[Acute myocardial infarction during labor: report of a case and review of the literature]. / Infarto miocardico acuto durante travaglio di parto: descrizione di un caso e revisione della letteratura.

Acute myocardial infarction in pregnancy is a rare condition with substantial risk of maternal and fetal death. There is very little information about the use in this setting of percutaneous coronary interventional therapy. Together with literature review on this topic, we present the case of a 33-year-old 39-week pregnant woman who sustained during labor an acute transmural anterior myocardial infarction. Immediately after successful cesarean section, she was treated by primary percutaneous coronary angioplasty and direct stenting of the left anterior descending coronary artery with maternal and fetal excellent outcome.

Acute and mid-term results of phosphorylcholine-coated stents in primary coronary stenting for acute myocardial infarction.

The aim of this pilot study was to evaluate the safety and efficacy of the BiodivYsio phosphorylcholine-coated stent in the primary treatment of acute myocardial infarction. The BiodivYsio stent (Biocompatible) is a balloon-expandable stent, laser etched from a 316 L stainless steel tube. This device is coated with phosphorylcholine, a synthetic, hemocompatible phospholipid polymer that has been shown in experimental studies to reduce platelet and protein adhesion to the surface of the metal. One hundred consecutive patients within 24 hr of symptoms of onset of acute MI, treated with primary PTCA, were enrolled. After PTCA, stenting was attempted in all eligible lesions (reference diameter > or = 2.5 mm; no bend lesion > 45 degrees ). Poststenting regimens contained ticlopidine (500 mg/day) and aspirin (325 mg/day) and 6-12 hr of heparin infusion. Procedural success (TIMI > or = II and residual stenosis < 30%) was obtained in 70/74 cases (95%). TIMI grade III was restored in 90% of cases. In the patient group with procedural success (70 cases), 70 BiodivYsio stents were placed. After stenting, diameter stenosis decreased from 96% +/- 11% to 22% +/- 12% (P < 0.01) and minimal luminal diameter increased from 0.13 +/- 0.29 to 2.47 +/- 0.43 (P < 0.01). Nominal stent diameter was between 3.0 and 4.0 mm (mean, 3.5 +/- 0.4 mm). Stent length was between 11 and 28 mm (mean, 17 +/- 4.5 mm). Clinical follow-up was obtained in all patients; angiographic follow-up was performed in 65/70 (93%). No acute or subacute thrombosis was reported. Two in-hospital major adverse cardiac events (MACE) were reported due to a nontreated left main disease that required coronary artery bypass graft (CABG) surgery. At follow-up, MACE were found in 9 of 68 patients (13%), target lesion revascularization (TLR) in 6%, and CABG in the remaining 6%. Primary stenting with phosphorylcholine-coated stent leads to excellent short- and mid-term clinical outcomes and is associated with a restenosis rate of 12%.

Hypothesis and development of a minimally invasive approach for percutaneous transmyocardial revascularization with holmium laser.

BACKGROUND: Percutaneous transluminal myocardial revascularization (PTMR) is a new procedure to improve perfusion of the ventricular wall for patients with intractable angina and untreatable by surgery or conventional catheter-based intervention. Actually PTMR requires femoral approach to utilize 8F-9F system device. We now report the feasibility study of PTMR using a laser delivered through a novel Eclipse system and new 6F and 7F guiding catheters that allow to perform PTMR even in patients with peripheral vascular disease and particularly suitable for alternative small vascular access. METHODS: Percutaneous vascular access for PTMR treatment was obtained via the femoral or radial artery. A 6F or 7F mono-directional catheter carrying flexible fiber optics was used with a Holmium laser (Eclipse system) and was placed across the aortic valve into the left ventricular cavity to create channels of 5 mm in depth from the endocardial surface into the myocardial tissue. From June 1999 to September 2000, 39 patients (28 males, 11 females, mean age 72 +/- 8 years, range 58-86 years) underwent PTMR with the Eclipse system. Preoperative mean Canadian Cardiovascular Society (CCS) angina class was 3.5 +/- 0.5 and previous myocardial procedures had been performed in 39 patients (18 coronary artery bypass graft and 31 coronary angioplasty). RESULTS: The procedure was well tolerated and a procedural success was obtained in all patients (100%). We performed a mean of 19 +/- 7 channels in a mean fluoroscopy time of 21 +/- 9 min. We report only one procedural complication: one embolic stroke (2.4%). No hospital major adverse cardiac events were observed. The average length of hospital stay was 3.1 days. The mean CCS angina class at entry was 3.5 and it declined from 3.5 +/- 0.5 to 1.25 +/- 0.8 at discharge. At the follow-up of 8.2 +/- 3.9 months the mean CCS was 1.5 +/- 0.7. CONCLUSIONS: This experience confirmed the safety and technical feasibility of PTMR with this mini-invasive approach with a reduction in operative and fluoroscopy time. The PTMR with the 6F or 7F guiding catheter is feasible in high risk patients even when the femoral approach is contraindicated. Immediate and short-term results confirm that a clinical improvement is obtained in most patients.

