Research Update: The following original research abstracts are from the November, December (2001) and January and February (200

A Randomized Trial of the Low-Molecular-Weight Heparin Certoparin to Prevent Restenosis Following Coronary Angioplasty Eric D. Grassman, MD, Fred Leya, MD, Jawed Fareed, PhD, Bruce E. Lewis, MD, Peter Bacher, MD, *Henry S. Loeb, MD, **John F. Moran, MD ABSTRACT: Objectives. The objectives of this study were to evaluate the effectiveness and safety of the low-molecular-weight heparin (LMWH) certoparin in preventing restenosis following balloon coronary angioplasty. Background. Restenosis following coronary angioplasty continues to limit the long-term efficacy of this procedure. Animal studies have indicated a potential role for LMWH in reducing restenosis by limiting smooth muscle proliferation. Methods. This study tested the effects of certoparin, self-administered for 3 months, in reducing restenosis following balloon coronary angioplasty. One hundred and eighteen patients with 158 lesions treated with angioplasty were enrolled in this randomized, placebo-controlled trial. One hundred and two patients completed the study. The endpoint was relative loss measured with quantitative coronary angiography. Results. The relative loss for placebo was 0.19 ± 0.23 compared to 0.14 ± 0.21 for LMWH (p = NS). The minimum lumen diameter (MLD) was 1.47 ± 0.66 for placebo and 1.40 ± 0.57 for the LMWH (p = NS). There was a reduction (31% for LMWH; 49% for placebo PSDP) in the percent of patients having binary restenosis (MLD Conclusions. Administration of certoparin for 3 months is safe, but appears ineffective in reducing post-PTCA restenosis. J INVAS CARDIOL 2001;13:723“728 Self-Expanding Stents for Carotid Interventions: Comparison of Nitinol Versus Stainless-Steel Stents Debabrata Mukherjee, MD, *Vidyasagar Kalahasti, MD, *Marco Roffi, MD, *Deepak L. Bhatt, MD, *Samir R. Kapadia, MD, *Christopher Bajzer, MD, *Joel Reginelli, MD, *Khaled M. Ziada, MD, *Kathy Hughes, RN, *Jay S. Yadav, MD ABSTRACT: Background. Angioplasty and stenting are becoming increasingly accepted techniques for the treatment of carotid stenosis. However, the optimal stent for carotid intervention is not known. Methods. We compared the short- and intermediate-term results of carotid stenting using either nitinol or stainless-steel self-expanding stents in 178 high surgical risk patients undergoing carotid stenting at our institution. Of these 178 patients, eighty-nine received stainless-steel stents and 89 received nitinol stents. The groups were similar with respect to age, gender, diabetes, hypertension, left ventricular function, and symptom status. There were more patients with contralateral carotid occlusion in the nitinol stent group. Independent neurological evaluation was performed in all patients pre- and post-carotid stenting. Results. At 6 months, there was a similar incidence of stroke (3.3% versus 2.2%) in the stainless-steel group and nitinol stent group, respectively. There was higher 6-month mortality noted in the stainless-steel stent group, but there were no neurological deaths in either group. Conclusions. In a single-center patient cohort with similar baseline characteristics, patients receiving nitinol stents and stainless-steel stents had similar neurological outcomes. J INVAS CARDIOL 2001;13:732“735 Aminophylline Does Not Protect Against Radiocontrast Nephropathy in Patients Undergoing Percutaneous Angiographic Procedures Nicolas W. Shammas, MD, Matthew J. Kapalis, Melodee Harris, RN, BSc, Dawn McKinney, MA, Edmund P. Coyne, MD ABSTRACT: Background. Radiocontrast nephropathy (RCN) is one of the leading causes of hospital-acquired acute renal insufficiency. Adenosine, a renal vasoconstrictor, is thought to play a role in RCN. In this study, aminophylline, a non-selective adenosine-competitive inhibitor, was evaluated as a potential agent to protect against RCN. Methods. Twenty-six patients treated with 200 mg intravenous aminophylline immediately prior to percutaneous coronary and peripheral procedures were individually matched to 26 controls for baseline creatinine (Cr), diabetes mellitus and amount of contrast used. The aminophylline-treated group was also