Clinical experience with the Palmaz-Schatz coronary stent. Initial results of a multicenter study.

Abstract

Stenting of native coronary arteries with a balloon-expandable stent was attempted in 226 patients after elective angioplasty. Delivery of the device was successful in 213 (94%) of the patients. Of these, 39 received aspirin and dipyridamole only (group 1) and 174 received aspirin, dipyridamole, and warfarin for 1-3 months (group 2). There was no abrupt closure (c1 day) or perioperative death in either group. In-hospital or perioperative complications in group 1 compared with group 2 were as follows: subacute closure (1-14 days), seven (18%) patients versus one (0.6%) patient, respectively, p<0.0001; myocardial infarction, five (13%) patients versus one (0.6%) patient, respectively; condition requiring urgent bypass surgery, one (2.5%) patient versus no patients, respectively. Thus, the incidence of major complications such as death, myocardial infarction, or a condition requiring urgent bypass surgery was 15% in group 1 and 0.6% in group 2. Clinical follow-up revealed that 92% of the patients were asymptomatic at 3 months after stenting compared with 6% before stenting (p<0.0001). Of the 13 patients who were symptomatic, nine underwent cardiac catheterization and, ultimately, successful elective coronary angioplasty or bypass surgery. We conclude that a high delivery success rate can be expected with this device and that clinical thrombosis is less frequent in anticoagulated patients than in nonanticoagulated patients. Furthermore, in this selected patient population, coronary stenting results in a low incidence of in-hospital and perioperative complications. Clinical success, defined by absence of symptoms, appears to be sustained at 3 months. (Circulation 1991;83:148- From the Cardiology Division of the Arizona Heart Institute Foundation (R.A.S, R.P., I.M.P., S

Stent Thrombosis in the Modern Era

“…For clinically defined stent thrombosis events, the associated 6-month mortality was 20.8%. These findings are consistent with the disastrous consequences of stent thrombosis reported in early studies 1,6,19,21,23,24 and are somewhat surprising because stent thrombosis events in our study patients were much more likely to occur while patients were still hospitalized. This is consistent, however, with a report by Hasdai et al 25 that showed poor clinical outcomes despite prompt restoration of blood flow after stent thrombosis.…”

Coronary artery bypass grafting versus percutaneous intervention in coronary revascularization: a historical perspective and review

“…The use of warfarin was found to significantly reduce rates of subacute occlusion (0.6%). 30 In this era, bleeding and vascular complications associated with the escalation of anticoagulant regimens significantly limited the use of PCI. In 1995, the importance of high-pressure post-dilation was recognized, informed by the use of intracoronary ultrasound, and this optimization of stent deployment allowed the use of less aggressive anticoagulation with aspirin and ticlopidine (replacing warfarin and dypyridamole).…”

A Discussion of the Role of Complex Evolved Systems in the Development of Invasive Cardiovascular Interventions as Illustrated by the Blalock- Taussig Shunt and Intra-Arterial Stents

“…[249,250]. This stent was subsequently modified to the Palmaz-Schatz stent, a heparin-coated stent [251][252][253]. The heparin-coated stent was superior to the BMS [254] but would ultimately be replaced by the drug eluting stent (DES).…”