Acute and Long-Term Results of Intracoronary Stent Implantation Without Conventional Anticoagulation

The implantation of stent is coronary arteries has been shown to reduce both acute complications and restenosis rate. However, clinical use of intracoronary stents increases the risk of subacute stent thrombosis and hemorrhagic complications associated with the anticoagulant regimen. To reduce these complications, the hypothesis that systemic anticoagulation is not necessary when adequate stent expansion is achieved by high pressure balloon dilatation and also when ticlopidine and aspirine antiplatelet regimen is used after stent implantation was prospectively evaluated on a consecutive series of patients who were performed intracoronary stents. From December 1994 to October 1996, 284 patients underwent intracoronary stent implantation. Stent delivery was successful in all patients, and the procedural success rate was 99.3%. Event-free outcome at 1- month was achieved in 277 (97.2%) patients. Major cardiac events were subacute thrombosis in 2 patients (0.7%), including death in 2 (0.7%), acute myocardial infarction in 3 (1.0%). Vascular complications that required transfusion, surgical repair, or both occurred in 8 (2.8%) patients. At 7-month clinical follow-up of 195 of 284 patients, there was a 0.5% incidence of death, a 1.0% incidence of myocardial infarction, a 5% rate of coronary bypass surgery, and a 11% rate of repeat angioplasty for symptomatic restenosis. These results suggest that adequate stent expansion with the use of high pressure balloon dilatations and the use of poststenting ticlopidine/aspirine antiplatelet treatment can significantly reduce the rates of subacute stent thrombosis and vascular complications. Seven months clinical follow-up data show that placement of an intracoronary stent results in a reduced requirement for repeat revascularization.