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Original Article

A Comparison of Balloon-Expandable-Stent Implantation with Balloon Angioplasty in Patients with Coronary Artery Disease

Patrick W. Serruys, Peter de Jaegere, Ferdinand Kiemeneij, Carlos Macaya, Wolfgang Rutsch, Guy Heyndrickx, Hakan Emanuelsson, Jean Marco, Victor Legrand, Pierre Materne, Jorge Belardi, Ulrich Sigwart, Antonio Colombo, Jean Jacques Goy, Paul van den Heuvel, Juan Delcan, and Marie-angele Morel for the Benestent Study Group

N Engl J Med 1994; 331:489-495August 25, 1994

Abstract

Background

Balloon-expandable coronary-artery stents were developed to prevent coronary restenosis after coronary angioplasty. These devices hold coronary vessels open at sites that have been dilated. However, it is unknown whether stenting improves long-term angiographic and clinical outcomes as compared with standard balloon angioplasty.

Methods

A total of 520 patients with stable angina and a single coronary-artery lesion were randomly assigned to either stent implantation (262 patients) or standard balloon angioplasty (258 patients). The primary clinical end points were death, the occurrence of a cerebrovascular accident, myocardial infarction, the need for coronary-artery bypass surgery, or a second percutaneous intervention involving the previously treated lesion, either at the time of the initial procedure or during the subsequent seven months. The primary angiographic end point was the minimal luminal diameter at follow-up, as determined by quantitative coronary angiography.

Results

After exclusions, 52 patients in the stent group (20 percent) and 76 patients in the angioplasty group (30 percent) reached a primary clinical end point (relative risk, 0.68; 95 percent confidence interval, 0.50 to 0.92; P = 0.02). The difference in clinical-event rates was explained mainly by a reduced need for a second coronary angioplasty in the stent group (relative risk, 0.58; 95 percent confidence interval, 0.40 to 0.85; P = 0.005). The mean (±SD) minimal luminal diameters immediately after the procedure were 2.48 ±0.39 mm in the stent group and 2.05 ±0.33 mm in the angioplasty group; at follow-up, the diameters were 1.82 ±0.64 mm in the stent group and 1.73 ±0.55 mm in the angioplasty group (P = 0.09), which correspond to rates of restenosis (diameter of stenosis, ≥ 50 percent) of 22 and 32 percent, respectively (P = 0.02). Peripheral vascular complications necessitating surgery, blood transfusion, or both were more frequent after stenting than after balloon angioplasty (13.5 vs. 3.1 percent, P<0.001). The mean hospital stay was significantly longer in the stent group than in the angioplasty group (8.5 vs. 3.1 days, P<0.001).

Conclusions

Over seven months of follow-up, the clinical and angiographic outcomes were better in patients who received a stent than in those who received standard coronary angioplasty. However, this benefit was achieved at the cost of a significantly higher risk of vascular complications at the access site and a longer hospital stay.

Media in This Article

Figure 1Cumulative Frequency Distribution Curves for the Two Study Groups, Showing Minimal Luminal Diameters Measured before and after Intervention and at Follow-up, the Percentage of Stenosis at Follow-up, and the Percentage of Patients with Clinical End Points.
Table 1Base-Line Clinical Characteristics of the 516 Patients Included in the Intention-to-Treat Analysis.
Article

Implantation of an intracoronary stent in conjunction with balloon angioplasty is not only highly effective in treating acute vessel closure due to balloon-induced dissection, but it may also reduce the rate of restenosis1-4. Unfortunately, all stents currently available are metallic and thus thrombogenic, a problem that necessitates anticoagulation therapy5,6. This therapy exposes the patient to an increased risk of major bleeding and vascular complications, which may prolong the hospital stay7. Despite these drawbacks and although the superiority of stent implantation over standard balloon angioplasty has not yet been proved, stenting has been used increasingly. Therefore, we conducted a multicenter, randomized study comparing stent implantation and balloon angioplasty with respect to their safety and efficacy in patients with stable angina pectoris and a single new lesion in a coronary artery.

Methods

Selection of Patients

Patients scheduled to undergo coronary angioplasty because of stable angina due to a single new lesion in a coronary artery were eligible for the study if they had no contraindication to anticoagulant or antiplatelet therapy and if they were also suitable candidates for coronary bypass surgery. The target lesion needed to be less than 15 mm long and to be located in a vessel more than 3 mm in diameter that supplied normally functioning myocardium. Patients with an ostial lesion, a lesion at a bifurcation, or a lesion in a previously grafted vessel were excluded from the study, as were patients in whom an intracoronary thrombus was suspected.

The study was carried out according to the principles of the Declaration of Helsinki. Oral or written informed consent according to local practice was obtained for every patient.

Randomization

Patients were randomly assigned by telephone from a central office to either implantation of a Palmaz-Schatz stent or balloon angioplasty. To ensure an equal distribution of treatments in each center, we developed the randomization sequence on a site basis in blocks of six treatment assignments.

Balloon Angioplasty and Stent Implantation

Balloon angioplasty and stent implantation were performed according to standard clinical practice by the femoral approach. The stent was deployed by inflating a balloon over which the collapsed stent was fitted. Inflation of the balloon expanded the stent. After the implantation of the stent, the stented area was often dilated further by standard balloon angioplasty. All patients received 250 to 500 mg of aspirin daily and 75 mg of dipyridamole three times a day; this treatment was started the day before the procedure and was continued for six months. During the procedure, patients receiving a stent were treated with a continuous infusion of dextran (1000 ml) and a bolus dose of 10,000 U of heparin, repeated if necessary, followed by a combination of heparin and oral anticoagulation therapy (with warfarin) after the removal of the sheath and titrated by measuring the prothrombin time and either the activated partial-thromboplastin time or the activated clotting time. The dose of heparin was decreased progressively after the prothrombin time had been in the therapeutic range (international normalized ratio, 2.5 to 3.5) for at least 36 hours. Warfarin therapy was continued for three months. The patients who underwent balloon angioplasty received only 10,000 U of heparin during that procedure, followed by an additional bolus dose or a continuous infusion if deemed necessary. In addition, both treatment groups received calcium antagonists until discharge from the hospital.

Clinical and Angiographic Follow-up

Patients were seen in the outpatient clinic after one, three, and six months for an interview, physical examination, and electrocardiogram. Exercise testing was performed before the second cardiac catheterization and coronary angiography at six months. If a revascularization procedure involving the treated segment had been performed before the six-month angiography, the most recent angiogram obtained before this intervention, if available, was used as the follow-up angiogram, regardless of the timing of the second intervention. If the time to follow-up angiography was less than three months and no second intervention was performed, the patient was asked to undergo angiography again at six months. In the absence of a second angiogram at six months, the angiogram obtained most recently within the previous three months was used, if available, provided that no end point had occurred.

Three angiograms were obtained for each patient -- one just before the intervention, one immediately after, and one at follow-up. All the angiograms were analyzed by the Cardiovascular Angiography Analysis System and sent to the core laboratory (Cardialysis, Rotterdam, the Netherlands). To standardize the method of data acquisition and to ensure the exact reproducibility of the angiograms performed after the intervention and at follow-up, measurements were made as described earlier8.

End Points

The primary clinical end points were whichever of the following occurred first: death, a cerebrovascular accident, myocardial infarction, bypass surgery, or a second percutaneous intervention involving the previously treated lesion between the time of the initial procedure and the angiography performed at 6 months (±4 weeks) (or at 7 months if no angiography was performed at 6 months). The indication for a second intervention or for bypass surgery had to be substantiated by symptoms or by electrocardiographic or scintigraphic evidence of myocardial ischemia at rest or during exercise. All events were reviewed by the critical-event committee, which was unaware of the treatment assignments.

Death was defined to include all deaths, regardless of cause. Cerebrovascular accidents occurring in patients receiving anticoagulant therapy were considered to be intracranial hemorrhages unless unequivocally demonstrated otherwise. Myocardial infarction was diagnosed if there were new pathologic Q waves according to the Minnesota Code9 or if there was an increase in serum creatine kinase to more than twice the normal value, together with a pathologic increase in myocardial isoenzymes. Bypass surgery was defined to include emergency or elective bypass surgery involving the previously treated segment. Emergency bypass surgery was defined as involving an immediate transfer from the angioplasty suite to the operating room during the initial phase of treatment. “Bailout” stent implantation was defined as the placement of a stent in the event of Thrombolysis in Myocardial Infarction (TIMI) grade 0 or 1 flow after angioplasty or in the case of worsening of the base-line TIMI flow by one grade10. In all instances, prolonged balloon angioplasty had to be attempted before bailout stenting was considered. By design, stent implantation as a bailout procedure was considered equivalent to emergency bypass surgery but was removed retroactively from the analysis of primary end points, since it is currently perceived as an integral part of an angioplasty strategy. Only the untoward clinical events associated with such stenting were counted as end points. Second interventions were those involving a previously treated lesion that followed the initial procedure, which was considered complete when the guiding catheter was removed from the arterial sheath. Revascularization (surgical or percutaneous) involving other coronary arteries did not constitute an end point.

