A randomized trial comparing stenting with balloon angioplasty in small vessels in patients with symptomatic coronary...

Area of Science:

• Interventional Cardiology
• Vascular Medicine
• Clinical Trials

Background:

• Over 30% of lesions treated interventionally are in small vessels (<2.8mm).
• Established stenting indications typically involve larger vessels.
• Small vessel interventions present unique clinical challenges.

Purpose of the Study:

• To compare the efficacy of stenting versus balloon angioplasty (PTCA) in small coronary vessels.
• To assess the impact of stenting on restenosis rates in vessels between 2 and 2.8 mm.
• To evaluate secondary clinical outcomes including revascularization and infarct-free survival.

Main Methods:

• Randomized trial comparing stenting (n=204) with PTCA (n=200) in small coronary vessels.
• Patients received adjunct therapy with abciximab, ticlopidine, and aspirin.
• Repeat angiography at 6 months assessed angiographic restenosis (primary endpoint); clinical events were secondary endpoints.

Main Results:

• No significant difference in infarct-free survival rates (96.6% stent vs. 97.0% PTCA).
• Target vessel revascularization rates were similar (20.1% stent vs. 16.5% PTCA).
• Angiographic restenosis incidence was comparable (35.7% stent vs. 37.4% PTCA).
• Net lumen gain at follow-up was identical between groups.

Conclusions:

• Stenting and PTCA demonstrate equally favorable results for treating lesions in small coronary vessels.
• Both interventional approaches offer comparable long-term outcomes in this patient subgroup.
• The findings support the use of either stenting or PTCA for small vessel coronary artery disease.