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Provisional stenting for multivessel PCI
1Cardiovascular Institute, Poriyya medical center, Tiberias, Israel.
Insights
For multivessel percutaneous coronary intervention (PCI), provisional stenting offers comparable long-term restenosis and target lesion revascularization (TLR) rates to optimal balloon angioplasty alone. This suggests provisional stenting is a viable strategy for multivessel PCI.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Medical Devices
Background:
- Bare metal stents reduce acute complications but incur costs and risk of in-stent restenosis.
- The optimal strategy for multivessel percutaneous coronary intervention (PCI) remains debated, specifically regarding universal stenting versus provisional stenting for suboptimal results.
Purpose of the Study:
- To compare long-term restenosis and target lesion revascularization (TLR) between stented and non-stented lesions in patients undergoing multivessel PCI.
Main Methods:
- Retrospective analysis of 129 patients undergoing multivessel PCI.
- Comparison of optimal balloon angioplasty versus balloon angioplasty with provisional stenting in native coronary lesions (>2.5 mm diameter).
- One-year follow-up assessing restenosis and repeat revascularization.
Main Results:
- Low in-hospital Major Adverse Cardiac Events (MACE) of 3.1% with high angiographic success (99.3%).
- One-year rates of clinically driven angiographic restenosis were similar: 17.1% for optimal balloon angioplasty vs. 18.6% for provisional stenting (P=0.871).
- One-year rates of target lesion revascularization (TLR) were also comparable: 13.9% vs. 16.3% (P=0.728).
Conclusions:
- Optimal balloon angioplasty and provisional stenting demonstrate comparable long-term angiographic restenosis and TLR in multivessel PCI.
- Provisional stenting emerges as an acceptable and effective approach for multivessel PCI, potentially offering an alternative to universal stenting.
Background:
Bare stents reduce acute complications and repeat revascularization following percutaneous coronary intervention (PCI), but are costly and may lead to in-stent restenosis. It remains unclear whether stents should be universally implanted or whether provisional stenting mainly to suboptimal balloon dilatation results is an acceptable approach for multivessel PCI.
Objective:
To compare the long-term clinical restenosis and target lesion revascularization (TLR) of stented and non-stented coronary artery lesions in patients who had multivessel PCI.
Methods:
We performed retrospective analysis of matched data from 129 consecutive patients who underwent multivessel PCI (at least optimal balloon angioplasty to one coronary artery segment and balloon angioplasty plus stenting to another coronary artery in the same patient, all lesions are de novo native coronary artery lesions with vessel diameter >/=2.5 mm). The study endpoint was restenosis and repeat revascularization at one-year follow-up.
Results:
Baseline characteristics were similar in both groups. Low in-hospital MACE (3.1%). Acute myocardial infarction, emergency revascularization via either PCI or CABG was detected and angiographic success was achieved in 99.3% of lesions in both groups. The rate of clinically driven angiographic restenosis and TLR at one-year (follow-up 100%) was similar (17.1% versus 18.6%, P=0.871, and 13.9% versus 16.3%, P=0.728, for optimal balloon angioplasty versus provisional stenting.
Conclusions:
The main findings from this study are that long-term angiographic restenosis and TLR was comparable for optimal balloon angioplasty and provisional stenting, suggesting that provisional stenting is an acceptable approach for multivessel PCI.