The primary angiographic end point was the minimal luminal diameter at follow-up. For each treated segment, this value was calculated from the mean values obtained in multiple matched projections.

Secondary end points included (1) the angiographic success rate, defined as the rate of achievement of less than 50 percent stenosis on visual assessment; (2) the procedural success rate, defined as the rate of achievement of less than 50 percent stenosis on quantitative assessment, without the occurrence of clinical events during the hospital stay; (3) the functional class according to the classification of the Canadian Cardiovascular Society at six months or at the time of intercurrent angiography and second intervention; (4) the results of exercise testing at six months or earlier, if clinically indicated; (5) the rate of restenosis (stenosis ≥ 50 percent at follow-up) at six months.

Power Calculations and Statistical Analysis

At the outset of the study, the size of the required sample (428 patients) was based on an assumed rate of clinical events of 30 percent in the angioplasty group and a reduction of that rate by 40 percent in the stent group (by a two-sided test with an alpha error of 0.05 and a power of 0.80). To compensate for unsuccessful interventions and losses to follow-up, the sample was enlarged by 10 percent (to 470 patients). In addition, to adjust for a loss of power due to a planned interim analysis, the sample was increased by another 10 percent, reaching a final size of 520 patients11.

The main clinical analysis consisted of a single comparison between the two study groups with respect to the primary clinical end point, regardless of its time of occurrence; this analysis involved all randomized patients with the exceptions of three patients found after randomization not to be eligible and of one patient who withdrew informed consent for further treatment and follow-up according to the intention-to-treat principle. The clinical events were ranked according to the highest category of severity on the following scale: death, cerebrovascular accident, myocardial infarction, emergency bypass surgery, elective bypass surgery, and repeat percutaneous intervention.

The main angiographic analysis consisted of a single comparison between the two study groups with respect to minimal luminal diameter and was performed according to the intention-to-treat principle.

Continuous variables are expressed as means ±SD and were compared by the unpaired Student's t-test. The chi-square test with Yates' correction was used to compare proportions. Discrete variables are expressed as counts and percentages and are compared in terms of relative risks (for stenting as compared with angioplasty), with 95 percent confidence intervals calculated by the formula of Greenland and Robins12. All statistical tests were two-tailed.

Results

Characteristics of the Patients

Between June 1991 and March 1993, 520 patients were randomly assigned to stent implantation (262 patients) or balloon angioplasty (258 patients) at 28 participating centers. Of these 520 patients, 4 were excluded from further analysis, 3 in the stent group and 1 in the angioplasty group. One patient withdrew his informed consent and left the hospital without receiving treatment, two other patients did not undergo coronary revascularization because their lesions proved to be unimportant during on-line quantitative coronary angiography at the time of the intended intervention, and one patient participated in another study with an investigational drug. There were no differences in base-line characteristics between the two study groups (Table 1Table 1Base-Line Clinical Characteristics of the 516 Patients Included in the Intention-to-Treat Analysis. and Table 2Table 2Angiographic Characteristics of the 516 Patients Included in the Intention-to-Treat Analysis and Characteristics of the Procedures They Underwent.).

In-Hospital Clinical Outcomes

Of the remaining 259 patients randomly assigned to receive stents, 14 (5.4 percent) did not receive a stent but were treated successfully with balloon angioplasty. The reasons for this crossover were the withdrawal of informed consent in five, the physician's preference because of the patient's unfavorable anatomy (e.g., small vessel size) or angiographic evidence of thrombus in three, and failure to cross the lesion with the stent in six. In addition, stent implantation was unsuccessful in 10 patients: 6 because the lesion was not dilated beforehand and 4 because the stent could not be deployed. Of these 10 patients, 8 underwent bypass surgery that was urgent in 3 and elective in 5. The remaining two patients, who unexpectedly had totally occluded coronary arteries that could not be recanalized, were treated medically.

Of the 257 remaining patients randomly assigned to balloon angioplasty, 13 (5.1 percent) received stents for the following reasons: acute vessel closure in 1, flow-limiting dissection in 11, and a suboptimal angiographic result in 1. Of these 13 patients, 2 were referred for urgent bypass surgery and 1 had a non-Q-wave myocardial infarction. In addition, three other patients who had complicated balloon angioplasty and in whom no bailout stent implantation was attempted underwent urgent bypass surgery. Therefore, the angiographic success rate was 96.9 percent in the stent group and 98.1 percent in the angioplasty group, whereas the procedural success rates were 92.7 and 91.1 percent, respectively.

The ranking and the total number of clinical events occurring in the hospital are shown in Table 3Table 3Frequency of Primary Clinical End Points in the Hospital and at Seven Months in Descending Order of Severity, Total Number of Events, and Quantitative Comparison of Immediate and Long-Term Angiographic Results.. The composite rate for all in-hospital events was similar in both groups (16 events or 6.2 percent in the angioplasty group vs. 18 events or 6.9 percent in the stent group; relative risk, 1.12; 95 percent confidence interval, 0.58 to 2.14). There were no in-hospital deaths in either group; one patient treated with balloon angioplasty had an intracranial hemorrhage. There was no difference between groups in the incidence of Q-wave and non-Q-wave infarction (3.1 percent in the angioplasty group vs. 3.4 percent in the stent group; relative risk, 1.12; 95 percent confidence interval, 0.44 to 2.85) or in the need for urgent or elective cardiac surgery or second angioplasty during the hospital stay (2.7 percent in the angioplasty group vs. 3.5 percent in the stent group; relative risk, 1.28; 95 percent confidence interval, 0.48 to 3.37).

Angiographically documented stent thrombosis during the hospital stay occurred in 3.5 percent of patients, an incidence similar to that of subacute vessel closure after balloon angioplasty (2.7 percent). It is noteworthy that no stent thrombosis occurred in the 13 patients treated with a bailout stent. However, the incidence of bleeding and vascular complications was significantly higher after stent implantation than after balloon angioplasty (13.5 vs. 3.1 percent; relative risk, 4.34; 95 percent confidence interval, 2.05 to 9.18; P<0.001).

The mean hospital stay was 8.5 days in the stent group and 3.1 days in the angioplasty group (P<0.001).

Clinical Outcomes at Seven Months

The numbers of various types of clinical events at seven months among all 516 patients are shown in Table 3. A primary clinical end point was reached by 76 of the 257 patients randomly assigned to balloon angioplasty (30 percent), as compared with 52 of the 259 patients randomly assigned to stent implantation (20 percent) (relative risk, 0.68; 95 percent confidence interval, 0.50 to 0.92; P = 0.02). This difference in long-term clinical outcome is shown in the cumulative distribution curves for the primary clinical end point in both treatment groups (Figure 1DFigure 1Cumulative Frequency Distribution Curves for the Two Study Groups, Showing Minimal Luminal Diameters Measured before and after Intervention and at Follow-up, the Percentage of Stenosis at Follow-up, and the Percentage of Patients with Clinical End Points.). The favorable long-term outcome in the stent group was also partly reflected in the difference between the two groups in functional class at the time of the second angiography (Table 4Table 4Functional Class at Seven Months of Follow-up or at the Time of the Intercurrent Intervention for the 516 Patients Included in the Intention-to-Treat Analysis.). The most striking difference in clinical outcomes was the significantly reduced need for an elective second revascularization by means of percutaneous intervention involving the target lesion. There was a 42 percent reduction favoring stent implantation.

During the study, three patients died, one in the angioplasty group and two in the stent group. One patient treated with balloon angioplasty committed suicide four months after the intervention. Two other patients died two and three weeks after successful stent implantations. In the first of these patients, death was preceded by chest pain associated with ST-segment elevation and was therefore thought to be related to a subacute occlusion. In the second patient, the cause of death was hypovolemic shock during surgical repair of an arteriovenous fistula. Although the stent was patent at the time of the pathological examination, the death was considered to be related to the stent.

