We compared spot drug-eluting stenting (DES) to full stent coverage for treatment
of long coronary stenoses. Consecutive, consenting patients with a long (>20 mm) coronary
lesion of nonuniform severity and indication for percutaneous coronary intervention
were randomized to full stent coverage of the atherosclerotic lesion with multiple,
overlapping stenting (full DES group, n = 90) or spot stenting of hemodynamically
significant parts of the lesion only (defined as diameter stenosis >50%; spot DES
group, n = 89). At 1-year follow-up, 14 patients with full DES (15.6%) and 5 patients
(5.6%) with spot DES had a major adverse cardiac event (MACE; p = 0.031). At 3 years,
MACEs occurred in 18 patients with full DES (20%) and 7 patients (7.8%) with spot
DES (p = 0.019). Cox proportional hazard model showed that the risk for MACEs was
almost 60% lower in patients with spot DES compared to those with full DES (hazard
ratio 0.41, 95% confidence interval 0.17 to 0.98, p = 0.044). This association remained
even after controlling for age, gender, lesion length, and type of stent used (hazard
ratio 0.42, 95% confidence interval 0.17 to 1.00, p = 0.05). In conclusion, total
lesion coverage with DES is not necessary in the presence of diffuse disease of nonuniform
severity. Selective stenting of only the significantly stenosed parts of the lesion
is an appropriate therapeutic alternative in this setting, offering a favorable clinical
outcome.
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References
- Predictors of restenosis after coronary stent implantation.J Am Coll Cardiol. 1998; 31: 1291-1298
- Stented segment length as an independent predictor of restenosis.J Am Coll Cardiol. 1999; 34: 651-659
- Influence of lesion length on restenosis after coronary stent placement.Am J Cardiol. 1999; 83: 1617-1622
- Procedural results and late clinical outcomes after percutaneous interventions using long (> or = 25 mm) versus short (<20 mm) stents.J Am Coll Cardiol. 2000; 35: 612-618
- Intravascular ultrasound-guided percutaneous transluminal coronary angioplasty with provisional spot stenting for treatment of long coronary lesions.J Am Coll Cardiol. 2001; 38: 1427-1433
- Usefulness of intravascular ultrasound in preventing stenting of hazy areas adjacent to coronary stents and its support of support spot-stenting.Am J Cardiol. 2001; 87: 1246-1249
- Very long sirolimus-eluting stent implantation for de novo coronary lesions.Am J Cardiol. 2004; 93: 826-829
- Multiple overlapping drug-eluting stents to treat diffuse disease of the left anterior descending coronary artery.J Am Coll Cardiol. 2005; 45: 1570-1573
- Intravascular ultrasound study of effects of overlapping sirolimus-eluting stents.Am J Cardiol. 2004; 93: 470-473
- Impact of overlapping drug-eluting stents in patients undergoing percutaneous coronary intervention.Catheter Cardiovasc Interv. 2006; 67: 595-599
- Two-year clinical outcomes after paclitaxel-eluting stent or brachytherapy treatment for bare metal stent restenosis: the TAXUS V ISR trial.JAMA. 2006; 295: 1253-1263
- Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents.JAMA. 2005; 293: 2126-2130
- Intraprocedural stent thrombosis during implantation of sirolimus-eluting stents.Circulation. 2004; 109: 2732-2736
- Observations and outcomes of definite and probable drug-eluting stent thrombosis seen at a single hospital in a four-year period.Am J Cardiol. 2008; 102: 298-303
- Direct versus predilatation drug-eluting stenting: a randomized clinical trial.J Invasive Cardiol. 2006; 18: 475-479
- Rapid progression of coronary artery stenoses assessed by quantitative coronary angiography.Circulation. 1955; 92: 2058-2065
- Sustained ventricular tachycardia induced by dobutamine stress echocardiography: a prospective study.Europace. 2005; 7: 433-439
- TAXUS IV 2-year follow-up: randomized comparison of polymer-based paclitaxel-eluting with bare metal stents for treatment of long, complex lesions.Eur Heart J. 2007; 28: 2578-2582
- Outcomes and complications associated with off-label and untested use of drug-eluting stents.JAMA. 2007; 297: 1992-2000
- Sirolimus-eluting stents for treatment of patients with long atherosclerotic lesions in small coronary arteries: double-blind, randomised controlled trial (E-SIRIUS).Lancet. 2003; 362: 1093-1099
- Angiographic and intravascular ultrasound study of the effects of overlapping sirolimus- and paclitaxel-eluting stents: comparison with same drug-eluting overlapping stents.Int J Cardiol. 2007; 123: 12-17
- Comparison of clinical outcomes of overlapping sirolimus- versus paclitaxel-eluting stents in patients undergoing percutaneous coronary intervention.Am J Cardiol. 2006; 98: 1563-1566
- Sirolimus-versus paclitaxel-eluting stents: a comparison of two consecutive series in routine clinical practice.J Interv Cardiol. 2006; 19: 31-37
- Differential response of delayed healing and persistent inflammation at sites of overlapping sirolimus- or paclitaxel-eluting stents.Circulation. 2005; 112: 270-278
- Inflammation and delayed endothelization with overlapping drug-eluting stents in a porcine model of in-stent restenosis.Circ J. 2008; 72: 463-468
- Balancing the risks of restenosis and stent thrombosis in bare-metal versus drug-eluting stents: results of a decision analytic model.J Am Coll Cardiol. 2008; 51: 1844-1853
- Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis.Lancet. 2007; 370: 937-948
- Stent thrombosis redux—the FDA perspective.N Engl J Med. 2007; 356: 984-987
- Cost-effectiveness of drug-eluting stents in patients at high or low risk of major cardiac events in the Basel Stent KostenEffektivitäts Trial (BASKET): an 18-month analysis.Lancet. 2007; 370: 1552-1559
- Drug-eluting stents: a systematic review and economic evaluation.Health Technol Assess. 2007; 11 (iii, xi–221)
- Randomized comparison of coronary stent implantation under ultrasound or angiographic guidance to reduce stent restenosis (OPTICUS study).Circulation. 2001; 104: 1343-1349
Article info
Publication history
Published online: July 23, 2009
Accepted:
April 27,
2009
Received in revised form:
April 27,
2009
Received:
March 3,
2009
Footnotes
Dr. Katritsis received research grants from Boston Scientific, Natick, Massachusetts, and Johnson and Johnson, Miami, Florida. Dr. Meier received research grants from Abbott Vascular, Santa Clara, California; Boston Scientific, Natick, Massachusetts; Johnson and Johnson, Miami, Florida; and Medtronic Inc., Minneapolis, Minnesota.
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
