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Cardiac allograft vasculopathy (CAV) is the major cause of late death following cardiac transplantation (CT). High restenosis rates (55% in a multicenter registry) have been reported after balloon angioplasty in this indication. However, little is known regarding the role of coronary artery stents for the treatment of CAV.
Objectives: To determine the total plasma homocysteine (tHcy) levels in our transplant population and the factors influencing these levels. The effect of folate therapy on tHcy was also evaluated.
Methods: 12 stents were implanted in 8 male patients (Pts)
aged 56 ± 14 years at a mean of 91 ± 21 months (52 to 120) after CT.
Mean EF was 61 ± 4%. 6/8 Pts had multivessel disease. All Pts were on
triple immunosuppressive therapy and received aspirin (100 mg/d) and
ticlopidine (500 mg/d) for 1 month after stenting. Quantitative coronary
angiography (QCA, Phillips DCI) for measurements of minimal lumen diameter
(MLD), reference diameter (RD), and percent diameter stenosis (%DS) was
performed before and after stent implantation and at a systematic 6 month
angiographic follow-up.
Results: 1 stent was implanted in 4 Pts and 2 stents in 4 Pts.
Location of stenting was: LAD in 6 cases, LCX in 5 and RCA in 1. Indication for
stenting was elective (42%), restenosis (42%), dissection (16%). Mean stent
length was 17 ± 8 mm (7 to 34 mm). Mean balloon size was 3.0 ± 0.1 mm
with a mean inflation pressure of 9 ± 2 atm. Procedural success was 100%.
At a mean follow-up of 15 ± 14 months after stent implantation, 7/8 Pts
were alive without myocardial infarction (1 Pt died from myeloma). At 6-month
follow-up, the angiographic restenosis rate (%DS>50%) was 36% (11/12
stents controlled). QCA results:
| RD (mm) |
MLD (mm) |
%DS |
|
| Pre-PTCA |
2.7± 0,3 |
0.8± 0.4 |
69±13 |
| Post-stent |
2.9±0.5 |
2.1±0.5* |
26±13* |
| Follow-up |
2.7±.0.7 |
1.6±0.6* |
42±18* |
*p<0.05 vs. pre-PTCA
Conclusion: Intracoronary stenting for CAV is feasible and safe. Restenosis rate appears acceptable and seems to compare favorably with balloon angioplasty in this setting. Thus, coronary artery stenting might become a valuable therapeutic option for cardiac transplant patients with CAV.