Angiographic Analysis

Angiographic follow-up data were obtained for 93 percent of the eligible patients (Table 3). The minimal luminal diameter at follow-up was greater after stent implantation than after balloon angioplasty (1.82 ±0.64 vs. 1.73 ±0.55 mm, P = 0.09; median difference, 0.17 mm). The cumulative distribution of the minimal luminal diameter and percentage of stenosis are shown in Figure 1A, Figure B, and Figure C. The incidence of restenosis (the criterion for which was ≥ 50 percent stenosis) was 22 percent after stent implantation as compared with 32 percent after balloon angioplasty (P = 0.02).

Discussion

We found that implantation of coronary stents in patients with stable angina and a single new coronary-artery lesion was associated with a rate of immediate clinical success similar to that of standard balloon angioplasty, but a significantly lower rate of restenosis. This translated into a superior long-term clinical outcome, mainly due to a reduced need for additional percutaneous intervention, at least according to the composite analysis of clinical end points. The advantage of this combined clinical end point is that it leads to a simple estimate of the effect of treatment. However, this analysis ignores the relative effect of various events (i.e., it considers death, a cerebrovascular accident, myocardial infarction, and the like to be equally harmful to the patient) and does not reflect the multiplicity of events that may occur (e.g., in a patient undergoing second angioplasty and surgery and ultimately dying). To address this shortcoming, a count of all events is included in Table 3.

One of the major drawbacks of studies on the prevention of coronary restenosis is that at follow-up the angiographic knowledge of coronary anatomy may influence the physician's therapeutic decision and artificially increase the number of second interventions. This is especially true when the investigator is not kept unaware of the treatment assignments, as when a new device is tested. To circumvent this possible source of bias, a second intervention was considered an end point in this study only when it was substantiated on the basis of anginal symptoms or objective evidence of ischemia (Table 5Table 5Presence of Clinical Symptoms, Ischemic Signs, and Degree of Stenosis in Patients Who Underwent a Second Intervention at Follow-up.). Only two second interventions in the angioplasty group and one in the stent group might not have been justified. Moreover, the fact that the cumulative curves for the composite clinical end points (Figure 1D) diverged between day 75 and day 150 indicates that the difference in clinical outcome was not artificially driven by the angiographic findings at the time of the second catheterization.

Not unexpectedly, the incidence of major bleeding complications was significantly higher in the stent group (13.5 percent) than in the angioplasty group (3.1 percent). The overall incidence reported in the literature, expressed as a weighted average of groin hematomas and pseudoaneurysms, was 7.5 percent (range, 2.7 to 26 percent) and 4.2 percent (range, 0 to 10.8 percent), respectively17.

Another significant difference between the two treatment groups was in the duration of hospitalization. However, Cohen et al. recently showed that length of stay, consumption of resources, and total costs were still substantially greater for bypass surgery than for stenting and that the initially higher in-hospital costs of stent implantation as compared with balloon angioplasty are compensated for by the reduction in subsequent interventions during follow-up18,19. The practitioner and the patient must, however, weigh a long hospital stay and a 13.5 percent risk of bleeding and vascular complications against the potential benefit of a reduction in the likelihood of clinical events from 30 percent to 20 percent.

It may be argued that the difference in drug therapy between the two study groups accounts for the observed differences in angiographic outcome and rate of restenosis. However, a number of clinical studies collectively rule out any beneficial effect of anticoagulant therapy on restenosis in humans20-25. Moreover, the degree of angiographically documented luminal loss was significantly higher after stent implantation than after balloon angioplasty (Table 3). Therefore, the beneficial angiographic and clinical effects of stent implantation are explained by the propensity of the stent to achieve a consistently greater increase in luminal diameter immediately after the procedure than is the case with balloon angioplasty, which is inherently limited by the well-described phenomenon of elastic recoil3,26.

It should be emphasized that in interpreting the favorable results observed in this trial, the restrictive nature of the criteria for inclusion and exclusion must be kept in mind, and thus the results may not be generalizable to other patients, indications, and types of stents. Finally, bleeding and vascular complications and the prolonged hospitalization remain major drawbacks of stent implantation and continue to hamper its acceptance in clinical practice.

Supported in part by a grant from Johnson and Johnson Interventional Systems, Warren, N.J.; Schneider and Co., Bulach, Switzerland; and Lorex Pharmaceutica BV, Maarssen, the Netherlands.

Source Information

From the University Hospital Rotterdam Dijkzigt, Thorax Center, Rotterdam, the Netherlands (P.W.S., P.J., M.A.M.); Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (F.K.); University Hospital San Carlos, Madrid, Spain (C.M.); Universitatsklinikum Rudolf Virchow, Charlottenburg, Berlin, Germany (W.R.); Onze Lieve Vrouwe Kliniek, Aalst, Belgium (G.H.); Sahlgrenska Hospital, Goteborg, Sweden (H.E.); Clinique Pasteur, Toulouse, France (J.M.); Sart-Tilman Centre Hospitalier Universitaire, Liege, Belgium (V.L.); Hopital de la Citadelle, Liege, Belgium (P.M.); Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina (J.B.); Royal Brompton National Heart and Lung Institute, London (U.S.); Centro Cuore Columbus, Milan, Italy (A.C.); Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (J.J.G.); Middelheim Ziekenhuis, Antwerp, Belgium (P.H.); and Gregorio Maranon, Madrid, Spain (J.D.).

Address reprint requests to Dr. Serruys at the Catheterization Laboratory, Thorax Center, Erasmus University Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, the Netherlands.

The remaining investigators in the Benestent Study Group are listed in the Appendix.

Appendix

The following institutions and investigators participated in the Benestent study. The number of patients enrolled at each center is given in parentheses.

University Hospital San Carlos, Madrid, Spain (76): F. Alfonso, J. Goicolea, R. Hernandez, and A. Iniguez; University Hospital Rotterdam Dijkzigt, Thorax Center, Rotterdam, the Netherlands (57): P.J. de Feyter and M. van den Brand; Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands (50): G.J. Laarman and R. vander Wieken; Universitatsklinikum Rudolf Virchow, Charlottenburg, Berlin, Germany (39): W. Rutsch; Onze Lieve Vrouwe Ziekenhuis, Aalst, Belgium (38): B. de Bruyne; Sahlgrenska Hospital, Goteborg, Sweden (36): P. Albertsson; Clinique Pasteur, Toulouse, France (32): J. Fajadet, S. Doucet, and O. Bar; Sart-Tilman Centre Hospitalier Universitaire, Liege, Belgium (32): V. Legrand; Hopital de la Citadelle, Liege, Belgium (19): J. Boland; Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina (19): J. Berrocal and R. Piraino; Royal Brompton National Heart and Lung Institute, London (12): N. Buller and K. Priestley; Centro Cuore Columbus, Milan, Italy (11): L. Maiello; Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland (11): E. Eeckhout; Middelheim Ziekenhuis, Antwerp, Belgium (10): F. van den Brande; Gregorio Maranon, Madrid, Spain (10): E. Garcia; Ziekenhuis de Weezenlanden, Zwolle, the Netherlands (8): H. Suryapranata and J. Hoorntje; St. Antonius Ziekenhuis, Nieuwegein, the Netherlands (8): T. Plokker and G. Mast; Hospital Maggiore, Trieste, Italy (8): S. Klugmann, E. Della Grazia, and A. Salvi; Hopital Cantonal Universitaire, Geneva, Switzerland (7): P. Urban and E. Camenzind; Academisch Ziekenhuis Groningen, Groningen, the Netherlands (6): P. den Heijer and R. van Dijk; Academic Medical Center, Amsterdam, the Netherlands (6): J. Piek and K. Koch; Christian Albrechts University, Kiel, Germany (6): R. Simon and G. Herrmann; Centre Cardiologique du Nord, Paris (5): M.C. Morice and T. Royer; St. James Hospital, Dublin, Ireland (5): P. Crean; Catharina Ziekenhuis, Eindhoven, the Netherlands (3): H. Bonnier, J. Koolen, and F. Bracke; Cliniques Universitaires St. Luc, Universite Catholique de Louvain, Brussels, Belgium (2): W. Wijns; Centre Hospitalier Regional et Universitaire, Nancy, France (2): N. Danchin and Y. Juilliere; and the Polyclinique Volney, Rennes, France (2): C. Bourdonnec.

Ethics and Safety Committee: F. Verheugt, Free University Amsterdam, Amsterdam, the Netherlands; J. Tijssen, Academic Medical Center, Amsterdam, the Netherlands; and G. de Backer, State University Ghent, Ghent, Belgium.

