720-6 Stenting for Progressive Dissection During PTCA: Clinical, Angiographic and Intravascular Ultrasound Criteria to Define a Low-risk Group not Requiring Subsequent Anticoagulation

Abstract

Data from our previous experience with stenting suggest a subgroup of patients with a low risk for subacute occlusion of the stented vessel. Within a six month study period, stents were implanted for progressive dissection in 141 patients. These patients were screened for the following risk crite-ria which are based on our previous experience: stent in LAD, bail-out for occlusion, major side branches within stented segment, adjacent stenoses ≥ 50%, dissection not fully covered by stent, TIMII or II distal run-off, myocardial infarction within the last two weeks, intracoronarythrombus, recanalized chronic occlusions, minimal lumnial area within stent under 8 mm 2 with intravascular ultrasound. 60 patients had less than two of these criteria, and in a prospective trial were treated with heparin Lv. for 24 hours, and subsequently received aspirin 200 mg/day and ticlopidin 500 mg/day (ambulation after 36h). The final minimal lumen diameter achieved after stenting was 3.15 ± 0.55 mm (median 3.8% residual stenosis). Comparing the four-week clinical follow-up of these patients with our previous experience in 301 patients all treated with coumadin, we saw no cardiac deaths (compared to 1.3%), no non-fatal myocardial infarction (3,9%), no subacute thrombotic stent occlusions (6.9%), no need for repeat revascularization (PTCA orCABG) of the stented vessel (7.3%); local vascular complications were seen in 1.7% (30.2%), requiring surgery in none (5.6%), major bleeding not related to the vascular access site occurred in 1.7% (9.0%). A six-month follow-up angiography is scheduled. Clinical, angiographic and ultrasound criteria allow the definition of a low-risk group of patients with stenting for progressive dissection. Our data suggest that in these patients the risk for complications is substantially decreased, and post-procedural anticoagulation is not required.