similar to control with respect to baseline ejection fraction, amount of post-procedure hydration, age, blood pressure and the use of nephrotic drugs. Results.There was no significant difference between the change from baseline Cr to peak measured Cr in either cases or controls. Also, when a change in Cr >= 25% from baseline was considered significant, Fisher™s exact test did not show a difference between the 2 groups. Conclusion. Aminophylline does not appear to add a protective role in preventing against RCN in patients undergoing percutaneous angiographic procedures. J INVAS CARDIOL 2001;13:738“740 Direct Stenting in Angiographically Apparent Thrombus-Containing Lesions Timur Timurkaynak, MD, Murat Ozdemir, MD, Atiye Cengel, MD, Mustafa Cemri, MD, Haci Ciftci, MD, Ridvan Yalcin, MD, Bulent Boyaci, MD, Ovsev Dortlemez, MD, Halis Dortlemez, MD ABSTRACT: The data regarding the potential benefits of direct stenting in the setting of angiographically apparent thrombus-containing lesions are scarce. The aim of this study was to evaluate the impact of direct stenting on the angiographic results in the setting of thrombus. We reviewed our institutional interventional database and identified 30 patients who had undergone stenting in the setting of angiographically apparent thrombus-containing lesions (33% unstable angina pectoris, 67% acute myocardial infarction). The majority of patients had a baseline TIMI 2 and 3 flow (80%). Of the 6 patients (20%) who had TIMI 0“1 flow at baseline, four of them achieved a TIMI 2 flow immediately after crossing the lesion with a 0.014´´ guidewire. Although the remaining 2 patients had TIMI 1 flow, as distal opacification beyond the stenosis was obtained we successfully implanted the stents directly. All stents were successfully implanted without any crossing failure or stent loss. There was no no re-flow, with a final TIMI 3 flow rate in 93%. In 1 patient with TIMI 2 flow after stenting, TIMI 3 flow was obtained after intracoronary verapamil. In 2 patients (7%, TIMI 2 flow), a final TIMI 3 flow could not be achieved despite intracoronary nitroglycerin and verapamil. There was no stent loss and imprecise stent placement. There were no in-hospital deaths, repeat interventions or coronary artery bypass graft surgeries. However, two patients had undergone mitral valve replacement due to severe mitral regurgitation. Eight patients with recurrent ischemia had control angiography; stents were found to be patent in all 8 patients. Two patients experienced recurrent myocardial infarction (6.6%). Direct stenting strategy in thrombus-containing lesions seems to be a safe and feasible approach in avoiding no re-flow. We believe that benefits observed with direct stenting in this study should be compared to conventional stenting in the same setting with a randomized study. J INVAS CARDIOL 2001;13:742“747 Dual Antiplatelet Therapy with Clopidogrel and Aspirin After Carotid Artery Stenting Deepak L. Bhatt, MD, Samir R. Kapadia, MD, Christopher T. Bajzer, MD,Derek P. Chew, MBBS, Khaled M. Ziada, MD, Debabrata Mukherjee, MD, Marco Roffi, MD, Eric J. Topol, MD, Jay S. Yadav, MD ABSTRACT: Background. Carotid artery stenting is being used as an alternative to carotid endarterectomy, both within the context of clinical trials and in non-surgical candidates. Though stenting is known to activate platelets, the role of antithrombotic therapy in carotid stenting has not been fully characterized. Methods and Results. Consecutive patients (n = 162) were followed in a single-center carotid stent registry. The cumulative rate of 30-day death, stroke, transient ischemic attack and myocardial infarction in those patients receiving a thienopyridine was determined, as were rates of stent thrombosis and intracranial hemorrhage. The mean age of the patients was 70.3 years and there was an extremely high prevalence of cardiovascular comorbidities, including 40% with unstable angina. The carotid lesion was symptomatic in 59% of patients. The average pre-treatment stenosis was 83%. The cumulative 30-day rate of death, stroke, transient ischemic attack and myocardial infarction was 5.6%. Specifically, in the patients who received ticlopidine (n = 23), the rate was 13%, versus 