Steering Committee: P.W. Serruys (chairman), H. Emanuelsson, G.R. Heyndrickx, P.P.T. de Jaegere, F. Kiemeneij (co-chairman), C. Macaya, J. Marco, and P. Materne.

Critical Event Committee: F. Kiemeneij (chairman), P.W. Serruys, P.P.T. de Jaegere, P.J. de Feyter, and P. van den Heuvel.

Angiographic Assessment Committee: P.P.T. de Jaegere (chairman), P.W. Serruys, W. Rutsch, B. de Bruyne, and V. Legrand.

Exercise Testing Committee: V. Legrand (chairman), G. Laarman, and N. Danchin.

Data Coordinating and Analysis Center and Quantitative Angiographic Core Laboratory: Cardialysis, Rotterdam, the Netherlands: M. Morel, A.G. Azar, G.A. van Es, J.P. Herrman, R. Melkert, J. Pameyer, and L.M. Rodenburg.

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    EFRAIN GAXIOLA, RONALD E. VLIETSTRA, ALAN S. BRENNER, KEVIN F. BROWNE, DOUGLAS G. EBERSOLE, LYDIA ROMAN, RICHARD A. KERENSKY. (2000) Diabetes and Multiple Stents Independently Double the Risk of Short-term Revascularization. Journal of Interventional Cardiology 13:2, 87-91
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    Louis Cannon, Dale Senior, Frederick Feit, Michael J. Attubato, Joel Rosenberg, Michael J. O'Donnell, Jeffrey Hirst, Michael Gibson. (2000) Directional coronary atherectomy in intermediate sized vessels: Final results of the intermediate vessel atherectomy trial (IVAT). Catheterization and Cardiovascular Interventions 49:4, 396-400
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    Kean-Wah Lau FRCP, Zee-Pin Ding, Abdullah Johan, Jui-Sung Hung. (2000) Mid-term clinical and angiographic follow-up outcome after placement of a new balloon expandable stent in native coronary arteries. Catheterization and Cardiovascular Interventions 49:3, 348-351
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    Ran Kornowski, Balram Bhargava, D.M.Shmuel Fuchs, Alexandra J Lansky, Lowell F Satler, Augusto D Pichard, Mun K Hong, Kenneth M Kent, Roxana Mehran, Gregg W Stone, Martin B Leon. (2000) Procedural results and late clinical outcomes after percutaneous interventions using long (≥25 mm) versus short (<20 mm) stents. Journal of the American College of Cardiology 35:3, 612-618
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    Wolfgang Rutsch, Ferdinand Kiemeneij, Antonio Colombo, Carlos Macaya, Jean-Leon Guermonprez, Lars Grip, Jaap Hamburger, Victor Umans, Mervyn Gotsman, Yaron Almagor, Marie-Claude Morice, Eulogio Garcia, Bernard Chevalier, Raimund Erbel, Michael Cobaugh, Marie-angèle Morel, Patrick W Serruys. (2000) Clinical and angiographic results with the NIR stent: First International NIR Endovascular Stent Study (FINESS-II). Acute Cardiac Care 3:3, 143-151
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    Harry Suryapranata, Jean L. Boland, Michael Pieper, Victor L. Legrand, Johannes JRM Bonnier, Jean-Michel Juliard, Matty CM Vrolix, Ricardo Seabra-Gomes, Jaap N. Hamburger, Ariel Roguin, Cor Oosterwijk, Gerrit-Anne van Es, Rafael Beyar, Patrick W. Serruys. (2000) Clinical and angiographic results with the beStent: the Registry for Optimal beStent Evaluation (ROSE) trial. Acute Cardiac Care 3:1, 21-28
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    Ciro Indolfi, Angelo Cioppa, Eugenio Stabile, Emilio Di Lorenzo, Giovanni Esposito, Alfonso Pisani, Antonio Leccia, Luigi Cavuto, Angela Maria Stingone, Alaide Chieffo, Claudia Capozzolo, Massimo Chiariello. (2000) Effects of hydroxymethylglutaryl coenzyme A reductase inhibitor simvastatin on smooth muscle cell proliferation in vitro and neointimal formation in vivo after vascular injury. Journal of the American College of Cardiology 35:1, 214-221
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    Leif Thuesen, Henning R. Andersen,. (2000) Six Months' Clinical and Angiographic Follow-up of a Flexible, Coiled Stainless Steel Stent in Long, Native Coronary Artery Lesions. Scandinavian Cardiovascular Journal 34:2, 182-185
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    HIDEO TAMAI, KEIJI IGAKI, TAKAFUMI TSUJI, EISHO KYO, KUNIHIKO KOSUGA, AKIYOSHI KAWASHIMA, SHIGEO MATSUI, HIDENORI KOMORI, SEIICHIRO MOTOHARA, HIROMU UEHATA, EIJI TAKEUCHI. (1999) A Biodegradable Poly-l-lactic Acid Coronary Stent in the Porcine Coronary Artery. Journal of Interventional Cardiology 12:6, 443-450
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    JÜRGEN HAASE, HANS STÖRGER, MANFRED HOFMANN, FRANZ SCHWARZ. (1999) Excimer Laser Angioplasty with Adjunctive Balloon Dilatation Versus Balloon Dilatation Alone for the Treatment of In-Stent Restenosis: Results of a Randomized Single-Center Study. Journal of Interventional Cardiology 12:6, 513-518
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    THIERRY LEFÈVRE, MARIE-CLAUDE MORICE. (1999) Interventional Treatment of Acute Myocardial Infarction: Is The Thrombolysis Era Coming to an End?. Journal of Interventional Cardiology 12:6, 477-486
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    Peter N Ruygrok, Rein Melkert, Marie-Angèle M Morel, John A Ormiston, Frits W Bär, Francisco Fernandez-Avilès, Harry Suryapranata, Keith D Dawkins, Claude Hanet, Patrick W Serruys. (1999) Does angiography six months after coronary intervention influence management and outcome?. Journal of the American College of Cardiology 34:5, 1507-1511
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    Young Keun Ahn, Myung Ho Jeong, Joon Woo Kim, Seong Hee Kim, Jang Hyun Cho, Jeong Gwan Cho, Chang Soo Park, Sang Woo Juhng, Jong Chun Park, Jung Chaee Kang. (1999) Preventive effects of the heparin-coated stent on restenosis in the porcine model. Catheterization and Cardiovascular Interventions 48:3, 324-330
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    Antonio L. Bartorelli, Francesco Lavarra, Daniela Trabattoni, Franco Fabbiocchi, Alessandro Loaldi, Stefano Galli, Piero Montorsi. (1999) Successful stent delivery with deep seating of 6 French guiding catheters in difficult coronary anatomy. Catheterization and Cardiovascular Interventions 48:3, 279-284
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    Amadeo Betriu, Monica Masotti, Antoni Serra, Joaquin Alonso, Francisco Fernández-Avilés, Federico Gimeno, Thierry Colman, Javier Zueco, Juan L Delcan, Eulogio Garcı́a, José Calabuig. (1999) Randomized comparison of coronary stent implantation and balloon angioplasty in the treatment of de novo coronary artery lesions (START). Journal of the American College of Cardiology 34:5, 1498-1506
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    PIOTR WACINSKI, PHILIP URBAN, PASCAL CHATELAIN, CAROLINE BACCHIOCCHI-SUILEN, JOSE RAMOS OLIVAL, PIERRE-ANDRÉ DORSAZ. (1999) Complete Myocardial Revascularization by Single Session Triple Vessel Percutaneous Coronary Angioplasty and Provisional Stenting. Journal of Interventional Cardiology 12:5, 349-353
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    Kim A. Eagle, Robert A. Guyton, Ravin Davidoff, Gordon A. Ewy, James Fonger, Timothy J. Gardner, John Parker Gott, Howard C. Herrmann, Robert A. Marlow, William C. Nugent, Gerald T. O’Connor, Thomas A. Orszulak, Richard E. Rieselbach, William L. Winters, Salim Yusuf, Raymond J. Gibbons, Joseph S. Alpert, Kim A. Eagle, Timothy J. Gardner, Arthur Garson, Gabriel Gregoratos, Richard O. Russell, Sidney C. Smith. (1999) ACC/AHA guidelines for coronary artery bypass graft surgery. Journal of the American College of Cardiology 34:4, 1262-1347
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    Etsuo Tsuchikane, Satoru Sumitsuji, Nobuhisa Awata, Toshinori Nakamura, Tomoko Kobayashi, Masahiro Izumi, Satoru Otsuji, Hitone Tateyama, Makoto Sakurai, Tohru Kobayashi. (1999) Final results of the STent versus directional coronary Atherectomy Randomized Trial (START). Journal of the American College of Cardiology 34:4, 1050-1057
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    EUGENE V. POMERANTSEV, ANTONIO COLOMBO, LOUIS FUENTE, EBERHARD GRUBE, CRAIG JUERGENS, D. MATHEY, M. SCHALIJ, J. J. GOY, M.C. MORICE, J. SCHOFER, IRAWAN SUGENG, SIMON H. STERTZER. (1998) Microstent to GFX: Experience in 2,325 Patients. Journal of Interventional Cardiology 11:2, 101-106
