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Clinical and angiographic follow-up after long versus short stenting in unselected chronic coronary occlusions
Si-Wan Choi1, Cheol Whan Lee, Myeong-Ki Hong
1Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea.
Insights
Longer stents (≥20 mm) for chronic total occlusion (CTO) increase restenosis risk compared to shorter stents (<20 mm). However, restenosis risk is similar in patients with larger vessels (≥3 mm).
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Limited data exist on the effectiveness of long stenting for chronic total occlusion (CTO) lesions.
- Chronic total occlusion (CTO) stenting outcomes require further investigation.
Purpose of the Study:
- To evaluate angiographic restenosis and long-term clinical outcomes after long stent implantation in patients with CTO.
- To compare short (<20 mm) versus long (≥20 mm) stenting in CTO patients.
Main Methods:
- Retrospective analysis of 220 CTO patients undergoing stent implantation.
- Comparison of short stenting (n=113) versus long stenting (n=107).
- Assessment of angiographic restenosis, target lesion revascularization, and clinical outcomes.
Main Results:
- Angiographic restenosis rates were 19.3% for short stents and 33.7% for long stents (p < 0.05).
- Postinterventional minimal lumen diameter was the sole independent predictor of restenosis.
- Restenosis was similar between groups for vessels ≥3 mm, but higher for long stents in vessels <3 mm.
Conclusions:
- Longer stents (≥20 mm) are associated with higher angiographic restenosis rates in CTO patients.
- Selected CTO patients with larger vessels (≥3 mm) show equivalent restenosis risk with short or long stents.
- Long-term clinical outcomes (death, MI, TLR) were similar between short and long stenting groups.
Background:
Few data are available on the efficacy of long stenting for lesions in unselected chronic total occlusion (CTO).
Hypothesis:
The study was undertaken to evaluate the angiographic restenosis and long-term clinical outcomes after long stent implantation in patients with CTO.
Methods:
Our retrospective analysis includes a consecutive series of stent implantation in 220 patients with CTO. We compared angiographic restenosis, target lesion revascularization, and long-term clinical outcomes of short stenting (< 20 mm, Group 1, n = 113) with a concurrent series of long stenting (> or = 20 mm, Group 2, n = 107).
Results:
Angiographic follow-up was obtained in 174 patients (79.5% of those eligible), and the rates of angiographic restenosis were 19.3% in Group 1 and 33.7% in Group 2 (p < 0.05). In multivariate analysis, the postinterventional minimal lumen diameter was the only independent predictor of restenosis (odds ratio = 0.20, 95% confidence interval 0.08-0.49, p < 0.01). The angiographic restenosis rate was significantly lower in Group 1 than in Group 2 in patients with final minimal lumen diameter < 3.0 mm (28.9 vs. 55.9%, respectively, p < 0.05). However, the angiographic restenosis rate was not significantly different between the two groups in patients with final minimal lumen diameter > or = 3 mm (12.0 vs. 19.2%, respectively, p = NS). During the follow-up (29.1 +/- 10.8 months), there was no difference between the two groups in death, nonfatal myocardial infarction, and target lesion revascularization.
Conclusions:
The use of long (> or = 20 mm) versus short (< 20 mm) stents in patients with CTO is associated with a higher angiographic restenosis rate, but there is an equivalent risk of restenosis in selected patients with relatively large-sized vessels.