Peripheral vascular complications of directional coronary atherectomy and stenting: Predictors, management, and outcome

Mauro Moscucci, Kathleen A. Mansour, K. Craig Kent, Richard E. Kuntz, Cynthia Senerchia, Donald S. Baim, Joseph P. Carrozza

Research output: Contribution to journalArticle

62 Scopus citations

Abstract

The hospital course of 688 patients consecutively treated with directional coronary atherectomy (375 procedures) or Palmaz-Schatz stenting (376 procedures) was evaluated to identify incidence, predictors, and outcome of major vascular complications. Major vascular complications (defined as surgical repair, major hematoma, or bleeding with a >10-point hematocrit decrease requiring transfusion alone, or nonsurgically managed arteriovenous fistula, pseudoaneurysm, retroperitoneal hematoma or femoral neuropathy) occurred in 11.7% of procedures, and were more common after stenting than after directional coronary atherectomy (16.8% vs 6.7%, p <0.001). In particular, surgical repair was required after 10.1% of stenting procedures, versus 5.1% of directional coronary atherectomies (p <0.02). Multivariable analysis Identified age >70 years, coronary stenting, female gender, multiple procedures during the index hospitalization, and a low nadir platelet count as independent predictors of major vascular complications (all p <0.03). In the stent subgroup, excessive anticoagulation, nadir platelet count, hypertension, and sheath removal protocol (other than a same-day, activated clotting time-guided protocol) were all independent predictors of vascular complications. Thus, the overall risk of vascular complications with new device procedures (stenting, directional atherectomy) is greater than that traditionally seen with balloon angioplasty alone, and is determined by patient-related factors, procedure type, and management parameters.

Original languageEnglish (US)
Pages (from-to)448-453
Number of pages6
JournalThe American Journal of Cardiology
Volume74
Issue number5
DOIs
StatePublished - Sep 1 1994

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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