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    Michel R. Le May, Marino Labinaz, Jean-François Marquis, Edward R. O'Brien, Rob S. Beanlands, Louise A. Laramée, William L. Williams, Richard F. Davies, Sharon Ann Kearns, Lyall A. Higginson. (1998) Late clinical and angiographic follow-up after stenting in evolving and recent myocardial infarction. American Heart Journal 135:4, 714-718
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    Spencer B. King, Wanlin Yeh, Richard Holubkov, Donald S. Baim, George Sopko, Patrice Desvigne-Nickens, David R. Holmes, Michael J. Cowley, Martial G. Bourassa, James Margolis, Katherine M. Detre. (1998) Balloon Angioplasty Versus New Device Intervention: Clinical Outcomes. Journal of the American College of Cardiology 31:3, 558-566
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    Gabriel S. Aldea, Jennifer A. Gaudiani, Oz M. Shapira, Paul O'Gara, Yusheng Bao, Harold L. Lazar, Richard J. Shemin. (1998) Comparison of Risk Profile and Outcomes in Patients Undergoing Surgical and Catheter-based Revascularization. Journal of Cardiac Surgery 13:2, 81-89
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    Jeffrey L. Roitman, Tom LaFontaine, Ami M Drimmer. (1998) A New Model for Risk Stratification and Delivery of Cardiovascular Rehabilitation Services in the Long-Term Clinical Management of Patients With Coronary Artery Disease. Journal of Cardiopulmonary Rehabilitation 18:2, 113-123
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    Christodoulos Stefanadis, Konstantinos Toutouzas, Eleftherios Tsiamis, Charalambos Vlachopoulos, Ioannis Kallikazaros, Costas Stratos, Pavlos Toutouzas. (1998) Total reconstruction of a diseased saphenous vein graft by means of conventional and autologous tissue-coated stents. Catheterization and Cardiovascular Diagnosis 43:3, 318-321
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    Pierre Meyer, Philippe Durand, Damien Metz, Nader Butto, Claude Touati, Andre Gervais. (1998) Six French sheathless coronary angioplasty using a novel technique to introduce the guiding catheter: The INTRUC, a preliminary retrospective study. Catheterization and Cardiovascular Diagnosis 43:3, 331-335
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    Michael P. Savage, David L. Fischman, Randal Rake, Martin B. Leon, Richard A. Schatz, Ian Penn, Masakiyo Nobuyoshi, Jeffrey Moses, John Hirshfeld, Richard Heuser, Donald Baim, Michael Cleman, Jeffrey Brinker, Sharon Gebhardt, Sheldon Goldberg. (1998) Efficacy of Coronary Stenting Versus Balloon Angioplasty in Small Coronary Arteries fn1fn1This study was supported in part by a grant from Johnson & Johnson Interventional Systems, Inc., Warren, New Jersey.. Journal of the American College of Cardiology 31:2, 307-311
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    Horst Sievert, Stephan Rohde, Roland Ensslen, Andreas Fach, Hartmut Merle, Rainer Schräder, Hans Spies. (1998) Initial clinical experience with the new EBI (BARD-XT) flexible coronary stent: Acute results and follow-up. Catheterization and Cardiovascular Diagnosis 43:2, 159-162
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    ANTONIO FERNÁNDEZ-ORTIZ, JAVIER GOICOLEA, MARÍA J. PÉREZ-VIZCAYNO, ROSANA HERNÁNDEZ, FERNANDO ALFONSO, JAVIER SEGOVIA, CAMINO BAÑUELOS, CARLOS MACAYA. (1998) Six-month Follow-up of Successful Stenting for Acute Dissection After Coronary Angioplasty: Comparison Between Slotted Tube (Palmaz-Schatz) and Flexible Coil (Gianturco-Roubin) Stent Designs. Journal of Interventional Cardiology 11:1, 41-47
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    Paul S. Watson, Chandrashekhar K. Ponde, Constantine N. Aroney, James Cameron, Adam Cannon, Mark Dooris, Paul J. Garrahy, Paul T. McEniery, John H. N. Bett. (1998) Angiographic follow-up and clinical experience with the flexible tantalum cordis stent. Catheterization and Cardiovascular Diagnosis 43:2, 168-173
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    E. James, P. Broadhurst, A. Simpson, S. Das. (1998) Bacteraemia complicating coronary artery stenting. Journal of Hospital Infection 38:2, 154-155
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    Gregg W. Stone, Bruce R. Brodie, John J. Griffin, Marie Claude Morice, Costantino Costantini, Frederick G. St. Goar, Paul A. Overlie, Jeffrey J. Popma, JoAnn McDonnell, Denise Jones, William W. O’Neill, Cindy L. Grines. (1998) Prospective, Multicenter Study of the Safety and Feasibility of Primary Stenting in Acute Myocardial Infarction: In-Hospital and 30-Day Results of the PAMI Stent Pilot Trial. Journal of the American College of Cardiology 31:1, 23-30
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    Michael A. Bettmann, Barry T. Katzen, Jack Whisnant, Cochairs Michael Brant-Zawadzki, Joseph P. Broderick, Anthony J. Furlan, Linda A. Hershey, Virginia Howard, Richard Kuntz, Chris M. Loftus. (1998) Carotid Stenting and Angioplasty: A Statement for Healthcare Professionals from the Councils on Cardiovascular Radiology, Stroke, Cardiovascular Surgery, Epidemiology and Prevention, and Clinical Cardiology, American Heart Association. Journal of Vascular and Interventional Radiology 9:1, 3-5
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    François Bouchart, Arnaud Dubar, Jean Paul Bessou, Michel Redonnet, Jacques Berland, Dominique Mouton-Schleifer, Catherine Haas-Hubscher, Robert Soyer. (1997) Pseudomonas aeruginosa Coronary Stent Infection. The Annals of Thoracic Surgery 64:6, 1810-1813
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    FOUAD R. AMIN, PAUL A. KELLY, ARVINDER S. KURBAAN, JONATHAN R. CLAGUE, ULRICH SIGWART. (1997) Stenting for Unprotected and Protected Left Main Stem Disease: A Comparison of Short- and Long-term Outcome. Journal of Interventional Cardiology 10:6, 401-407
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    David K. Murdock, Timothy Logemann, Mark T. Hoffmann, Karen J. Olson, Richard S. Engelmeier. (1997) Feature topic: Clinical use of abciximab: Coronary artery stenting for suboptimal PTCA results in acute myocardial infarction in patients treated with abciximab: Early and six-month outcome. Catheterization and Cardiovascular Diagnosis 42:2, 173-179
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    Hisashi Yokoi, Hiroyuki Daida, Yoichi Kuwabara, Hideo Nishikawa, Fumimaro Takatsu, Hitoshi Tomihara, Yasuro Nakata, Yasunori Kutsumi, Shigeru Ohshima, Shinichiro Nishiyama, Akira Seki, Kenichi Kato, Shigeyuki Nishimura, Tatsuji Kanoh, Hiroshi Yamaguchi. (1997) Effectiveness of an Antioxidant in Preventing Restenosis After Percutaneous Transluminal Coronary Angioplasty: The Probucol Angioplasty Restenosis Trial. Journal of the American College of Cardiology 30:4, 855-862
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    RAFAEL BEYAR, ARIEL ROGUIN, JAAP HAMBURGER, ANDRE SAAIMAN, ANTONIO L. BARTORELLI, CARLO DiMARIO, ANTONIO COLOMBO, CHRISTIAN W. HAMM M.D., CHRISTOPHER J. WHITE, J. MARCO, PATRICK W. SERRUYS. (1997) Multicenter Pilot Study of a Serpentine Balloon-Expandable Stent (beStent TM ): Acute Angiographic and Clinical Results. Journal of Interventional Cardiology 10:4, 277-286
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    Glenn Levine, Musa M. Khan, Neal S. Kleiman, Albert E. Raizner, Mohammed O. Jeroudi, Judith Mickelson, M. Nadir Ali. (1997) Use of bare-mounted Palmaz-Schatz stents employing the stent saddle technique on the delivery balloon: A single center experience. Catheterization and Cardiovascular Diagnosis 41:4, 361-368
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    Clemens von Birgelen, Gary S Mintz, Antonino Nicosia, David P Foley, Wim J van der Giessen, Nico Bruining, Sergei G Airiian, Jos R.T.C Roelandt, Pim J de Feyter, Patrick W Serruys. (1997) Electrocardiogram-Gated Intravascular Ultrasound Image Acquisition After Coronary Stent Deployment Facilitates On-Line Three-Dimensional Reconstruction and Automated Lumen Quantification. Journal of the American College of Cardiology 30:2, 436-443
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    (1997) A Comparison of Coronary-Artery Stenting with Angioplasty. New England Journal of Medicine 337:4, 277-278
