Intracoronary stent implantation in Jamaica: the initial experience

Intracoronary stent implantation resulted in the complete or near complete dilatation of high gread occlusions of the left anterior descending coronary arteries in the four patients in whom it was undertaken. Intracoronary stent implatation is a useful adjuct to Percutaneous Transluminal Angioplasty (PTCA) and is applicable in selected patients with symptomatic ischaemic heart disease in a developing country with limited health resources like Jamaica. This is so since financial data presented here document the significant savings this technique (when appropriately utilised) could realise compared to the use of baloon angioplasty alone. (AU)

Stenting of partial and total cornary occlusions in Trinidad and Tobago

In order to evaluate the efficacy and safety of coronary stenting, we reviewed the first 32 consecutive patients (34 vessels) who underwent elective coronary stenting during the period August 1999 to August 2000 inclusive at the Digital Lab installed at the Eric Williams Medical Complex, Trinidad and Tobago. Aspirin, heparin and ticlopidine were used routinely. Abciximab was used in selected cases (38 percent). The mean age of patients was 55 ñ 10 years. Eighty-one percent were male, 52 percent were hypertensive and 21 percent diabetic. Sixty-five percent had severe angina. Prior Coronary Artery Bypass Grafting (CABG) was performed in 3 percent and previous Percutaneous Transluminal Coronary Angioplasty (PTCA) in 3 percent. Multivessel disease was present in 43 percent. The mean left ventricular ejection fraction was 53 ñ 12 percent. The culprit lesion was located in either the native left anterior descending (LAD) coronary artery (53 percent), right coronary artery (RCA) (31 percent), circumflex artery 13 percent and saphenous vein graft (3 percent). The mean baseline diameter stenosis was occluded vs 50 percent for 8 totally occluded vessels. For the total occlusions, procedural sucess was inversely related to the duration of the occlusion. There were no cases of death, acute vessel closure, Q-wave myocardial infarction, repeat PTCA or emergency Coronary Artery Bypass Graft (CABG) during and following the procedure. Distal embolization occurred in one patient. The mean duration of hospital stay was one day (for 30 outpatient cases). One patient had recurrence of symptoms with a negative stress test. No patient underwent repeat angiography during the first year of follow-up. Coronary stents were successfully implanted at a tertiary care facility in the Caribbean with low in-hospital morbidity and mortality. Stents markedly reduced the diameter stenosis of the coronary lesion during PTCA. The incidence of clinical restenosis was low. Coronary revascularisation can be successfully achieved by coronary stenting in the Caribbean (AU)

Coronary stents: a safe and effective intervention for treating coronary artery disease

Percutaneous Transluminal Coronary Angioplasty (PTCA) is a less invasive form of coronary revascularisation than Coronary Artery Bypass Grafting (CABG). The major limitation of PTCA is renarrowing of the dilated lesion (restenosis), which may occur in up to one-third of cases. Stents are the only new devices proven to lower the restenosis rate. To evaluate the efficacy and safety of coronary stent implantation, we reviewed the charts of the first 121 patients (133 stents) undergoing coronary stenting using the J & J Stent at Emory University Hospital. Age of the patients studied (yrs; mean ñ SD) was 60.5 ñ 10.5. 77 percent were male, 46 percent were hypertensive and 27 percent were diabetic. 82 percent had class 3 or 4 angina. Prior surgical revascularisation was performed in 66 percent, previous PTCA in 55 percent and previous PTCA to stented vessel in 19.5 percent. Multivessel disease was present in 74 percent. The mean ejection fraction was 52 ñ 11.8 percent. The target lession was located in- a saphenous vein graft in 60.3 percent. The mean baseline diameter stenosis was 80.2 ñ 11.2 percent and this was reduced to 8.8 ñ 8.2 percent after stenting. The stent/s were successfully deployed in 98.6 percent of cases. In hospital clinical success was defined as procedural success in the absence of in-hospital death (0.8 percent), Q-wave myocardinal infarct (MI) (1.7 percent), repeat PTCA (3.3 percent), or emergent CABG (2.5 percent). At a mean follow up of 2.5 years the incidence of death was 11 percent, subsequent MI (15.2 percent), CABG (26.6 percent) and repeat PTCA (39.6 percent). Restenosis was defined as more than 50 percent residual diameter stenosis of the previously dilated coronary segment on follow up angiography. Follow up angiography was performed in 34 of the 121 stented patients because of recurrence of symptoms or a positive stress test. 16 patients had restenosis (15 percent of 121 patients). Coronary stents can be successfully implanted with low hospital morbidity and mortality. Stents markedly reduce the diameter stenosis of the coronary lesion during PTCA. The incidence of restenosis after stenting is low.(AU)