Strecker Stent as a Bailout Device Following Percutaneous Transluminal Coronary Angioplasty

Abstract

The Strecker stent is a balloon‐mounted flexible endoprothesis of knitted tantalum wires, successfully used in peripheral arteries. In our practice stents are only implanted as a bailout device after percutaneous transluminal coronary angioplasty (PTCA). In 112/5,000 consecutive patients (2.2%), a dissection could not be sealed with prolonged balloon inflations and resulted in total (28%) or subtotal occlusion. A total of 127 stents (71 Schatz–Palmaz, 56 Strecker) had to be implanted. All patients were pretreated with aspirin p.o. and 20,000 U heparin IV. Before stent implantation, they received 500 mg intracoronary aspirin, 5,000 U heparin, and 500 mL Dextrane; and after implant, between 1,500 and 2,300 U/hour heparin IV overlapping a 3‐month treatment with Coumadin, aspirin p.o., and Pyridamol. Results of Strecker (n = 48) versus Schatz‐Palmaz (n = 64) stent: technical success (97% vs 95%); acute thrombosis (13% vs 16%); subacute thrombosis (8% vs 16%); severe bleeding (15% vs 9%); myocardial infarction (2% vs 3%); emergency CABG (6% vs 5%); in‐hospital death (10% vs 6%); restenosis (42% vs 31%); and late death (6–12 months) (6% vs 3%). Conclusion: (1) The Strecker coronary stent can be easily placed even in acute takeoff and tortuous vessels. (2) In bailout situations a high incidence of early thrombotic occlusions sets limits to both stents. (3) We, therefore, recommend urgent bypass operation after stent placement in these patients when the area at risk is large.