Toshiya Muramatsu

Efficacy and issues of emergent percutaneous transluminal coronary angioplasty : comparison of clinical results in younger and elderly patients

The authors investigated the efficacy and prognosis of emergency percutaneous trans luminal coronary angioplasty (PTCA) in elderly patients. A study was conducted on the early and late prognosis of the study group composed of 66 younger patients < sixty-five years in Group A and 46 elderly patients ≥ seventy years in Group B who underwent reperfusion therapy, including PTCA, for acute myocardial infarction (AMI). No difference was seen in the initial success rate of 82% for Group A and 85% for Group B, or in the vessel patency in the predischarge coronary arteriogram (CAG) with 84% for Group A and 87% for Group B. However, in-hospital mortality was 3% for Group A and 11% for Group B. The patient restenosis rate in the 4.2 months follow-up CAG was 28% for Group A and 50% for Group B. The lesion restenosis rate was 30% for Group A and 53% for Group B (P < 0.05), and the late period mortality rate was 3% for Group A and 11% for Group B. Although there was no difference in the initial success rate of reperfusion through PTCA for AMI in the elderly as compared with the younger patient group, poorer results were seen in the restenosis rate and mortality rate.

Immediate results and dilatation effect of the vein‐covered Palmaz‐Schatz stent assessed by intravascular ultrasound

To evaluate the clinical results of stenting using the vein-covered Palmaz-Schatz (PS) stent by intravascular ultrasound (IVUS). Twenty-eight patients with angina pectoris or confirmed ischemia were entered into this study. Thirteen were allocated to the vein-covered PS stent group and 15 to the normal Palmaz-Schatz stent group. The immediate clinical results in these groups and changes in lumen dimension as assessed by IVUS, were investigated. Acute success was 100% in both groups. There were no immediate complications. Subacute thrombosis occurred in one patient in the vein-covered PS group. In the vein-covered PS group, percent diameter stenosis of the involved coronary artery changed from 70.2% before stenting to 8.8% immediately after and 42.2% at 5 months follow-up. The respective values were 84.5%, 13.4%, and 36.5% in the normal Palmaz-Schatz group. Restenosis in the vein-covered group was 23.1% and in the Palmaz-Schatz group was 20%, showing no significant differences between the two groups. The luminal area in the vein-covered group as assessed by IVUS increased from 3.2 mm2 to 7.4 mm2 (pre to post) and from 3.2 mm2 to 8.2 mm2 in the normal Palmaz-Schatz group. The plaque area decreased from 13.6 mm2 to 10 mm2 (pre to post) in the vein-covered group and from 13.0 mm2 to 9.2 mm2 in the Palmaz-Schatz group. In this study, conducted in a limited number of cases, it is possible to use vein-covered stent like as usual Palmaz-Schatz stent. The vein-covered stent had less dilative effect compared with the Palmaz-Schatz stent. This was probably because of its increased profile but there was no difference in the occurrence of subacute thrombosis or in restenosis rate.