Coronary Artery Disease
Comparison of Aggressive Versus Nonaggressive Balloon Dilatation for Stent Deployment on Late Loss and Restenosis in Native Coronary Arteries

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Abstract

Aggressive balloon dilatation is currently performed to assure full stent expansion and minimize the risk of stent thrombosis. It is not known if aggressive stent expansion leads to further increases in intimal proliferation and restenosis. A retrospective analysis was performed of 688 consecutive coronary narrowings in which stents were implanted. Angiographic follow-up was performed and quantitative coronary angiographic measurements were obtained using electronic calipers. Patients were divided into 2 groups. Group A (212 narrowings) had stents implanted before 1993, before the routine use of aggressive stent expansion techniques. Group B (476 narrowings) had stents implanted after 1993, when oversized balloons or high-pressure inflations were performed inside stents. Comparisons were made between angiographic changes and clinical outcomes between the 2 groups. Group B lesions had less favorable characteristics due to longer lengths of lesions. Despite this there was less angiographic and clinical restenosis in this cohort. There was no difference in late loss between the 2 groups. Thus, aggressive stent implantation techniques were not associated with increased late loss or restenosis.

Section snippets

Patients:

This study includes 649 consecutive patients undergoing stenting of 688 narrowings between May 1991 and June 1994. Baseline and follow-up clinical data as well as lesion and procedural characteristics were prospectively entered into a dedicated database (Filemaker Pro, Claris Corporation, Santa Clara, California). Patients were routinely seen or contacted at 6 months and encouraged to have follow-up angiography.

Patient Groups:

During the time period of this series of patients information from ultrasound

Baseline Characteristics:

Baseline clinical characteristics are displayed in Table I. Palmaz-Schatz stents (Johnson & Johnson Interventional Systems, Warren, New Jersey) were used in 91% of narrowings, including all lesions in group A (before 1993). Fourteen percent of lesions in group B (1993 and afterward) did not receive Palmaz-Schatz stents, but had only other stent types including Wiktor (Medtronic Interventional, San Diego, California), Microstent (AVE, Applied Vascular Engineering, Santa Rosa, California), and

Discussion

Information from intravascular ultrasound has demonstrated that stents are frequently underdeployed despite acceptable angiographic results,2, 12, 13, 14which has led to the use of aggressive techniques to more fully expand the stents. This change in strategy has contributed to lower rates of stent thrombosis and the abandonment of anticoagulant therapy in favor of antiplatelet agents. There have been concerns that the increased barotrauma of aggressive stent deployment techniques might lead to

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