloon (final diameter = 3.46 ± 0.42 mm) at 10 bars. OCA results were:Empty CellBefore stentingAftar stentingReference diameter (mm)3.02 ± 042321 ± 051Minimal luminal diameter (mm)095 ± 0482.79 ± 0.60*Diameter stenosis (%)68 ± 1513 ± 9*Area stenosis (%)88 ± 925 ± 16**p < 0.001 p < 0.001 One month major complications included 2 deaths (0.96%). 2 O-wave MI (0.96%) and 1 emergency CABG (0.5%). SST during the first month occured in 1 pt (0.5%). One pt (0.5%) required external compression for false aneurism and one (0.5%) blood transfusion for gastric hemorrhage. Pre and post coronary stenting treatment with ticlopidine regimen provides low rate of SST with acceptable vascular bleeding complications. Routine IVUS utility with this regimen remains uncertain.