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Randomized comparison of J&J Crown stent versus NIR stent after routine coronary angioplasty
S Miketic1, J Carlsson, U Tebbe
1Department of Internal Medicine II (Cardiology), Klinikum Lippe-Detmold, Detmold, Germany. sinisa.miketic@klinikum-lippe.de
Insights
This randomized trial found no significant differences in restenosis rates or clinical outcomes between J&J Crown and NIR coronary artery stents. Both stent types demonstrated comparable procedural success in treating coronary artery disease.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Coronary artery stents are crucial for treating vessel occlusion and preventing restenosis post-angioplasty.
- This study evaluated the procedural success and long-term patency of two flexible coronary stents in diverse lesion morphologies.
Purpose of the Study:
- To compare the procedural outcomes and long-term patency of NIR stents versus J&J Crown stents.
- To assess the restenosis rate and minimal luminal diameter at 6-month follow-up.
Main Methods:
- A randomized trial involving 203 patients undergoing coronary angioplasty for symptomatic coronary artery disease.
- Patients received either J&J Crown stents (n=103) or NIR stents (n=100) with high-pressure implantation and antiplatelet therapy.
- Follow-up angiography was performed at 6 months to evaluate restenosis (>50% diameter stenosis).
Main Results:
- Procedural success rates were similar: 96.1% for J&J Crown and 99% for NIR stents (P=.19).
- Restenosis occurred in 18.4% of J&J Crown patients versus 22.0% of NIR stent patients (P=.42).
- Higher crossover rates from J&J Crown to NIR stents were observed (3.9% vs 0%, P=.047).
Conclusions:
- No significant angiographic or clinical differences were found between J&J Crown and NIR stents.
- Both stent types achieved similar procedural success rates.
- NIR stents showed successful implantation in challenging vessels where J&J Crown stents had previously failed.
Background:
Coronary artery stents are used for the treatment of acute or threatening vessel occlusion complicating coronary angioplasty or for prevention of restenosis after angioplasty. The current randomized trial compared the procedural outcome and long-term patency of 2 different flexible stents in unselected lesion morphology.
Methods:
The study population consisted of consecutive patients undergoing coronary angioplasty for symptomatic coronary artery disease followed by high-pressure stent implantation. The poststent treatment consisted of antiplatelet therapy. The primary hypothesis was an assumed restenosis rate of 30% in the group receiving NIR stents (Boston Scientific Europe SPRL, Parc Industriel de Petit-Rechain, Belgium) and a reduction of the restenosis rate (defined as >50% vessel diameter at follow-up) by 50% in the group undergoing J&J Crown stent (Cordis, Johnson & Johnson Interventional Systems, Warren, NJ) implantation: the restenosis rate and minimal luminal diameter at follow-up. Follow-up angiography was performed 6 months after the initial procedure.
Results:
A total of 203 patients were randomized to receive either the J&J Crown stent (n = 103) or the NIR stent (n = 100). The procedural success was similar in both groups (96.1% vs 99% in the NIR stent group, respectively; P =.19). There were 4 cases of crossover from the J&J Crown to the NIR stent group. In one patient, stent implantation of either stent model did not succeed. One patient died from fulminant pulmonary embolism. Restenosis, defined as >50% diameter stenosis at follow-up 5.8 +/- 1.3 months after the initial procedure occurred in 19 patients (18.4%) in the J&J Crown stent group compared with 22 patients (22.0%) in the NIR stent group (P =.42). There was a significantly higher rate of crossover from the J&J Crown stent to the NIR stent (3.9% vs 0%, respectively, P =.047), whereas reverse crossover did not occur. The one lesion in which NIR stent implantation was not successful had an extremely tortuous proximal part. This patient underwent only balloon angioplasty. Clinical events were rare during 6 months of follow-up and the incidence did not differ between both groups (nonfatal myocardial infarction: J&J Crown stent 1.0% vs 0% in the NIR stent group, P =.32; all-cause mortality: J&J Crown stent 1.0% vs 0% in the NIR stent group, P =.32).
Conclusions:
There were no significant angiographic and clinical differences between the J&J Crown and NIR stents. Both stents had a similar procedural success rate, although the implantation of NIR stents was successful even in vessels in which previous attempts at J&J Crown stent placement had failed.