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    Verghese Mathew, David Hasdai, David R Holmes, Kirk N Garratt, Malcolm R Bell, Amir Lerman, Steven Melby, Diane E Grill, Peter B Berger. (1997) Clinical Outcome of Patients Undergoing Endoluminal Coronary Artery Reconstruction With Three or More Stents. Journal of the American College of Cardiology 30:3, 676-681
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    Leonard Schwartz, Brian Blew, Sanh Bui. (1997) Intracoronary-stent placement for coronary artery disease. The Lancet 350:9071, 113-114
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    Bernhard Reimers, Issam Moussa, Tatsuro Akiyama, Gina Tucci, Massimo Ferraro, Giovanni Martini, Simonetta Blengino, Carlo DI Mario, Antonio Colombo. (1997) Long-Term Clinical Follow-Up After Successful Repeat Percutaneous Intervention for Stent Restenosis. Journal of the American College of Cardiology 30:1, 186-192
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    Gregory S. Pavlides, Peter Barath, Athanasios Maginas, Vasilios Vasilikos, Dennis V. Cokkinos, William W. O'Neill. (1997) Intramural drug delivery by direct injection within the arterial wall: First clinical experience with a novel intracoronary delivery-infiltrator system. Catheterization and Cardiovascular Diagnosis 41:3, 287-292
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    James J. Glazier, Jeffrey A. Hirst, Francis J. Kiernan, Daniel B. Fram, Adel M. Eldin, Charles A. Primiano, Joseph F. Mitchel, Raymond G. McKay. (1997) Site-specific intracoronary thrombolysis with urokinase-coated hydrogel balloons: Acute and follow-up studies in 95 patients. Catheterization and Cardiovascular Diagnosis 41:3, 246-253
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    Morton J. Kern, Bernard de Bruyne, Nico H.J. Pijls. (1997) From Research to Clinical Practice: Current Role of Intracoronary Physiologically Based Decision Making in the Cardiac Catheterization Laboratory. Journal of the American College of Cardiology 30:3, 613-620
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    Roger J. Laham, Kalon K.L. Ho, Donald S. Baim, Richard E. Kuntz, David J. Cohen, Joseph P. Carrozza. (1997) Multivessel Palmaz-Schatz Stenting: Early Results and One-Year Outcome. Journal of the American College of Cardiology 30:1, 180-185
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    Holmes, David R. Jr., . (1997) Preventing Coronary Restenosis and Complications. New England Journal of Medicine 336:24, 1748-1749
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    Teirstein, Paul S., Massullo, Vincent, Jani, Shirish, Popma, Jeffrey J., Mintz, Gary S., Russo, Robert J., Schatz, Richard A., Guarneri, Erminia M., Steuterman, Stephen, Morris, Nancy B., Leon, Martin B., Tripuraneni, Prabhakar, . (1997) Catheter-Based Radiotherapy to Inhibit Restenosis after Coronary Stenting. New England Journal of Medicine 336:24, 1697-1703
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    The Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes (GUSTO IIb) Angioplasty Substudy Investigators. (1997) A Clinical Trial Comparing Primary Coronary Angioplasty with Tissue Plasminogen Activator for Acute Myocardial Infarction. New England Journal of Medicine 336:23, 1621-1628
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    Antonio M. Calafiore, Giovanni Teodori, Gabriele Di Giammarco, Giuseppe Vitolla, Angela Iaco', Teresa Iovino, Sergio Cirmeni, Giovanni Bosco, Giovanni Scipioni, Sabina Gallina. (1997) Minimally invasive coronary artery bypass grafting on a beating heart. The Annals of Thoracic Surgery 63:6, S72-S75
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    JEFFREY MOSES, ISSAM MOUSSA, GREGG STONE. (1997) Clinical Trials of Coronary Stenting in Acute Myocardial Infarction. Journal of Interventional Cardiology 10:3, 225-229
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    Mazen S. Ganim, Richard W. Smalling. (1997) Editorial comment: Coronary AVE micro stents: Do we need another stent?. Catheterization and Cardiovascular Diagnosis 41:2, 225-225
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    Eric Van Belle, Luc Maillard, Fermin O. Tio, Jeffrey M. Isner. (1997) Accelerated Endothelialization by Local Delivery of Recombinant Human Vascular Endothelial Growth Factor Reduces In-Stent Intimal Formation. Biochemical and Biophysical Research Communications 235:2, 311-316
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    Morton J Kern, Patrick Dupouy, John H Drury, Frank V Aguirre, Eduardo Aptecar, Richard G Bach, Eugene A Caracciolo, Thomas J Donohue, Jean-Luc Dubois Rande, Herbert J Geschwind, Carol J Mechem, Ghanshyam Kane, Emannuel Teiger, Thomas L Wolford. (1997) Role of Coronary Artery Lumen Enlargement in Improving Coronary Blood Flow After Balloon Angioplasty and Stenting: A Combined Intravascular Ultrasound Doppler Flow and Imaging Study. Journal of the American College of Cardiology 29:7, 1520-1527
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    ULRICH SIGWART. (1997) Ten Years Of Stenting: What Next?. Journal of Interventional Cardiology 10:3, 195-205
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    Abdullateef Khoja, Cem Özbek, Wolfgang Bay, Armin Heisel. (1997) Trouser-like stenting: A new technique for bifurcation lesions. Catheterization and Cardiovascular Diagnosis 41:2, 192-196
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    Edouard Benit, Luc Missault, Thierry Eeman, Marc Carlier, Luc Muyldermans, Pierre Materne, Pol Lafontaine, Jan De Keyser, Olivier Decoster, Suzanne Pourbaix, Marc Castadot, Jean Boland. (1997) Brachial, radial, or femoral approach for elective Palmaz-Schatz stent implantation: A randomized comparison. Catheterization and Cardiovascular Diagnosis 41:2, 124-130
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    JONATHAN R. CLAGUE, ARVINDER S. KURBAAN, PAUL A. KELLY, LIN DENNE, SIMON W. DAVIES, ANTHONY F. RICKARDS, ULRICH SIGWART. (1997) The New ACS Multilink Coronary Stent: Single Center Experience in 103 Consecutive Patients With and Without Oral Anticoagulation. Journal of Interventional Cardiology 10:3, 183-191
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    EULOGIO GARCÍA. (1997) In-Hospital Results of the Wiktor Stent in Acute Myocardial Infarction. Journal of Interventional Cardiology 10:3, 231-235
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    RAFAEL BEYAR, ARIEL ROGUIN. (1997) Early and Late Results of the Self-Expanding Nitinol Stents: Interim Report from a Multicenter European Study. Journal of Interventional Cardiology 10:3, 207-213
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    Peter P. de Jaegere, Frank D. Eefting, Pieter R. Stella, Huub W. Meijburg, Pieter W. Westerhof, Etienne Robles de Medina. (1997) Revascularization of patients with coronary artery disease: The interventional cardiologist's perspective. The Annals of Thoracic Surgery 63:6, S23-S27
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    Christopher J. White. (1997) Stent recoil: Comparison of the Wiktor-GX coil and the Palmaz-Schatz tubular coronary stent. Catheterization and Cardiovascular Diagnosis 41:1, 1-3
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    (1997) Randomised placebo-controlled trial of abciximab before and during coronary intervention in refractory unstable angina: the CAPTURE study. The Lancet 349:9063, 1429-1435
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    Eldad Rechavia, Michael C. Fishbien, Tony DeFrance, Masato Nakamura, Asish Parikh, Frank Litvack, Neal Eigler. (1997) Temporary arterial stenting: Comparison to permanent stenting and conventional balloon injury in a rabbit carotid artery model. Catheterization and Cardiovascular Diagnosis 41:1, 85-92
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    Cem Özbek, Armin Heisel, Bernhard Groß, Wolfgang Bay, Hermann Schieffer. (1997) Coronary implantation of silicone-carbide-coated Palmaz-Schatz stents in patients with high risk of stent thrombosis without oral anticoagulation. Catheterization and Cardiovascular Diagnosis 41:1, 71-78