Italian BiodivYsio open registry (BiodivYsio PC-coated stent): study of clinical outcomes of the implant of a PC-coated coronary stent.

UNLABELLED: Rapid technological developments have made new materials available for percutaneous coronary intervention procedures. The coronary stent in particular has undergone progressive structural improvements leading to the recent availability of a third generation of stents, namely, coated stents. The rapid evolution of the stent has often made its evaluation problematical, since trials are frequently confined to small groups of patients in single centers. The purpose of this registry was to verify the safety and efficacy of the BiodivYsio stent (a stent coated with phosphorylcholine polymer) in a broad population of patients who reflect the daily reality of coronary intervention in a cardiac catheterization laboratory. METHODS AND RESULTS: The registry was designed to collect the principal angiographic and clinical data of a consecutive series of Oreal worldO patients. Patients were treated with a BiodivYsio stent (Biocompatibles, Galway, United Kingdom) in 12 centers (11 Italian and 1 Swiss) between January 1998 and January 1999. Procedural, in-hospital, 30-day and six-month follow-up data were collected. The monitoring, data entry and statistical analyses were carried out by an independent center. During the study, 218 patients were enrolled; 165 (76%) male and 53 (24%) female, with an average age of 61.6 +/- 9.4 years (range, 36Eth 84 years). A total of 258 stents were implanted in 233 lesions (1.1 stents per lesion), of which 233 (90%) were the BiodivYsio PC coated stent, the remaining 25 implants were of other stent types. The percutaneous transluminal coronary angioplasty and stenting procedure were carried out in 109 (50%) patients with unstable angina, 65 (30%) with stable angina, 29 (13%) with acute myocardial infarction, and 15 (7%) patients with silent ischemia. Procedural success was achieved in 217/218 (99.5%) patients. Optimal results were achieved in 212 (97.7%) patients. In 34 (15.6%) cases, patients were treated with periprocedural abciximab. During the hospitalization period, one (0.4%) death occurred on day 7 due to subacute occlusion of the stent, and 3 (1.4%) myocardial infarctions were reported. At 30-day follow-up, 211 (97.2%) patients were asymptomatic, as were 189 (87%) patients at clinical follow-up at 6 months. CONCLUSIONS: This study evaluated the safety and efficacy of a third-generation stent. The results demonstrate a high procedural success rate and a low incidence of major adverse cardiac events at short- and medium-term follow-up. It appears that the BiodivYsio stent should be considered safe in clinical and/or anatomical situations with a high risk of complications, confirming the hypothesis that PC may have non-thrombogenic properties. To corroborate these results, an appropriately designed study would be required to measure the stentOs efficacy in the most suitable clinical context, i.e., clinical situations that are at the highest risk of ischemic relapse.

Transcatheter mechanical thrombus aspiration for stent thrombosis.

Currently, in-stent thrombosis is a rare but serious clinical event. The mechanical or pharmacological approach has not totally solved this problem. In this report we describe the treatment of in-stent thrombosis with a new device for mechanical thrombus aspiration. We used the Rescue catheter (Rescue Catheter System, Boston Scientific), a new 4.5F dual lumen monorail catheter that was able to break and aspirate thrombus without evidence of distal embolization. In this case the procedure was quickly performed with good angiographic results after mechanical aspiration and additional traditional coronary angioplasty. Moreover, the excellent clinical outcome confirmed the efficacy of the technique in the percutaneous treatment of this late complication of stent implantation.

Percutaneous transmyocardial revascularization with holmium laser in patients with refractory angina: a pilot feasibility study.