4.3% in the patients who received clopidogrel (n = 139) (p = 0.01). In this series, there were no cases of stent thrombosis and 1 intracranial hemorrhage. Conclusion. Dual antiplatelet therapy with clopidogrel plus aspirin in patients receiving carotid artery stents is associated with a low rate of ischemic events. Furthermore, clopidogrel appears superior to ticlopidine. Thus, our findings lend support to the dual antiplatelet strategy of clopidogrel plus aspirin for patients undergoing carotid artery stenting. J INVAS CARDIOL 2001;13:767“771 Controlled Balloon Inflation Reduces Long-Term Restenosis After Percutaneous Transluminal Coronary Angioplasty Martin Unverdorben, MD, Petra Glaeser, MD, Ralf Degenhardt, PhD, *Gerd Rippin, PhD, Heiner K. Berthold, MD, PhD, Christian Vallbracht, MD ABSTRACT: Purpose. The trauma induced by balloon angioplasty has an impact on the outcome of coronary interventions, such as stent procedures. However, balloon inflation for PTCA is not yet standardized even though procedural and long-term outcomes might be affected. Methods. During routine PTCA, a total of 454 patients [mean age, 60.9 ± 9.0 years; 162 (35.7%) with 1-vessel disease; 159 (35%) with 2-vessel disease; 133 (29.3%) with 3-vessel disease] were allotted to computer-assisted dilatation (CAPS) with a pressure slope of 0.2 bar/s (CAPS 0.2; n = 149 patients), 1.0 bar/s (CAPS 1.0; n = 154 patients) or to standard inflation with a hand-driven pump (n = 151 patients). Angiographic follow-up rates after 4.1 ± 3.2 months were 88.1% for the hand-driven pump, 94% for CAPS 0.2 and 87.7% for CAPS 1.0. Results. Flow reducing (1.3“2.0%) and non-flow reducing (12.6“14.9%) dissections were equally distributed among all groups as were major adverse cardiac events (2.6“4.0%). The stent rate was 1.3% with the hand-driven pump, 0.7% with CAPS 0.2 and 1.3% with CAPS 1.0. Angiographic restenosis rate was 48.9% with the hand-driven pump, 44.3% with CAPS 0.2 and 32.6% with CAPS 1.0. (hand-driven pump versus CAPS 1.0, p Conclusions. The pressure slope during balloon inflation in PTCA has a significant impact on restenosis. The impact on stent procedures has yet to be determined. J INVAS CARDIOL 2001;13:774“781 Treatment of Long, Diffuse, In-Stent Restenotic Lesions with Beta Radiation Using Strontium 90 and Sequential Positioning Pullback Technique: Procedural Details and Clinical Outcomes Ian Crocker, MD, Michel Joyal, MD, Tim Fox, PhD, Andre Arsenault, MD, Raoul Bonan, MD ABSTRACT: Background. Long, diffuse, in-stent restenotic lesions have been problematic for many patients, necessitating the need for multiple repeat percutaneous coronary interventions (PCI). The need for repeat PCI has been significantly reduced in patients since the advent of vascular brachytherapy. In-stent restenosis resulting in long lesions (> 30 mm) presents even more of a challenge. The interventional injury length created during PCI is usually greater than 30 mm and the vascular brachytherapy systems available in most hospitals are 30 mm or 40 mm in length. The purpose of this paper is to define pullback technique and to report the Montreal Heart Institute (MHI) data to show that the pullback technique using the Novoste system seems to be a safe and effective method for using vascular brachytherapy to treat long, diffuse, in-stent restenotic lesions. Methods. We reviewed the database of patients enrolled in the Compassionate Use Registry between August 1999 and July 2000. The data are reported on 23 consecutive patients treated with the pullback technique. Results. The mean lesion length was 49.4 ± 19.8 mm. Three patients (13%) underwent target vessel revascularization. Angiographic follow-up was obtained in 18 patients (78%). Seven patients (38.8%) showed angiographic restenosis (> 50% luminal re-narrowing). No aneurysms or zones of ectasia were noted. Conclusion. This angiographic and clinical evaluation of the MHI Compassionate Use Registry data show the pullback technique to be safe from both a dosimetric and clinical point of view. J INVAS CARDIOL 2001;13:782“787 Reducing Bedrest Following Arterial Puncture for Coronary Interventional Procedures Impact on Vascular Complications: The BAC Trial Wendy Vlasic, RN, MScN, CCN(C), David