THERAPY AND PREVENTION Low-pressure deployment of stents: short- and long-term outcome Carlos Cafri, Jean Marc Weinstein, Harel Gilutz, Sergio Kobal and Reuben Ilia This study investigates a strategy of low-pressure stenting with concomitant anti-platelet treatment designed to prevent short- and long-term events after stenting. Ninety consecutive patients who underwent percutaneous transluminal coronary angioplasty with ( stenting using low-pressure stent deployment mean ) 8.1 atmospheres with concomitant anti-platelet therapy based on ticlopidine and aspirin were followed. The 30-day outcome revealed a stent thrombosis rate of 6.4%, while the 9-month major clinical event rate was 8.6%. Low-pressure stent deployment appears to confer added risk for acute or sub-acute thrombosis even when aspirin and ticlopidine are used. Conversely, low-pressure inflation is associated with excellent long-term results. Coron Artery Dis 12:313–316  2001 Lippincott Williams & Wilkins. Coronary Artery Disease 2001, 12:313–316 Keywords: coronary angioplasty, stent, stent thrombosis, stent restenosis Cardiology Department, Soroka Medical Center and Faculty of Health Sciences, Ben Gurion University, Beer Sheva, Israel. Correspondence and requests for reprints to: Carlos Cafri, MD, Cardiology Department, Soroka Medical Center, Beer Sheva, Israel 84105. Tel: +972 7 6400951; fax: +972 7 6238248; e-mail: cafricar@kruhama.org.il Received 07 September 2000 Accepted 27 March 2001 Introduction Clinical outcome after coronary stent implantation has been strongly associated with acute or sub-acute throm- bosis in the early post-procedural period and restenosis risk in the long-term. Recently, however, important advances in stent deployment techniques, in addition to adjunctive pharmacologic therapy, have led to a signifi-   cant decrease in the stent thrombosis rate 1,2 . Current stent implantation technique is based on high- pressure inflation, and is often associated with the use of larger balloons and intracoronary ultrasound guidance  3 . This strategy has become widely accepted despite reports suggesting major vascular injury, and higher   frequencies of restenosis 4  8. Powerful anti-platelet regimens based on ticlopidine and aspirin, introduced for the perfomance of coronary stenting, have been associated with lower rates of stent thrombosis. There has been no study to investigate whether the use of high-pressure balloon inflation, in combination with aspirin and ticlopidine, still provides added protection against stent thrombosis post-proce- durally. The aim of this paper is to investigate the frequency of stent thrombosis and the early and long-term major clinical event rate in a group of patients treated with ticlopidine and aspirin that underwent coronary stenting using low-pressure inflation. Methods A retrospective analysis of 90 consecutive patients who underwent successful coronary stenting with the AVE Ž microstent during a 1-year period December 1995 to . December 1996 was performed. Patients were selected on the basis of having undergone low-pressure stent Ž . deployment defined as less than 11 atmospheres , along with concomitant treatment with an anti-platelet regi- men consisting of aspirin and ticlopidine. Low-pressure inflation was applied systematically in all the cases based on the manufacturer’s recommendations for the AVE microstent regardless of the lesion morphology or diameter. All the lesions underwent balloon predilation. The diameter of the balloon catheter and of the stent were selected on the basis of the vessel reference diameter to obtain a balloonvessel ratio of 1 : 1 and stentvessel ratio of 1.1 : 1. Post-dilatation was not per- 0954-6928  2001 Lippincott Williams & Wilkins