Incidence, management, and outcome of stent loss during intracoronary stenting

Autor: Albrecht Vogt, Conrad Pfafferott, Heinz-Jürgen Engel, Ulrich Neumann, Johann Bolte, K. v. Olshausen, H C Mehmel
Rok vydání: 2001
Předmět:
Zdroj: The American journal of cardiology. 88(5)
ISSN: 0002-9149
Popis: C stent embolization is an uncommon but potentially hazardous complication of percutaneous transluminal coronary angioplasty (PTCA). Previous small-sized clinical studies reported incidence rates ranging from 0.9% to 8.4%.1–5 In this study we report the incidence, management, and hospital follow-up of a large, consecutive series of patients with coronary stent embolization. • • • The German registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausarzte includes prospectively all PTCA procedures from 74 centers since October 1992. The organization of the registry has been published elsewhere.6 Two audit visits per year ensured the completeness of the data including complications. From August 23, 1995, to June 28, 1997, a total of 56,807 PTCA procedures were registered. In 20,298 patients, $1 stents were implanted (implantation rate 35.7%). A total of 25,558 stent implantations resulted in 1.26 stents per procedure. Four hundred twenty-nine lost stents were documented and were analyzed retrospectively by a detailed questionnaire. The clinical follow-up on 18 patients was incomplete or not available. Thus, the study presents data of 411 stent embolizations in 387 patients involving 96% of all stents lost (Table 1). During the same time interval, similar data from 19,869 consecutive patients having undergone stent procedures without embolization were collected; these patients served as a control population to the lost stent cohort. The outcomes of interest were all-cause mortality, nonfatal acute myocardial infarction (AMI), the need for coronary artery bypass graft (CABG) surgery, and noncoronary sequelae after stent embolization. Continuous variables are expressed as mean 6 1 SD. The likelihood ratio test as chi-square test was used to test homogeneity; the significance was calculated by Fisher’s exact test. A 2-tailed p value ,0.05 was considered significant. Baseline characteristics of patients who had stent embolization are detailed in Table 1. On the basis of 25,558 implanted stents and 20,298 treated patients the incidence of stent loss amounted to 1.7% per implanted stent and 2.1% per treated patient. Patients with stent loss were older than patients without stent loss (64.4 6 9.2 vs 60.7 6 9.7 years; p ,0.001). Angiographic characteristics, target lesions, and technical approach are listed in Table 2. A multiple group comparison identified 3 groups of target lesions: stent embolization in the left anterior descending coronary artery was underrepresented, whereas embolization in the left main coronary artery was overrepresented. Stents placed in the left circumflex artery, right coronary artery, and bypass graft showed average rates of embolization (p ,0.0001). The number and type of lost stents are detailed in Table 3. For statistical purposes only, stent types with .1,000 implantations were considered. The 4 major stent types, Palmaz-Schatz, Micro-stent, MultiLink, and Wiktor (68.1% of implantations) were composed of 6.9% of lost stents. However, 3 groups of stent embolization rates could be distinguished. Manually crimped Palmaz-Schatz and Wiktor stent embolized most often, whereas the MultiLink stent embolized least. The Micro, Pura, Nir, and Sitomed stent showed average rates of stent embolization (p ,0.001). The causes of stent loss, their location, and management are presented in Table 4. The operator tried to retrieve the embolized stent in 63% of cases. However, only 118 stents (29%) could be retrieved. In 36 cases (9%) the guiding catheter sprung uncontrollably into the aortic root during catheter manipulations pulling the stent-balloon assembly together with the guidewire outside the coronary artery. In 4 cases an inserted stent was displaced when it was crossed by a second stent. In another 4 cases a second stent embolized while crossing an already deployed stent. Only 1 embolization was due to balloon rupture. The stent was lost within the coronary arteries in 45% of cases and outside the coronary arteries in the remainder. Eighty-two embolized stents were successfully implanted or fixed in a site initially not selected From the General Hospital Hamburg-Altona; Klinikum Ingolstadt; Klinikum Kassel; Zentral-Krankenhaus Links der Weser Bremen; and Stadtische Kliniken Karlsruhe, Hamburg, Germany. Dr. von Olshausen’s address is: 3rd Medical Department, Cardiology, General Hospital Hamburg-Altona, Paul-Ehrlich-Strasse 1, D-22763 Hamburg, Germany. E-mail: klausvo@t-online.de. Manuscript received November 24, 2000; revised manuscript received and accepted April 11, 2001. TABLE 1 Characteristics of 387 Patients With Stent Loss
Databáze: OpenAIRE
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