Almond, MD, FRCP(C), David Massel, MD, FRCP(C) ABSTRACT: Background.The optimal time for ambulating patients following femoral arterial puncture for percutaneous coronary intervention is unknown. This study was designed to test the hypothesis that reducing time to ambulation from 6 hours to 2 hours would not increase vascular complications. Methods. In this randomized, controlled, single-center trial, patients were randomly assigned to receive either 2, 4 or 6 hours (control group) of bedrest after hemostasis was achieved at the femoral arterial puncture site. A total of 354 patients, enrolled from March 1997 to October 1998, participated in the study with 299 completing the full protocol. The primary endpoint was the incidence of vascular complications and any resulting interventions or outcomes including surgery, blood transfusion, prolonged length of stay or ultrasound compression. Results. The 2 hour and 4 hour experimental groups were comprised of 99 patients each, while the 6 hour control group was comprised of 101 patients. There were no differences in vascular complications between the groups. A subgroup analysis of patients who received abciximab (n = 43) did not reveal any differences between groups. Only one patient developed a pseudoaneurysm (p = 0.36), requiring surgical repair and a prolonged length of stay. Conclusions. Patients undergoing femoral arterial puncture for coronary interventional procedures can safely ambulate 2 hours after hemostasis of the puncture site. Patients receiving abciximab as part of their coronary procedure may be able to ambulate as early as 2 hours following hemostasis. J INVAS CARDIOL 2001;13:788“792 Percutaneous Mitral Balloon Valvotomy: Six-Year Follow-up Humberto Dighero, MD, Flavio Zepeda, MD, Pablo Sepúlveda, MD, Juan Ramón Soto, MD, *Waldo Aranda, MD ABSTRACT: Objective. Percutaneous mitral valvotomy (PMV) is an alternative to the surgical treatment of mitral stenosis. Results obtained with PMV appear to depend on the echocardiographical characteristics of the valvular apparatus. The purpose of this study was to report the immediate and late-term results with PMV. The incidence of late events (restenosis, mitral valve replacement and death), and their correlation with echocardiographic score (Wilkin™s score) are also discussed. Methods.Between December 1987 and August 1999, a total of 160 PMVs were performed at our institution. Ninety-six patients with a minimum of 6 months follow-up and echocardiographic evaluation of the mitral valve (Wilkin™s score) before and after the procedure were selected for this study. Follow-up was available for 99% of the patients, with a mean follow-up of 33 ± 22 months (range, 6 months to 11 years). Hazard ratio (HR) and Cox™s regression were used for statistical analyses. Results. PMV was successfully performed in 97% of the cases; in 84%, the result was considered optimal. The incidence of complications related to the procedure was 10%; no mortality was observed due to PMV. Severe mitral regurgitation was observed in 7% of the patients, but only 3% of the total group developed ventricular dysfunction or worsened their New York Heart Association functional class. Eight-four percent of the patients were free of late events at the end of the follow-up period. A restenosis rate of 34% was observed during follow-up; this rate did not correlate with age, functional class or atrial fibrillation. Restenosis was associated with pulmonary hypertension (HR 2.85; 95% confidence interval, 0.68“11.80). Also, Wilkin™s score was not useful to predict the development of restenosis or clinical events in the mid- to long-term. Conclusion. In our series, PMV had a high immediate success rate and a low incidence of complications due to the procedure. Incidence of late events was also low and was unrelated to the Wilkin™s score; however, recurrence of stenosis was observed in one-third. Pulmonary hypertension should be considered to be an important clinical predictor of restenosis. J INVAS CARDIOL 2001;13:795“799 Triple Vessel Stenting for Triple Vessel Coronary Disease Beatriz Villegas, MD, Marie-Claude Morice, MD, Salvador Hernandez, MD, Rémi Choussat, MD, Pierre Dumas, MD, Thierry Lefèvre, MD, Yves