BACKGROUND: Percutaneous transluminal myocardial revascularization (PTMR) is a new procedure to improve perfusion of the ventricular wall for patients with intractable angina that is untreatable by surgery or conventional catheter-based intervention. PTMR allows the creation of myocardial channels through the controlled delivery of holmium laser energy from the ventricular chamber. Preliminary studies in animals and human subject have yielded promising results. We now report the feasibility study of PTMR using a laser delivered through a novel Eclipse system, and we present the results of this sole therapy in patients with severe coronary disease and angina refractory to maximal medical treatment angina (III-IV CCS). METHODS: Percutaneous vascular access for PTMR treatment was obtained via the femoral artery. A 9F directional catheter carrying flexible fiber optics was used with a holmium laser (Eclipse system) and was placed across the aortic valve into the left ventricle cavity to create channels with a depth of 5 mm from the endocardial surface into the myocardial tissue. From April to November 1998, 15 patients underwent PTMR with Eclipse system. Two patients were female; the mean age was 66 +/- 8 (range 59-74). Five patients had a severe LV dysfunction (FE < 30%). Preoperative angina class was III in 10 patients and IV in 5 and previous myocardial procedures had been performed in all patients. RESULTS: The procedure was well tolerated and procedural success was obtained in 14 of 15 patients. There was one myocardial perforation because of guiding-catheter manipulation (pericardial drainage in fourth day). We performed a mean of 13 +/- 4 channels in a mean fluoro time of 23 +/- 11 min. Upon release and during follow-up (5.3 months +/- 4.2, range 2-10), angina class had significantly improved in 14 of 14 patients with complete PTMR treatment, with 4 asymptomatic patients, 6 patients in CCS I, 3 in CCS II, 2 in CCS III and only one patient hospitalized due to angina. CONCLUSION: This pilot study confirmed the safety and technical feasibility of PTMR. Immediate and short-term results confirm that a clinical improvement is obtained in most patients. Although these are early clinical benefits, the true efficacy of this approach will necessarily be defined by a randomized trials with prospectively-defined endpoints and with PTMR compared with medical therapy.

[Primary angioplasty in acute myocardial infarct with or without a stent implant: the experience and results at 6 months in the first 200 patients]. / Angioplastica primaria nell'infarto miocardico acuto con o senza impianto di stent: esperienza e risultati a sei mesi nei primi 200 pazienti.

BACKGROUND: Although it is superior to thrombolysis, primary PTCA does have some limitations, both in hospital (recurrent ischemia and reinfarction due to reocclusion of the infarct-related artery) and at the six-month follow-up (high rate of late restenosis). Coronary stenting is a promising way of solving some of these problems, even if its use in patients with acute myocardial infarction could prove to be controversial because of intracoronary thrombus. In this study, we propose two procedural strategies in the treatment of the infarct-related artery (IRA): the search for optimal angiographic results after PTCA ("stent-like result"--SLR--with residual stenosis < or = 20%--no dissection--TIMI III flow) or intracoronary stenting when SLR was not obtained after a second inflation. METHODS AND RESULTS: From December 1995 to May 1998, 200 patients with AMI underwent direct PTCA or rescue PTCA because of failed thrombolysis. There were 143 men and 57 women, mean age 65 (range 36-84). Nineteen patients were in cardiogenic shock and 25 were in Killip class > II. Recanalization of the IRA was achieved in 196 patients (98%). In four patients, it was not possible to cross total occlusion with the guide-wire. SLR post-PTCA was achieved in 40 patients (20%). Stents were placed in 147 patients (75%), with "elective" implantation in 73 lesions because of suboptimal results after PTCA in 41, and early loss or coronary dissection with threatening occlusion in 33. In nine patients without SLR, stenting was not performed because of diffuse disease of the IRA. In-hospital complications included ten deaths (8 of 19 patients with cardiogenic shock at admission and 2 with multivessel disease and severe left ventricular dysfunction). None of the patients required emergency coronary bypass for procedural complications. One patient had a subacute thrombosis on the third day after bail-out stent implantation (re-PTCA). Five patients required elective bypass surgery to complete revascularization for multivessel disease with ten days after the surgical procedure. At the six-month follow-up, one patient had died of cardiogenic shock. Eleven (5%) patients with bail-out procedures underwent coronary bypass surgery or PTCA. Thirty-one patients (31/168) had recurrence of ischemia: 15 patients in the stent group, 11 in SLR group and 5 in the non-SLR group. Re-PTCA was performed in 20 patients, CABG in five and medical therapy in six. Other patients were angina-free at follow-up. CONCLUSIONS: Based on our experience, seeking optimal angiographic results with or without (SLR) stent implantation is a safe and effective operative approach to achieve the best procedural and clinical outcome and reduce complications in patients undergoing PTCA for AMI.

