Elective intracoronary Micro-Stent II implantation without quantitative coronary angiography or intravascular ultrasound guidance and without subsequent anticoagulation: short- and long-term results.

Intracoronary stenting has been shown to reduce acute closure and restenosis rate in patients treated with coronary angioplasty. The use of high inflation pressures and intravascular ultrasound guidance allowed the substitution of anticoagulants with antiplatelet agents but increased the cost. The aim of this study was to investigate the effectiveness, safety, and long-term outcome of the elective implantation of a relatively new type of stent (Micro-Stent II), without the use of quantitative coronary angiography or intravascular ultrasound guidance and without subsequent anticoagulation. The study included 361 patients who underwent elective microstent implantation. Stent expansion was performed at 8 atm followed by higher inflation pressure at 14-20 atm. Heparin was given intraarterially only once immediately after the arterial sheath insertion. Ticlopidine was started at least 48 hours before the procedure and continued for 1 month while aspirin was continued indefinitely. All patients were followed up for 12.9 +/- 3.6 months. Short term outcome (first month): Stent implantation was successfully achieved in 361 of 366 patients (98.6%). Seven patients (1.9%) were excluded from the study and received anticoagulants because of a suboptimal result. In total, 423 stents were implanted. There was no subacute thrombosis, but acute vessel closure occurred in one patient (0.3%). Non-Q wave myocardial infarction occurred in six patients (1.7%), Q wave myocardial infarction occurred in one patient (0.3%), and only one death (0.3%) of nonischemic origin was reported. No major peripheral vascular complications were observed. Late results: Q or non-Q wave infarction occurred in 13 patients (3.6%), 26 patients (7.2%) underwent a repeat angioplasty, eight patients (2.2%) underwent coronary artery bypass grafting, and four patients (1.1%) died. Overall, 284 patients (78.7%) were free of symptoms, while 77 (21.3%) had recurrent coronary ischemia. In conclusion, Micro-Stent II implantation without quantitative coronary angiography or intravascular ultrasound guidance and without anticoagulation was found to be effective, safe, and with good long-term outcome.

Angioplasty followed by coronary stenting at the anastomotic site of saphenous vein bypass graft with the native vessel: a case that needs special procedural strategy.

In this report we describe a case in which a saphenous vein graft stenosis at the site of anastomosis with the left anterior descending artery (LAD) was dilated with a special Controlled Angioplasty Technology (CAT) balloon, and then stented. Balloon angioplasty and stenting at the site of anastomosis represents a technical problem because of diameter discrepancy and needs special attention in order to avoid minor or major complications.

Angioplasty without the use of "Y connector": a new, easier, bloodless method.

The "Y connector" that is used in angioplasty has the following disadvantages: 1) it is not blood-tight; 2) we need to "screw and unscrew" every time we want to inject contrast material or measure the pressure; and 3) it does not allow the advancement of the guidewire or the balloon catheter during the injection of contrast material. We created a new type of connection composed of a cut sheath for the femoral artery, connected with a cut (at the "hub") guiding catheter. The aim of this study was to examine the feasibility, efficacy, and safety of the new method. Using the new technique we performed plain-balloon angioplasty, implantation of stent, and atherectomy in 350 patients. The technical success of the method was 100%, and no complications related to the method were seen. In conclusion, the novel connection that we created eliminated all the disadvantages of the "Y connector" and was found to have 100% technical success and safety.