Stents in total occlusion for restenosis prevention. The multicentre randomized STOP study. The Israeli Working Group...

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Medicine

Background:

• Chronic total occlusions (CTO) of coronary arteries present a significant challenge.
• Percutaneous transluminal coronary angioplasty (PTCA) for CTO has a high restenosis rate.
• Coronary stenting is explored as a method to reduce restenosis and reocclusion post-PTCA.

Purpose of the Study:

• To evaluate if coronary stenting improves outcomes after successful balloon angioplasty for CTO.
• To compare restenosis and reocclusion rates between PTCA alone and PTCA with stenting in CTO.

Main Methods:

• A multicentre randomized study involving 96 patients with CTO.
• Patients with optimal PTCA results were randomized to either no further treatment or stent implantation (AVE microstent).
• Clinical follow-up at 1, 3, and 6 months, with coronary angiography at 6 months or earlier if indicated.

Main Results:

• Stent implantation was successful in all patients with no major complications.
• Binary restenosis rates were significantly lower in the stent group (42.1%) compared to the PTCA group (70.9%) (P=0.034).
• Reocclusion rates were 7.9% in the stent group versus 16.1% in the PTCA group. Restenosis patterns differed: focal in PTCA, diffuse in-stent in the stented group.

Conclusions:

• Coronary stenting significantly decreases restenosis and reocclusion rates in CTO.
• The diffuse nature of in-stent restenosis suggests careful consideration of stent length and placement at the occlusion site.