935-35 Results of Stent Implantation for Diffuse Coronary Disease Assisted by Intravascular Ultrasound

Abstract

The long term benefit of elective Palmaz-Schatz stent implantation for focal lesions in large vessels has been clearly delineated. The elective use of stents in diffuse disease. however, has not been fully evaluated. This study reports on the use of stents in 89 pts with 108 lesions (les) with diffuse disease. Diffuse disease was defined as a lesion length longer than 20 mm. After a successful angiographic result was obtained. intravascular ultrasound (IVUS) was performed to confirm optimal stent expansion and lesion coverage and to guide further balloon dilation and stent implantation. The mean age was 57 ± 10. Mean lesion length was 32 ± 6 mm. Vessel distribution was 51 LAD (47%). 45 RCA (42%). 10 LCX (9%). and 2 vein graft(2%). Lesion location was 49 proximal (45%). 52 mid (48%), and 7 distal (7%). 274 stents were implanted (139 Palmaz-Schatz, 34 short (7 mm) Palmaz-Schatz, 48 GianturcoRoubin, and 53 Wiktor) for an average of 2.4 ± 1.4 stents/lesion. Procedure success was achieved in 83 patients (93%). Procedure associated complications included 3 myocardial infarction (3%) and 3 emergency bypass (3%) and 1 elective bypass (1%). Following the procedure. 77 pts (93%) with 94 les were treated only with anti platelet therapy and no anticoagulation. Angiographic follow up at 4–6 months was performed on 49 of the eligible 65 lesions (71%). Baseline, final and follow up angiographic (AG) results are below:AG ResultsReference (mm)MLD(mm)% StenosisBaseline3.11 ± 0.470.66 ± 0.5879 ± 19Post Stent309 ± 0.503.01 ± 0.473 ± 12Follow Up3.01 ± 0.481.80 ± 0.9140 ± 28 There was 1 acute stent thrombosis event (1.2%). Restenosis by 50% diameter stenosis criteria was present in 17 of 49 lesions (35%) and 13 of 39 patients (34%). (1) Stent Implantation in diffuse disease that is assisted by IVUS is associated with acceptable procedure complication rate and a low stent thrombosis rate despite the absence of post stent anticoagulation in the majority of patients. (2) The restenosis rate of 35% appears to represent an improvement over the reported restenosis rates for diffuse disease after angioplasty or other devices