Acute or subacute stent thrombosis, bleeding complications and restenosis remain major clinical concerns in coronary stenting despite high pressure inflation and intravascular ultrasound guidance. A new strategy of local heparin delivery may maintain sustained local concentration and limit systemic complications. To observe the feasibility and efficacy of local heparin delivery in stenting, local heparin deliveries were performed in stented patients.

Heparin was delivered(5,000 Units, 1.0ml/min over 10 min) using the Dispatch Catheter, after predilation of target lesons in 10 patients(4 unstable angina, 6 acute myocardial infarction, mean age 52±7 yr) in the left anterior descending artery without systemic heparin loading. After local heparin delivery. Palmaz-Schatz stents were placed using standard methods. APTT and CK were checked at 1hr, 3hrs and 24 hrs after local heparin delivery and stenting. Follow-up coronary angiograms were done at 48 hrs and 6 months after stenting.

All patients had no ischemic symptoms or ECG changes during and after local heparin delivery. All APTT and CK values were unchanged at 3 hrs and 24 hrs after local heparin delivery and stenting. Follow-up quantitative coronary angiograms at 48 hrs and 6 months showed all stents patent, with TIMI III distal flow, and without intra-stent thrombus(%diameter stenosis : 79.4±4.2% before predilation, 32.9±7.7% after predilation, 32.4±13.1% after local delivery, 14.2±2.3% immediately after stenting, 13.9±2.5% at 48 hrs and 21.7±8.8% at 6 months after stenting).

Intracoronary stenting may be performed safely and effectively without systemic heparin therapy by using local heparin prior to stent implantation. Long-term stent patency and lack of coronary events appear favorable.