Louvard, MD, Christophe Loubeyre, MD, Jean Fajadet, MD, Jean Marco, MD ABSTRACT: Background. Randomized clinical trials have established the feasibility of implanting multiple coronary stents and, in selected patients, have measured survival after multiple stenting to be comparable to coronary artery bypass graft surgery (CABG). However, the proportion of candidates for this therapy is unclear. This prospective study was performed to measure the percentage of patients eligible for elective multiple stenting of triple vessel coronary artery disease and to examine their short- and intermediate-term outcomes. Methods. Between January 1996 and January 1999, percutaneous coronary interventions (PCI) were performed in 6,810 consecutive patients, of whom 115 (1.7%) had triple vessel coronary artery disease treated with >= 3 stents. The mean age of these patients was 62.9 years (range, 35“85 years), 83% were men and 13 patients (11%) were diabetic. The treatment was performed in a single procedure in 80% of patients and 362 vessels were dilated, including the left anterior descending artery in 85%, the right coronary artery in 84%, the left circumflex in 49%, the left diagonal artery in 27%, the posterior descending artery in 8% and the posterior lateral artery in 4% of patients. Results. A total of 483 stents were implanted, representing an average of 4.2 ± 1.4 stents per patient (range, 3“10 stents). The total length of stents averaged 66.9 ± 4.9 mm. In-hospital adverse events included 2 deaths (1.7%), 2 emergency CABG (1.7%) and 5 myocardial infarctions (4.3%). The mean hospitalization duration was 2.7 ± 2.2 days. During a follow-up ranging between 1 and 36 months (mean, 16.7 months), 2 patients died (1.7%), 2 patients underwent CABG (1.7%) and 22 patients (19.1%) underwent further coronary artery dilatations. The 3-year event-free survival was 71.3%. In univariate analysis, patients who underwent additional target vessel revascularization were younger and were more likely to have stented segments > 80 mm in the index procedure. No other clinical, angiographic or procedural characteristic was predictive of adverse events. Conclusions. In this consecutive series of patients undergoing elective PCI, candidates for stenting of >= 3 arteries were few. Most eligible patients underwent uncomplicated and immediately successful procedures. The long-term outcome was comparable to controlled studies of CABG, except for a higher rate of repeat revascularization procedures due to restenosis. J INVAS CARDIOL 2002;14:1“5 Novel Femoral Artery Puncture Closure Device in Patients Undergoing Interventional and Diagnostic Cardiac Procedures Haresh Mehta, MD, Martin Fleisch, MD, Tushar Chatterjee, MD, Stephan Windecker, MD, Ali Garachemani, MD, Franz R. Eberli, MD, Bernhard Meier, MD ABSTRACT: Background. The wide range of closure devices for arterial access sites still leaves room for improvement. Methods and Results. We report our initial experience with a novel, cost-effective, suture-mediated device (6 French X-PRESS device, X-SITE Medical, Blue Bell, Pennsylvania) for closure of the arterial access site after both diagnostic and therapeutic interventions. A total of 51 consecutive patients are reported. The closure was performed immediately after the procedure. No patient had more than 5,000 U heparin administered during the procedure. The closure device was used in 36 patients (73%) after diagnostic angiography and in 15 patients (27%) after therapeutic intervention. The device could be successfully deployed in 48 patients (94%). In the remaining 3 cases (6%), hemostasis was achieved with standard manual compression without any further event. Immediate total hemostasis was achieved with the device in 44 of 48 patients (92%). Four devices (8%) could not be deployed correctly due to technical problems and the patients needed additional manual compression. The average time to achieve complete hemostasis was 5.5 ± 3.5 minutes (range, 3“26 minutes). The patients were ambulated after a period of 1.3 ± 0.4 hours of bedrest (range, 0.8“3.5 hours). Time to possible discharge was 4.2 ± 3.4 hours (range, 0.9“12.5 hours). One patient experienced a minor complication (hematoma Conclusion. The 