Coronary artery stenting in cardiac allograft vascular disease

Cardiac allograft vascular disease is characterized by diffuse and multifocal heterogeneous myointimal hyperplasia with or without vascular remodeling. Catheter-based interventions are indicated in selected patients. This study documents our experience with percutaneous transluminal coronary angioplasty and coronary stents (n=48) in a group of 27 patients 5.7±2.9 years after heart transplantation. Early and intermediate results were controlled by angiography and intravascular ultrasound. Conventional percutaneous transluminal coronary angioplasty resulted in a mild and mostly inadequate gain in luminal dimensions (lumen area: 3.17±0.92 mm2 to 3.70±1.21 mm2; minimal lumen diameter: 1.84±0.23mm to 2.04±0.36 mm). Coronary stenting led to a further improvement of luminal gain (lumen area: 3.70±1.21 mm2 to 5.86±1.76 mm2; minimal lumen diameter: 2.04±0.36 mm to 2.53±0.38 mm). These results were stabilized by application of aspirin and ticlopidine only. There were no stent thromboses or bleeding complications, and early hospital discharge of the patients was possible. At follow-up (mean follow-up period 7.72±5.45 months (range 0.50 to 23.13 months) all patients were clinically event free. In six of 24 stented vessels (25%) in 16 patients, significant restenosis (>50%) was found by intravascular ultrasound (n=20) or by angiography (n=4) 6 months after stent placement. We conclude that in eligible cardiac allograft vascular disease lesions primary stenting may be the method of choice. However, further evaluation of the modalities of stent application and different stent designs with respect to long-term survival is necessary.