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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Overlapping vs. one long stenting in long coronary lesions
Sang Hak Lee1, Yangsoo Jang, Sung Jin Oh
1Cardiology Division, Yonsei Cardiovascular Center, Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, South Korea.
Insights
For long coronary lesions, overlapping stents offer similar outcomes to single long stents. Patient age and distal vessel diameter are key predictors of in-stent restenosis (ISR).
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Technology
Background:
- Treating long coronary artery lesions remains a clinical challenge.
- Optimal stent strategies for these lesions are not well-defined.
- Limited data exist on overlapping stents versus single long stents for long lesions.
Purpose of the Study:
- To compare the efficacy of overlapping stents versus a single long stent for long coronary lesions.
- To identify predictors of in-stent restenosis (ISR) in patients treated for long coronary lesions.
Main Methods:
- A prospective study involving 64 patients with long coronary lesions (> 20 mm).
- Patients were randomized to receive either one long stent (n=32) or two overlapping stents (n=32).
- Clinical and angiographic outcomes, including ISR rates, were assessed at follow-up.
Main Results:
- Both strategies demonstrated similar procedural success rates.
- Major adverse cardiac events occurred in 36% (single stent) and 29% (overlapping stents) (P=0.56).
- Six-month in-stent restenosis rates were comparable: 39% (single stent) and 41% (overlapping stents) (P=0.91).
Conclusions:
- Stent overlapping is a viable strategy for long coronary lesions, yielding outcomes comparable to single long stents.
- Patient age (≥ 65 years) was an independent predictor of ISR.
- Distal reference diameter < 2.5 mm showed a trend towards predicting ISR.
Abstract:
Intervention of long coronary lesions remains problematic, and optimal treatment strategy is yet to be determined. Despite advancement of stent technology, data are few regarding the efficacy of overlapping stents vs. a single long stent in long coronary lesions. This study was performed to evaluate the results of those strategies for long coronary lesions and to determine the predictors of in-stent restenosis (ISR). Sixty-four lesions (> 20 mm) in 64 patients were treated with either one long stent (group 1, n = 32) or two overlapping stents (group 2, n = 32). Overlapping stents were used at tortuous or calcified lesions and at lesions with diameter discrepancy or significant dissection. Immediate results, follow-up clinical and angiographic outcomes, and predictors of ISR were evaluated. Procedures were successful in all patients in both groups. Clinical and angiographic follow-ups were performed in 54 (84%) cases and 50 (78%) cases, respectively. During the follow-up, major adverse cardiac event occurred in 36% of group 1 and 29% of group 2 (P = 0.56). Six-month ISR rates were 39% in group 1 and 41% in group 2 (P = 0.91). Age (>/= 65 years old) was an independent risk factor of ISR (54% vs. 23%; OR = 4.4; P = 0.04), and distal reference diameter (RD) of less than 2.5 mm tended to predict ISR in multivariate analysis (60% vs. 25%; OR = 3.5; P = 0.06). In conclusion, stent overlapping can be used with outcome similar to that of one long stent in long coronary lesions. The optimal result may be obtained by considering the patient's age and the distal vessel diameter of the lesion.