6 French X-PRESS device is safe and effective in providing rapid hemostasis following interventional or diagnostic catheterization procedures. Use of the device is associated with a low rate of complications and facilitates quick hemostasis, mobilization and discharge. J INVAS CARDIOL 2002;14:9“12 Acute Angiographic and Clinical Results of the NIR w/SOX Stent Yoshio Kobayashi, MD, Issam Moussa, MD, George Dangas, MD, Roxana Mehran, MD, Kartik Desai, MD, Milena Adamian, MD, Michael Collins, MD, Edward Kreps, MD,Gregg W. Stone, MD, Martin B. Leon, MD, Jeffrey W. Moses, MD ABSTRACT: Acute angiographic and clinical results of the NIR w/SOX stent (Boston Scientific/Scimed, Inc., Maple Grove, Minnesota) were evaluated. Between March 2000 and May 2000, a total of 102 lesions in 88 patients underwent stenting with the NIR w/SOX stent. The reference vessel diameter and lesion length were 2.97 ± 0.50 mm and 16.2 ± 6.5 mm, respectively. The minimal lumen diameter increased from 0.68 ± 0.45 to 3.07 ± 0.50 mm. Stent delivery failure was observed in 4 lesions (3.9%). On the other hand, the NIR w/SOX stent was successfully delivered in 7 of 9 lesions that had unsuccessful delivery of other kinds of stents. Angiographic success was observed in all except 1 lesion where the NIR w/SOX stents could not be delivered. There were no procedural myocardial infarctions or deaths. In one case, procedural coronary bypass surgery was performed. There was no acute closure or subacute stent thrombosis. Despite unfavorable lesion characteristics, the NIR w/SOX stent achieves high procedural success and acceptable stent delivery. Furthermore, it may have a high probability to be delivered in lesions where other kinds of stent result in unsuccessful delivery. J INVAS CARDIOL 2002;14:14“18 Noninvasive Assessment of Coronary Artery Bypass Graft Patency and Flow Characteristics by Electron-Beam Tomography Bin Lu, MD, Ru-Ping Dai, MD, Nan Zhuang, MD, *Matthew J. Budoff, MD ABSTRACT: Objective. To evaluate the flow characteristics and accuracy for the detection of patent or occluded coronary artery bypass grafts (CABG) with multi-slice flow study of electron-beam tomography (EBT). Methods. One hundred and twenty-three patients who had undergone CABG surgery were enrolled in this study. Flow datasets were assessed with time-density curves by EBT. The EBT results were blindly compared with post-operative cardiac catheterizations in 26 patients. Results. Image quality was adequate to evaluate in 111 patients (90.2%). Flow curves of bypass grafts were technically adequate in 265 of 309 (85.8%) saphenous-vein grafts (SVG) and 35 of 56 (62.5%) internal mammary artery (IMA) grafts (p Conclusion. EBT flow study can be used in the assessment of CABG patency and quantification of intra-graft flow of patent CABG vessels. J INVAS CARDIOL 2002;14:19“24 Role of the Dogbone Effect of Balloon-Expandable Stents: Quantitative Coronary Analysis of DUET and NIR Stent Implantation Introducing a Novel Indexing System Christoph Hehrlein, MD, *Jennifer J. DeVries, Amina Arab, MD, *Scott D. Haller, MS, *Ann Kloostra, RN, *Michael A. Lauer, MD, *Malcom T. Foster, MD, *Tim A. Fischell, MD ABSTRACT: Stent design and deployment characteristics of balloon-expandable stents may play an important role in determining both early and late outcomes of stenting. The purpose of this study was to compare the percent residual stenosis (RS) of two new-generation stent delivery systems, DUET and NIR, in patients with CAD. From September 1998“1999, a total of 100 consecutive patients with CAD receiving either a DUET (18 or 23 mm length; n = 50) or NIR stent (16 or 25 mm length; n = 50) using a 3.0 or 3.5 mm stent delivery system were compared by quantitative coronary analysis. The ability of each balloon delivery system to fully expand the stent was assessed using a new scoring index entitled the stent delivery balloon expansion ratio (SDBR; %). A high SDBR correlates with the angiographic appearance of a dogbone that is sometimes seen during stent deployment. A stent scalloping score was developed to quantitatively assess the cobblestone appearance observed angiographically with plaque protrusion after stent implantation. Mean deployment pressures