Following initiation of a dedicated program with implementation of quality and performance guidelines, complex CTO revascularization may be safely performed with outcomes comparable with reports from established centers. Despite higher resource utilization, CTO revascularization is associated with a positive contribution margin. Requirement of educational and performance standards, mentorship from experts, consensus review for appropriateness and provision of catheterization laboratory policies may represent a model for program development.

Late stent thrombosis has not been reported in the absence of prior coronary brachytherapy. We reviewed our experience in 1,855 consecutive patients who received at least one stent and did not receive coronary brachytherapy. Half of all stent thromboses occurred within the first week and nearly 65% (22) occurred within 15 days. The incidence of stent thrombosis within this traditional time frame was 1.2%. An additional 12 patients, however, presented with stent thrombosis between 33 and 270 days post-procedure (mean ‫؍‬ 72.9 ؎ 23 days). The true incidence of stent thrombosis was therefore 1.8% (34/1,855). There were three bypass operations, one stroke and two deaths in the late stent thrombosis group. Late stent thrombosis is an unusual but serious complication in patients who have not received coronary brachytherapy. Intracoronary radiation may potentiate a phenomenon that already occurs after stent deployment. Prolonged treatment (6 -12 months) with anti-platelet agents should be considered after percutaneous intervention with coronary stents. Cathet Cardiovasc Intervent 2001;53:23-28.

Late stent thrombosis has not been reported in the absence of prior coronary brachytherapy. We reviewed our experience in 1,855 consecutive patients who received at least one stent and did not receive coronary brachytherapy. Half of all stent thromboses occurred within the first week and nearly 65% (22) occurred within 15 days. The incidence of stent thrombosis within this traditional time frame was 1.2%. An additional 12 patients, however, presented with stent thrombosis between 33 and 270 days post-procedure (mean = 72.9 +/- 23 days). The true incidence of stent thrombosis was therefore 1.8% (34/1,855). There were three bypass operations, one stroke and two deaths in the late stent thrombosis group. Late stent thrombosis is an unusual but serious complication in patients who have not received coronary brachytherapy. Intracoronary radiation may potentiate a phenomenon that already occurs after stent deployment. Prolonged treatment (6-12 months) with anti-platelet agents should be considered after percutaneous intervention with coronary stents.