Transradial approach for coronary procedures: initial experience and results.

BACKGROUND: Due to the recent miniaturization of angioplasty equipment, the transradial approach has gained favor as an alternative catheterization method for coronary procedures. The purpose of this study was to assess the practical clinical application of this method. METHODS: Between June 1997 and February 1998, one operator (MG) attempted the percutaneous transradial approach in 185 consecutive unselected patients with functional radial arch attested using Allen's test. In this series of patients, 102 interventional procedures, balloon angioplasty including stent implantation, were performed with 6F or 7F guiding catheters. RESULTS: Radial arterial punctures for diagnostic procedures were performed in 179 patients with a success rate of 97%. In the six failed transradial accesses, the procedure was performed via the transfemoral route. Balloon angioplasty was performed in 29 patients, 28% (33 lesions), PTCA and stent implantation were performed in 73 patients, 72% (80 lesions). Procedural success was achieved in 100 (98.2%). Two PTCA failed due to the impossibility of crossing a total occlusion. During hospitalization, one patient died of unstable angina and poor left ventricular function 7 days after stenting without stent occlusion at angiography. No major complications related to entry site were observed, and no patients required vascular surgery or blood transfusions. CONCLUSION: This preliminary experience suggests that coronary procedures can be performed safely using the transradial approach. Access-site complications are virtually eliminated and early ambulation may result in a shortened hospital stay and lower hospital costs.

Transcatheter management of cardiac and pericardial metastatic involvement.

We performed percutaneous balloon pericardiotomy and pulmonary valvuloplasty in a woman affected with cardiac and pericardial involvement from a primary pulmonary adenocarcinoma. Pericardial window was indicated for a recurrent, symptomatic, pericardial effusion. Valvular stenosis was severe and related to metastatic infiltration of cardiac tissue. Open surgery was avoided and the procedures were completed in two steps under local anesthesia in less than 60 min. The patient had no recurrence of pulmonary stenosis or pericardial effusion at 7 months post treatment. Transcatheter techniques are successful in helping to manage malignant diseases with cardiac metastasis, particularly in critically-ill patients. It may become the preferred treatment for avoiding a more invasive procedure for patients with a limited life expectancy.

[Non-cardiac transcatheter intervention: operative possibilities in a hemodynamics laboratory]. / Interventistica transcatetere non cardiaca: possibilità operative in un Laboratorio di Emodinamica.

INTRODUCTION: New possibilities for transcatheter treatment of the cardiovascular system are guaranteed with the improvement of materials and the availability of new devices. Nevertheless, a rationalization of the potential activity in this sector seems to be necessary, and it could arise through the presence of Catheterization Laboratories "open" to diagnostic procedures and therapy that are not confined to the coronary system. This clinical study reports the experiences and results of our work in this field. MATERIALS AND METHODS: During the period from May 1995 to May 1997, our laboratory performed 205 diagnostic procedures that did not involve the coronary system. Based on this diagnostic work, there emerged 91 cases with an indication for transcatheter intervention, which was subsequently performed at our laboratory. There were 68 peripheral angioplasty procedures on the iliofemoral axis, 2 angioplasties of the subclavian artery, 8 of the renal artery, 2 procedures involving the treatment of A-V fistulas, one case of femoral pseudoaneurysm treatment and 10 cases of transcutaneous pericardiotomy performed with a balloon catheter. All the procedures were performed by our laboratory staff using materials that are normally at our disposal. RESULTS: Successful results were obtained in 65 out of the 68 peripheral angioplasty procedures and in all of the 8 renal and 2 subclavian angioplasties. The positioning of the endoprosthesis for the closure of the A/V fistula was effective in one of the two cases. The transcatheter treatment of the femoral pseudoaneurysm was successful. In all cases where a pericardiotomy was performed with a balloon catheter, there was no reoccurrence of cardiac tamponade during the follow-up period. No complications were noted as a result of any of the procedures. CONCLUSIONS: Our experience documents how it is possible to increase the diagnostic and therapeutic options in a Catheterization Laboratory. However, willingness on the part of the staff to update their skills continually and collaborate with other specialists is necessary in order to maintain optimal operative standards.

