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Ten-year clinical and angiographic follow-up of coronary Wallstent

      Although the concept of implanting a tubular metallic structure in an arterial segment to maintain vessel patency after luminal dilatation was introduced by Dotter and Judkins in 1964,
      • Dotter C.T.
      • Judkins M.P.
      Transluminal treatment of arteriosclerotic obstruction description of a new technique and a preliminary report of its application.
      its clinical application in humans was not undertaken until 1986.
      • Sigwart U.
      • Puel J.
      • Mirkowitch V.
      • Joffre F.
      • Kappenberg L.
      Intravascular stents to prevent occlusion and restenosis after transluminal angioplasty.
      The self-expanding woven mesh stent (Wallstent) was the first to be used for this purpose in human studies. Despite a high rate of acute and subacute thrombosis, this initial experience helped to define the clinical and angiographic criteria for patient selection. Although long-term follow-up studies
      • Nobuyoshi M.
      • Kimura H.
      • Nosaka H.
      • Mioka S.
      • Ueno K.
      • Hamasaki N.
      • Horiuchi H.
      • Oshishi H.
      Restenosis after successful percutaneous transluminal coronary angioplasty serial angiographic follow-up of 299 patients.
      ,
      • Serruys P.W.
      • Luitjen H.E.
      • Beatt K.J.
      • Geuskens R.
      • De Feyter P.J.
      • Van Den Brand M.
      • Reiber J.H.
      • Ten Kate H.J.
      • Van Es G.A.
      • Hugenholtz P.G.
      Incidence of restenosis after successful coronary angioplasty a time-related phenomenon. A quantitative angiographic study in 342 consecutive patients at 1, 2, 3 and 4 months.
      indicate that a 6-month angiogram can be considered as a valid end point for assessing the result of balloon angioplasty, it has not been determined whether the time course of restenosis is similar after implantation of a metallic stent. Although a 6-month angiographic follow-up of patients at the 5 centers evaluating the Wallstent has been reported,
      • Serruys P.W.
      • Strauss B.
      • Beatt K.
      • Bertrand M.E.
      • Puel J.
      • Rickards A.F.
      • Meier B.
      • Goy J.J.
      • Vogt P.
      • Kappenberger L.
      • Sigwart U.
      Angiographic follow-up after a self-expanding coronary artery stent.
      ,
      • Strauss B.
      • Serruys P.W.
      • Bertrand M.E.
      • Puel J.
      • Meier B.
      • Goy J.J.
      • Kappenberger L.
      • Rickards A.
      • Sigwart U.
      Quantitative angiographic follow-up of the coronary Wallstent in native vessels and bypass grafts (European Experience-March 1986 to March 1990).
      no further angiographic follow-up had been performed to assess whether luminal renarrowing within the Wallstent actually ceases after this period. To assess whether continued exposure to the metallic surface and sustained pressure (barotrauma) associated with coronary stents provides a permanent stimulus for neointimal proliferation, we addressed the 10-year angiographic outcome of patients in whom a Wallstent had been implanted at our institution and in whom a subacute occlusion or restenosis at 6 months had not occurred. Our study population included the first patient ever to have received a stent (Figure 1).
      Figure thumbnail GR1
      Figure 1First coronary stent implantation in a human (March 1986). PTCA = percutaneous transluminal coronary angioplasty.
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