were 14 ± 2 atm (DUET) and 13 ± 2 atm (NIR) (p = NS). Extent of elastic recoil was similar (6 ± 5% for DUET vs. 6 ± 4% for NIR; p = NS). Scalloping was more pronounced in the DUET stent (score, 0.66 ± 0.6 for DUET vs. 0.24 ± 0.4 for NIR; p Conclusion. The second-generation DUET and NIR stents and their respective delivery systems show angiographically different acute performance characteristics. Insufficient deployment of stents visualized by the dogbone effect plays a role in the extent of RS after stenting. The introduced angiographic indexes require further validation. J INVAS CARDIOL 2002;14:59“65 The Draw-Back Stent Deployment Technique: A Strategy for the Treatment of Coronary Branch Ostial Lesions Leonard Schwartz, MD and Amir Morsi, MD ABSTRACT: Isolated ostial lesions in the coronary tree are not uncommon; the percutaneous coronary intervention (PCI) of choice is stent implantation. This report describes a simple technique for accurate stent deployment to effectively treat such lesions without visible encroachment on the main vessel lumen. The stent is advanced distally into the sidebranch. Using a separate system, a balloon is inflated as a fulcrum in the main vessel within the segment straddling the sidebranch. The sidebranch stent is withdrawn undeployed until it contacts the inflated main vessel balloon and is then deployed. This technique was attempted in 14 cases and successful in 13, with excellent stent deployment and lesion resolution attained in 12 cases. There were no instances of main vessel aggravation or procedural events. Subsequent target vessel revascularization has been necessary in two patients. This technique is a simple approach for managing these troublesome lesions. J INVAS CARDIOL 2002;14:66“71 Prophylactic Abciximab in Elective Coronary Stenting: Results of a Randomized Trial Corrado Tamburino, MD, Giovanni Russo, MD, Antonino Nicosia, MD, Alfredo R. Galassi, MD, Rosario Foti, MD, V. Scriffignano, DSc, *Dean J. Kereiakes, MD, Giuseppe Giuffrida, MD ABSTRACT: Background. The use of abciximab (c7E3 Fab; ReoPro®, Eli Lilly & Company, Indianapolis, Indiana) during percutaneous coronary intervention (PCI) decreases the incidence of early (30-day) and late (6-month to 1 year) adverse cardiac ischemic events. In a high-risk population, abciximab also reduced the need for target lesion revascularization. PCI of lesions with complex morphology, particularly long lesions, is associated with more complicated outcomes. The use of multiple and/or long intracoronary stents to cover long coronary lesions may lower the incidence of acute or subacute occlusion, but is still limited by a high late restenosis rate. We characterized patients undergoing elective implantation of long or multiple overlapping coronary stents and determined the impact of abciximab administration on clinical and angiographic outcomes. Methods and Results. In a prospective, single-center randomized trial, a total of 107 patients undergoing elective implantation of long or multiple overlapping coronary stents were randomly assigned to receive either standard-dose heparin (n = 53) or abciximab plus low-dose heparin (n = 54). The use of abciximab was not associated with an increased incidence of bleeding or vascular complications compared to standard heparin regimen (3.7% versus 3.8%, respectively; p = NS). A 68% reduction in composite in-hospital cardiac events (i.e., death, myocardial infarction, urgent revascularization) was observed in the abciximab group (3.7% versus 11.5%, p = 0.1). At 6-month follow-up, a 48% reduction of target lesion revascularization (11% versus 21%; p = 0.1) and a decrease in binary angiographic restenosis were observed for abciximab-treated patients (17% versus 34%; p Conclusion. The peri-procedural use of abciximab during implantation of long or multiple overlapping coronary stents is safe and effective, as it does not increase bleeding or vascular complications compared to standard heparin anticoagulation and reduces the incidence of in-hospital adverse cardiac events; moreover, abciximab improves 6-month clinical and angiographic outcomes in such a complex setting. J INVAS CARDIOL 2002;14:72“79

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