[Coronary stenting for treatment of intimal dissection and occlusive thrombosis during primary PTCA in acute myocardial infarction]. / Stent coronarico per il trattamento di dissezione intimale e trombosi occlusiva durante PTCA primaria nell'infarto miocardico acuto.

Coronary angioplasty during acute coronary syndrome, and particularly in MI, continues to involve a greater risk of acute and subacute occlusion. Stenting for acute or threatened vessel closure has a high initial success rate and reduces the need for emergency bypass surgery. Nevertheless, under these conditions intracoronary thrombus actually appears to be a relative contraindication to stent implantation. We report the successful implantation of two Palmaz Schatz stents to treat a coronary occlusion refractory to multiple ballooning during primary PTCA in myocardial infarction with angiographic evidence of intimal dissection containing thrombus. The good clinical improvement and the results of short- and long-term clinical angiographic follow-up confirm both the feasibility and effectiveness of using this technical approach to manage complications in acute and unstable syndromes.

"Functional myocardial bridging" and "hyperkinetic state": a rare association as a cause of acute myocardial infarction.

An 82-year-old female was admitted to the catheterization laboratory for investigation of acute antero-lateral myocardial infarction with evidence of severe left ventricular dysfunction. Angiographically, she was found to have normal coronary arteries, with the exception of the presence of myocardial bridging in the left anterior descending coronary artery. This was recognized as a "functional" variation of anatomical bridging, in which a systolic coronary compression is caused by abnormal muscular septal hypertrophy. We describe this condition as an unusual cause of myocardial infarction and outline its treatment with beta-blockade therapy, using only esmolol, an ultra-short-acting drug. The patient recovered successfully, with complete recovery of ventricular function and the disappearance of this "functional condition", as shown in an angiographic check-up done prior to hospital discharge. A subsequent long-term follow-up was favorable.

[Clinical experience with the use of implantable vascular systems in advanced heart failure]. / Esperienza clinica di utilizzo dei sistemi per accesso vascolare impiantabili nelle cardiopatie in stadio avanzato.

BACKGROUND: Patients with end-stage cardiomyopathy frequently require acute or chronic infusional treatments and long hospitalization. Availability of a simple and safe vascular access is a true necessity for these patients, especially in case of inotropic or diuretic outpatient treatment. In this study we have evaluated the usefulness and the applicability of implantable vascular access in the management of end-stage cardiomyopathy. Technical problems and both short and long term complications have been analysed. METHODS: Nineteen implantable vascular system (16 Port-A-Cath, Pharmacia; 3 Celsite, Bruneau) have been implanted in a group of 15 patients with end-stage cardiomyopathy. All patients had been previously hospitalized and needed prolonged infusional therapy. Implantation was performed in local anaesthesia with technique derived from pace-maker implantation. RESULTS: All the interventions were well tolerated, average procedural time was 30 min (range 20-60 min). No procedural complications occurred. Re-implantation of the system was required in 2 patients due to catheter thrombosis, In 1 patient due to catheter rupture caused by wrong positioning of infusion needle, and in 1 patient due to inflammatory reaction. In 2 further cases catheter thrombosis was treated with local infusion of urokinase. In 1 patient the catheter was repositioned after dislocation. The average in situ permanence of the systems was 8 months (range 15 day-18 months). CONCLUSIONS: Vascular implantable systems have proved useful and easily applf1p4e in the management of patients with end stage cardiomyopathy. After training some of the implied complications are easily avoidable. The use of this device has concurred to reduce duration and frequency of hospitalizations.

Percutaneous balloon pericardiotomy for malignant pericardial tamponade.

Recurrent pericardial effusion or tamponade can complicate malignant disease. The medical approach with pharmacologic agents has a high recurrence rate. Balloon pericardiotomy (BP) may provide a less invasive alternative to surgery. We performed BP in ten high-risk patients with malignant pericardial tamponade (MPT). BP was performed with aseptic technique under fluoroscopic and echocardiographic guidance. We used a percutaneous subxiphoid approach. A 20- to 25-mm-wide and 4-cm-long balloon was introduced over a stiff guide wire, positioned across the parietal pericardium, and manually inflated until the waisting disappeared. Echocardiographic study and chest radiograph were taken before, immediately after the procedure, and during follow-up. The procedure was successful and well tolerated in all patients. There were no immediate or late complications. No patients developed recurrence of pericardial effusion at up to 10 months' follow-up. In conclusion, BP can be performed in patients with MPT with high rate of procedural success. It may become the preferred treatment to avoid a more invasive procedure in these critically ill patients.