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    Anoop Chauhan, Mohammad Zubaid, Christopher E. Buller, Michael D. Moscovich, Donald R. Ricci, Laureen Lepicq, Rebecca Fox, Ian M. Penn. (1997) Comparison of bailout versus elective stenting: Time to reassess our benchmarks of outcome. Catheterization and Cardiovascular Diagnosis 41:1, 40-47
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    David Antoniucci, Renato Valenti, Giovanni Maria Santoro, Leonardo Bolognese, Enrico Taddeucci, Maurizio Trapani, Alberto Santini, Pier Filippo Fazzini. (1997) Bailout coronary stenting without anticoagulation or intravascular ultrasound guidance: Acute and six-month angiographic results in a series of 120 consecutive patients. Catheterization and Cardiovascular Diagnosis 41:1, 14-19
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    Martin Fleisch, Bernhard Meier. (1997) Editorial comment: Left main coronary angioplasty: Is the Bastille of bypass surgery about to go down?. Catheterization and Cardiovascular Diagnosis 41:1, 30-31
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    Eric Van Belle, Fermin O Tio, Donghui Chen, Luc Maillard, Dongfen Chen, Marianne Kearney, Jeffrey M Isner. (1997) Passivation of Metallic Stents After Arterial Gene Transfer of phVEGF165 Inhibits Thrombus Formation and Intimal Thickening. Journal of the American College of Cardiology 29:6, 1371-1379
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    K Gutensohn, C Beythien, J Bau, T Meinertz, P Kuehnl. (1997) FLOW CYTOMETRIC ANALYSIS OF CORONARY STENT-INDUCED ALTERATIONS OF PLATELET ANTIGENS IN AN IN VITRO MODEL. Thrombosis Research 86:1, 49-56
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    MICHAEL P. SAVAGE, RICHARD H. KIM, DAVID L. FISCHMAN, SHELDON GOLDBERG. (1997) Stenting in Saphenous Vein Grafts: Progress and Future Challenges. Journal of Interventional Cardiology 10:2, 145-153
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    ANTONIO COLOMBO. (1997) Coronary Stenting: Current State of the Art. Journal of Interventional Cardiology 10:2, 137-144
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    JAMES J. FERGUSON. (1997) New Pharmacological Adjuncts for Coronary Stenting: Can New Anticoagulants Improve Outcomes?. Journal of Interventional Cardiology 10:2, 155-159
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    G. Berland, P. Block, T. DeLoughery, G. Grunkemeier. (1997) Clinical one-year outcomes after stenting in acute myocardial infarction. Catheterization and Cardiovascular Diagnosis 40:4, 337-341
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    RON WAKSMAN. (1997) Intracoronary Radiation Adjunct Therapy to Stenting. Journal of Interventional Cardiology 10:2, 133-135
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    Stacy C. Smith, Kenneth J. Winters, John M. Lasala. (1997) Stent thrombosis in a patient receiving chemotherapy. Catheterization and Cardiovascular Diagnosis 40:4, 383-386
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    RENÉ KONING, ALAIN CRIBIER, HÉLÈNE ELTCHANINOFF, CHRISTOPHE TRON, BRICE LETAC. (1997) Primary Intracoronary Stenting of Unprotected Left Main Coronary Artery Stenosis in Two Patients with No Contraindication to Surgery: Immediate and Follow-Up Results. Journal of Interventional Cardiology 10:2, 127-131
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    Christian Müller, Axel W. Frey, Helmut Roskamm, John McB. Hodgson. (1997) Single device approach to ultrasound-guided percutaneous transluminal coronary angioplasty and stenting: Initial experience with a combined intracoronary ultrasound/variable diameter balloon. Catheterization and Cardiovascular Diagnosis 40:4, 393-399
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    Chandrashekhar K. Ponde, Constantine N. Aroney, Paul T. McEniery, John H. N. Bett. (1997) Plaque prolapse between the struts of the intracoronary Palmaz-Schatz stent: Report of two cases with a novel treatment of this unusual problem. Catheterization and Cardiovascular Diagnosis 40:4, 353-357
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    D. Stephan, EG Nabel. (1997) Gene and other biological therapies for vascular diseases. Fundamental & Clinical Pharmacology 11:2, 97-110
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    Christodoulos Stefanadis, Eleftherios Tsiamis, Charalambos Vlachopoulos, Konstantinos Toutouzas, Nikos Giatrakos, Costas Tsioufis, Leonidas Diamantopoulos, Pavlos Toutouzas. (1997) Arterial autologous graft-stent for treatment of coronary artery disease: A new technique. Catheterization and Cardiovascular Diagnosis 40:3, 302-307
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    Zoltan G. Turi, John G. McGinnity, David Fischman, Mary Jane Kreiner, James J. Glazier, Diane Rehmann, Barbara S. Fromm. (1997) Retrospective comparative study of primary intracoronary stenting versus balloon angioplasty for acute myocardial infarction. Catheterization and Cardiovascular Diagnosis 40:3, 235-239
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    Thomas J. Linnemeier. (1997) Editorial comment: Left main coronary disease: Is stenting an option?. Catheterization and Cardiovascular Diagnosis 40:3, 276-276
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    Atul D. Abhyankar, Gai Luyue, Brian P. Bailey. (1997) Stent implantation in severely angulated lesions: Safety, efficacy, and morphological remodelling. Catheterization and Cardiovascular Diagnosis 40:3, 261-264
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    Fernando Alfonso, Pedro Rodriguez, Paul Phillips, Javier Goicolea, Rosana Hernández, Maria-José Pérez-Vizcayno, Antonio Fernández-Ortiz, Javier Segovia, Camino Bañuelos, Paloma Aragoncillo, Carlos Macaya. (1997) Clinical and Angiographic Implications of Coronary Stenting in Thrombus-Containing Lesions. Journal of the American College of Cardiology 29:4, 725-733
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    Jacques Julien. (1997) Cardiac complications in non-insulin-dependent diabetes mellitus. Journal of Diabetes and its Complications 11:2, 123-130
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    Srinivas Duvvuri, Narinder Bhalla, Abbas Shehadeh, James R. Albanese, George Dangas, Samin K. Sharma. (1997) A single-step stent delivery, deployment, and expansion system. Catheterization and Cardiovascular Diagnosis 40:3, 308-310
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    Christodoulos Stefanadis, Eleftherios Tsiamis, Charalambos Vlachopoulos, Konstantinos Toutouzas, Costas Stratos, Ioannis Kallikazaros, Manolis Vavuranakis, Pavlos Toutouzas. (1997) Autologous vein graft-coated stents for the treatment of thrombus-containing coronary artery lesions. Catheterization and Cardiovascular Diagnosis 40:2, 217-222
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    ENRICO BARBIERI, FACC LUISA ZANOLLA, PIERO ZARDINI. (1997) Economic and Ethical Issues Regarding Therapeutic Procedures in Interventional Cardiology: State of the Art in Italy. Journal of Interventional Cardiology 10:1, 87-90
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    Randy K. Bottner, Kenneth R. Hardigan. (1997) High-speed rotational ablation for in-stent restenosis. Catheterization and Cardiovascular Diagnosis 40:2, 144-149
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    Ferdinand Kiemeneij, Gert Jan Laarman, Ton Slagboom, Ron van der Wieken. (1997) Outpatient Coronary Stent Implantation. Journal of the American College of Cardiology 29:2, 323-327
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    GILLIAN A. J. JESSURUN, PETER DEN HEIJER, RENÉ A. TIO, HANS O. J. PEELS, HARRY J. G. M. CRIJNS. (1997) Economic and Ethical Issues of Interventional Cardiology in The Netherlands: It Is Time for Managed Care. Journal of Interventional Cardiology 10:1, 73-79
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    Severin P. Schwarzacher, Jonas A. Metz, Paul G. Yock, Peter J. Fitzgerald. (1997) Vessel tearing at the edge of intracoronary stents detected with intravascular ultrasound imaging. Catheterization and Cardiovascular Diagnosis 40:2, 152-155
