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Clinical outcomes of long coronary stents: a single-center experience
Shukri S Mushahwar1, Jason R Pyatt, Robert Lowe
1The Cardiothoracic Centre, Liverpool, UK.
Insights
Long coronary stents (>= 30 mm) show a 94% procedural success rate for treating long coronary lesions. This approach offers acceptable early and intermediate clinical outcomes for patients undergoing percutaneous coronary intervention.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous coronary intervention (PCI) for long coronary lesions traditionally has low success rates and high complication risks.
- Current strategies for long lesions include single, multiple, or spot stenting, with multiple stenting linked to increased restenosis.
- The clinical outcomes of using long coronary stents (>= 30 mm) for these complex lesions remain incompletely defined.
Purpose of the Study:
- To evaluate the early and intermediate clinical outcomes of single and multiple long coronary stent implantation (>= 30 mm).
- To assess the safety and efficacy of long stent use in treating complex coronary artery disease.
Main Methods:
- Retrospective analysis of 123 consecutive patients undergoing stenting with one or more long coronary stents (>= 30 mm).
- Data collection included baseline clinical characteristics, procedural details, and clinical follow-up up to 52 weeks.
- Lesion types and outcomes were analyzed, focusing on procedural success and major adverse events.
Main Results:
- A high procedural success rate of 94% was achieved.
- The majority of treated lesions were complex (77% type B2 or C).
- Major adverse events occurred in 11% of patients, with revascularization needed in 8 patients during follow-up (occlusion/thrombosis or restenosis).
Conclusions:
- Long coronary stents (>= 30 mm) provide a reasonable procedural success rate for complex coronary artery disease.
- This stenting strategy demonstrates acceptable early and intermediate clinical outcomes.
- Long stents are a viable option for diffuse native vessel disease, saphenous vein graft disease, and long coronary dissections.
Abstract:
BACKGROUND: Coronary artery stenting is particularly useful during percutaneous coronary intervention for long lesions previously associated with a low procedural success rate and a high complication rate of dissection and occlusion. Current treatment options include implantation of a single long stent, multiple contiguous stents, or 'spot' stenting. However, multiple stent implantation may result in sections of overlapping stent or gaps of unstented segments and is an independent predictor of restenosis. The early and intermediate clinical outcome of single and multiple long stent (>/= 30 mm) implantation is not established. METHODS AND RESULTS: The authors retrospectively identified 123 consecutive patients who had undergone stenting using one or more long coronary stents. Baseline clinical data, procedural outcomes and completed clinical follow-up to 52 weeks were obtained by case-note review. The majority (69%) required intervention for stable coronary disease. Seventy-seven per cent of lesions were either type B2 or C and only 2% were in saphenous vein grafts. The procedural success rate was 94%. A total of 15 major events occurred in 13 patients (11%). Ten acute events occurred and five events were during the follow-up period from 30 days to 52 weeks. Two patients died, one from uncontrolled bleeding secondary to the use of antithrombotic agents and one at four weeks due to sudden death. One patient had a postprocedural infarct. Two patients required in-hospital repeat revascularization for acute vessel closure and eight required revascularization during follow-up (three cases of occlusion/thrombosis and five cases of restenosis). CONCLUSIONS: The use of long coronary stents (>/= 30 mm) for the treatment of long diffuse native vessel disease, saphenous vein graft disease and long coronary dissections is associated with a reasonable procedural success rate and acceptable early and intermediate-term clinical outcomes.