Balloon expandable stent implantation after iatrogenic arterial dissection of the left subclavian artery.

A patient undergoing attempted angioplasty of a left internal mammary artery graft to left anterior descending coronary artery developed an iatrogenic dissection of the left subclavian artery, with symptoms of left arm claudication. A balloon expandable stent was inserted with an excellent angiographic result. The patient has remained free of symptoms or signs of decreased arm flow, with a patent subclavian artery demonstrated on angiography 8 months later. The excellent early-to-moderate term clinical and angiographic results support the efficacy of this technical approach.

[The use of myoglobin for the early diagnosis of reperfusion in acute myocardial infarct]. / Impiego della mioglobina per la diagnosi precoce di riperfusione nell'infarto miocardico acuto.

Myoglobin (Mb) is an intracardiac protein known to be rapidly released after onset of reperfusion. The new automated latex-enhanced nephelometric immunoassay is an interesting fast alternative to the other methods. Therefore we sought to assess the accuracy of rapid rise of Mb concentration to predict the success of reperfusion. Thirty consecutive patients, admitted to the coronary care unit for first acute Q-wave myocardial infarction, were prospectively studied. They underwent thrombolysis 126 +/- 45 min (range 30-180) after onset of symptoms. Mb determinations were obtained before starting therapy and, thereafter, hourly for 5 hours, and after 8 and 12 hours. The usual non invasive markers of reperfusion were considered, and coronary arteriography was performed in all patients at 5.5 +/- 0.9 days (range 1-6). In 23 patients (77%) patent infarct-related artery (IRA) (TIMI II-III) and in 7 (23%) occluded IRA (TIMI 0-I) was observed at coronary arteriography. We modified the judgment in 3 cases (10%) with occluded IRA. All reperfused patients (Group A) showed a rapid rise of Mb concentration with a mean time to peak occurring 133 +/- 80 min (range 60-180) after therapy. Mean value of unreperfused patients (Group B) was 330 +/- 173 min (range 180-420). We retrospectively stated a time to peak of Mb concentration within 180 min as diagnostic threshold for reperfusion. Sensitivity was 100%, specificity 50%, positive predictive value 93%, negative predictive value 100%. The results of this study confirm that Mb release kinetics may play an interesting role in the early prediction of patency of IRA in acute myocardial infarction after thrombolysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary stenting: single institution experience with the initial 100 cases using the Palmaz-Schatz stent.

We studied 100 patients who had coronary implantation of Palmaz-Schatz stents in our institution from November 1989 until March 1991. A total of 126 standard and 6 short stents were implanted. The patients' mean age was 58 +/- 5 years, and 97 were males. The indications were lesions with high risk of restenosis (29 patients), restenosis (27 patients), suboptimal result of angioplasty (24 patients), dissection (16 patients), and recanalized chronic total occlusion (6 patients). In 17 patients a brachial cut-down approach was used. Stents were correctly placed in 98 patients. Stent related complications occurred in 9 patients: major ischemic complications in 7 patients (acute myocardial infarction in 2 patients, emergency bypass surgery in 3 patients and emergency angioplasty in 2 patients); in 3 of these patients there was a subacute closure of the stent and in 2 patients there were delivery problems. Vascular complications at the site of arterial puncture occurred in 3 patients (some patients had more than one complication). A learning curve was observed. There was a decrease in the complication rate with the higher number of patients treated: 28% for the first 50 patients and 6% for the last 50 patients. Clinical follow-up was available in all patients. Of the 92 patients eligible for follow-up (7 +/- 2 months), 69 patients were asymptomatic and 23 had recurrence of angina: 19 patients for stent restenosis and 4 patients for coronary artery disease progression. Follow-up angiogram was done in 79/92 (86%) patients: 21 had restenosis (27%).(ABSTRACT TRUNCATED AT 250 WORDS)

Coronary stenting with a balloon-expandable stent after the recanalization of chronic total occlusions.

To diminish the restenosis rate after successful recanalization of chronic total coronary occlusion, we have implanted the Palmaz-Schatz stent in 6 patients. All procedures were successfully done without major complications. The angiographic follow-up at 6 months showed restenosis in one asymptomatic patient who had had 2 stents implanted. Five other patients had no evidence of restenosis.