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    A. J. KERR, M. J. A. WILLIAMS, G. T. WILKINS. (1997) Primary stenting as treatment for coronary-subclavian steal syndrome. Australian and New Zealand Journal of Medicine 27:1, 80-81
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    David R. Holmes, Malcolm R. Bell, David R. Holmes, Peter B. Berger, John F. Bresnahan, LaVon N. Hammes, Diane E. Grill, Kirk N. Garratt. (1997) Interventional cardiology and intracoronary stents—a changing practice: Approved vs. nonapproved indications. Catheterization and Cardiovascular Diagnosis 40:2, 133-138
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    David S. Eccleston, A.Michael Lincoff. (1997) Catheter-based drug delivery for restenosis. Advanced Drug Delivery Reviews 24:1, 31-43
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    Guido Belli, Patrick L. Whitlow. (1997) Editorial comment: Should we spark interest in rotational atherectomy for in-stent restenosis?. Catheterization and Cardiovascular Diagnosis 40:2, 150-151
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    John Lambros, Ahmad Farshid, Mark R. Pitney. (1997) Simultaneous use of a diagnostic catheter to facilitate stent deployment in aorto-ostial artery stenosis: A case report. Catheterization and Cardiovascular Diagnosis 40:2, 210-211
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    Kenneth Rosenfield, Robert Schainfeld, Ann Pieczek, Laura Haley, Jeffrey M Isner. (1997) Restenosis of Endovascular Stents From Stent Compression. Journal of the American College of Cardiology 29:2, 328-338
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    Reda A. El-Shiekh, Mark W. Burket, Assad Mouhaffel, Joseph A. Moore, Christopher J. Cooper. (1997) U.S. experience of transradial coronary stenting utilizing Palmaz-Schatz stents. Catheterization and Cardiovascular Diagnosis 40:2, 166-169
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    Krishna J. Rocha-Singh, Robert V. Trask, Charles L. Lucore, Susan G. Horn. (1997) One balloon, one stent: An effective cost-containment strategy for elective stent deployment. Catheterization and Cardiovascular Diagnosis 40:1, 17-20
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    Ranjit S More, Anoop Chauhan. (1997) Antiplatelet rather than anticoagulant therapy with coronary stenting. The Lancet 349:9046, 146-147
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    C. Janicki, D. M. Duggan, C. W. Coffey, D. R. Fischell, T. A. Fischell. (1997) Radiation dose from a phosphorous-32 impregnated wire mesh vascular stent. Medical Physics 24:3, 437
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    Peter Währborg. (1997) Percutaneous Transluminal Coronary Angioplasty or Coronary Artery Bypass Grafting for Coronary Artery Disease?. Scandinavian Cardiovascular Journal 31:4, 201-211
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    D. Cusick, C. Davidson, T. Frohlich, G. Davis, M. Salinger. (1997) Coronary artery stenting postcardiac transplant: A report of two cases. Catheterization and Cardiovascular Diagnosis 40:1, 92-96
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    Shigeru Nakamura, Patrick Hall, Antonio Gaglione, Fabio Tiecco, Marinella Di Maggio, Luigi Maiello, Giovanni Martini, Antonio Colombo. (1997) High Pressure Assisted Coronary Stent Implantation Accomplished Without Intravascular Ultrasound Guidance and Subsequent Anticoagulation. Journal of the American College of Cardiology 29:1, 21-27
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    R. S. Schwartz, D. R. Holmes. (1997) The future of stenting. Minimally Invasive Therapy & Allied Technologies 6:3, 221-223
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    Malcolm R. Bell, Paula J. Britson, Aloysius Chu, David R. Holmes, John F. Bresnahan, Robert S. Schwartz. (1997) Validation of a new UNIX-based quantitative coronary angiographic system for the measurement of coronary artery lesions. Catheterization and Cardiovascular Diagnosis 40:1, 66-74
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    Yukio Ozaki, Patrick W Serruys. (1997) Recent Progress in Coronary Interventions. Japanese Circulation Journal 61:1, 1-13
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    Albert Schömig, Franz-Josef Neumann, Hanna Walter, Helmut Schühlen, Martin Hadamitzky, Eva-Maria Zitzmann-Roth, Josef Dirschinger, Jörg Hausleiter, Rudolf Blasini, Claus Schmitt, Eckhard Alt, Adnan Kastrati. (1997) Coronary Stent Placement in Patients With Acute Myocardial Infarction: Comparison of Clinical and Angiographic Outcome After Randomization to Antiplatelet or Anticoagulant Therapy. Journal of the American College of Cardiology 29:1, 28-34
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    Issam Moussa, MD, Carlo Di Mario, MD, FACC, Bernhard Reimers, MD, Tatsuro Akiyama, MD, Jonathan Tobis, MD, FACC, Antonio Colombo, MD, FACC. (1997) Subacute Stent Thrombosis in the Era of Intravascular Ultrasound-Guided Coronary Stenting Without Anticoagulation: Frequency, Predictors and Clinical Outcome. Journal of the American College of Cardiology 29:1, 6-12
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    Luisa Gregorini, MD, Jean Marco, MD, Jean Fajadet, MD, Monique Bernies, MD, Bernard Cassagneau, MD, Philippe Brunel, MD, Irene M Bossi, MD, Pier Mannuccio Mannucci, MD. (1997) Ticlopidine and Aspirin Pretreatment Reduces Coagulation and Platelet Activation During Coronary Dilation Procedures. Journal of the American College of Cardiology 29:1, 13-20
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    MARK A. HLATKY. (1996) Economic and Ethical Considerations in Percutaneous Coronary Revascularization. Journal of Interventional Cardiology 9:6, 469-473
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    Philip Wong, Chi-Ming Wong, Chun-Ho Cheng, Patrick Ko, Joseph Chow, Yau-Ting Tai, Christopher Barnes. (1996) Early clinical experience with the multi-link coronary stent. Catheterization and Cardiovascular Diagnosis 39:4, 413-419
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    Kumar Sridhar, David Fischman, Sheldon Goldberg, Andrew Zalewski, Paul Walinsky, Doranne Porter, Sarah Fenton, Bhavdeep Gupta, Randal Rake, Sharon Gebhardt, Michael Savage. (1996) Peripheral vascular complications after intracoronary stent placement: Prevention by use of a pneumatic vascular compression device. Catheterization and Cardiovascular Diagnosis 39:3, 224-229
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    Per Anton Sirnes, Svein Gold, Yngvar Myreng, Per Mølstad, Håkean Emanuelsson, Per Albertsson, Magne Brekke, Arild Mangschau, Knut Endresen, John Kjekshus. (1996) Stenting in chronic coronary occlusion (SICCO): A randomized, controlled trial of adding stent implantation after successful angioplasty. Journal of the American College of Cardiology 28:6, 1444-1451
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    Karl R. Karsch, Melitta B. Preisack, Rainer Baildon, Volker Eschenfelder, David Foley, Eulogio J. Garcia, Martin Kaltenbach, Christoph Meisner, Hans K. Selbmann, Patrick W. Serruys, Man F. Shiu, Martin Sujatta, Raoul Bonan. (1996) Low molecular weight heparin (reviparin) in percutaneous transluminal coronary angioplasty results of a randomized, double-blind, unfractionated heparin and placebo-controlled, multicenter trial (REDUCE trial). Journal of the American College of Cardiology 28:6, 1437-1443
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    Arnd B. Buchwald, Stefan Hammerschmidt, Jens Stevens, Jens Göring, Klaus Nebendahl, Christina Unterberg. (1996) Inhibition of Neointimal Proliferation After Coronary Angioplasty by Low-Molecular-Weight Heparin (Clivarine) and Polyethyleneglycol-Hirudin. Journal of Cardiovascular Pharmacology 28:4, 481-487
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    John H. Stevens, Thomas A. Burdon, Lawrence C. Siegel, William S. Peters, Mario F. Pompili, Frederick G. St. Goar, Gerald J. Berry, Greg H. Ribakove, Mark A. Vierra, R. Scott Mitchell, John M. Toomasian, Bruce A. Reitz. (1996) Port-access coronary artery bypass with cardioplegic arrest: acute and chronic canine studies. The Annals of Thoracic Surgery 62:2, 435-441
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Letters