Coronary stenting during rescue angioplasty after failed thrombolysis

Moreno, Raúl; Garcı́a, Eulogio; Abeytua, Manuel; Soriano, Javier; Elı́zaga, Jaime; Botas, Javier; López‐Sendón, José‐Luis; Delcan, J. L.

doi:10.1002/(sici)1522-726x(199905)47:1<1::aid-ccd1>3.0.co;2-2

Cited by 24 publications

(12 citation statements)

References 24 publications

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“…One prior report of 20 patients undergoing rescue stenting reported one possible stent thrombosis [27]. Similarly, our stent cohort had only one presumed stent thrombosis despite the possibility of increased platelet activation in the setting of acute myocardial infarction and thrombolysis [10,11].…”

Section: Discussionmentioning

confidence: 93%

“…The rate of bleeding complications did not differ between the balloon angioplasty and stenting groups despite the more frequent use of additional anti-platelet therapy in the stent group. The rate of severe bleeding complications and vascular repair (Ͻ3%) was low despite the use of delayed, full dose abciximab in 29% of rescue coronary intervention patients, which differs from two prior small series suggesting that the delayed use of abciximab after thrombolysis is contraindicated [27,28]. Although the simultaneous use of thrombolytics and abciximab is being extensively studied in trials such as TIMI 14 [29], the delayed use of full dose abciximab in rescue coronary intervention may warrant further study as well.…”

Section: Discussionmentioning

confidence: 99%

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Angiographic and clinical outcomes after rescue coronary stenting

Dauerman¹,

Prpic²,

Andreou³

et al. 2000

Cathet. Cardiovasc. Intervent.

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The role of coronary stenting in improving outcomes after failed thrombolysis has not been well described. This study represents a registry of rescue coronary interventions performed during a 3 year period in which interventional treatment was changing for this high risk population. We analyzed acute angiographic results and clinical outcomes in 108 consecutive patients treated for thrombolytic failure with either balloon angioplasty (n = 63) or coronary stenting (n = 45). The overall in-hospital mortality rate was 5.5%, and there was no increase in complications in the stent group. Coronary stenting was associated with improved angiographic results including lower residual stenosis in the culprit artery (15 +/- 10% vs. 31 +/- 22%, P < 0.001) without increasing bleeding complications. The rate of in-hospital and long term target vessel revascularization in the stent group was significantly lower than in the unmatched PTCA group. Rescue coronary stenting is safe, improves acute angiographic results compared to PTCA alone and leads to excellent in-hospital and long term outcomes.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Angiographic and clinical outcomes after rescue coronary stenting

Dauerman¹,

Prpic²,

Andreou³

et al. 2000

Cathet. Cardiovasc. Intervent.

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“…Nevertheless, in-hospital mortality rates of 6 to 10% were reported with uncoated stents in recently published studies, in which cardiogenic shock patients were not included. 17,18) Systemic heparin use probably was necessary after rescue coronary stenting with a heparin-coated stent to minimize the thrombotic stent occlusion in patients with failed thrombolysis in acute myocardial infarction. Severe bleeding complications did not occur despite concomitant tirofiban administration in 41% of the patients.…”

Section: Discussionmentioning

confidence: 99%

“…Recently published reports have suggested that stent implantation during rescue PTCA after failed thrombolysis is feasible and safe and associated with a good clinical outcome. 18,21) Dauerman, et al analyzed the angiographic and clinical outcomes in patients treated with either balloon angioplasty or coronary stenting for thrombolytic failure. 8) Acute stent thrombosis was reported in one of the 45 patients (2.2%), a finding similar to our registry.…”

Section: Discussionmentioning

confidence: 99%

Rescue Coronary Stenting with Heparin-coated Jostents for Failed Thrombolysis in Acute Myocardial Infarction

et al. 2003

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SUMMARYThe aim of the present study was to assess the procedural safety and in-hospital and long-term effectiveness of heparin-coated Jostents after failed thrombolysis in acute myocardial infarction. We prospectively analyzed the acute and long-term clinical and angiographic outcomes of 35 consecutive patients treated with heparin-coated Jostents for thrombolytic failure. Rescue coronary stenting was successful in 34 of 35 patients (97%). Thrombolysis in Myocardial Infarction flow grade 3 was obtained in 31 patients (88.5%). The only patient with procedural failure died from cardiogenic shock a day after the procedure. One patient (2.8%) underwent an emergency coronary bypass operation because of angiographic evidence of stent thrombosis with re-infarction. During in-hospital follow-up, 2 patients (5.7%) underwent an elective coronary bypass operation after successful stent implantation of the infarct-related artery because of existing severe multivessel coronary artery disease. Minor bleeding complications at the vascular access site occurred in 3 (8.6%) patients. No cerebrovascular or any other major bleeding complication occurred. One patient (2.1%) underwent repeat coronary angioplasty for restenosis and an elective coronary artery bypass operation was performed in one patient (2.8%) during the 294 ± 150 days follow-up. The rate of target vessel revascularization was 14.3% and the event-free survival rate was 80%. Twenty-six patients (90%) had angiographic follow-up at six months, and stent restenosis was found in 5 (19.2%). This study demonstrates that heparin-coated Jostents are safe, with low in-hospital and long-term mortality rates for the treatment of failed thrombolysis in acute myocardial infarction. The angiographic restenosis and target vessel revascularization rates of this registry are also acceptable. (Jpn Heart J 2003; 44: 335-345)

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“…Por exemplo, em 1999, um pequeno estudo espanhol, com 20 pacientes submetidos a ATC de resgate com stent convencional, obteve resultados satisfatórios em seguimento de seis meses, mas a taxa de sangramento foi um obstáculo à exeqüibilidade da estratégia 19 .…”

Section: Indicaçõesunclassified

Angioplastia de resgate no infarto agudo do miocárdio

Moraes¹,

Carvalho²

2007

Rev. Bras. Cardiol. Invasiva

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Background: Acute myocardial infarction is a serious and frequent illness, and its treatment with thrombolytic therapy or percutaneous coronary intervention (PCI) is well established. Rescue PCI is an alternative when thrombolysis fails. In the last ten years several clinical studies have tested different features about this procedure. Methods: Eighty four studies about rescue angioplasty published in the major cardiovascular relevance literary sources were analyzed between 1997 to 2007. Results: Rescue PCI was superior to conservative treatment, such as rethrombolysis, when well indicated, and seemed similar to primary PCI, in some features. The concomitant use of GPIIb/IIIa inhibitors seemed to show clinical benefits. The use of drug-eluting stents and the association with mechanic thrombectomy still requires better scientific support. The latest metaanalysis about this topic have shown clear favorable results to rescue angioplasty according to clinical outcomes, heart failure and re-infarction, but not so definite results as to mortality. On the other hand, there was a trend of increased stroke risk, of the same magnitude as benefit. Conclusion: Rescue PCI has better results than conservative treatment or repeat fibrinolysis. However, the indication of the procedure still needs more precise selection criteria as well as better definition of the clinical benefit/safety ratio. These uncertainties persist due to the small number of rescue angioplasty procedures compared to the total number of angioplasties performed. In the CENIC Registry, rescue angioplasty amounts to 4% of all angioplasties performed.

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Coronary stenting during rescue angioplasty after failed thrombolysis

Cited by 24 publications

References 24 publications

Angiographic and clinical outcomes after rescue coronary stenting

Angiographic and clinical outcomes after rescue coronary stenting

Rescue Coronary Stenting with Heparin-coated Jostents for Failed Thrombolysis in Acute Myocardial Infarction

Angioplastia de resgate no infarto agudo do miocárdio

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