Comparison of sirolimus-eluting and bare metal stent for treatment of patients with total coronary occlusions:...

Area of Science:

• Cardiovascular Medicine
• Interventional Cardiology
• Biomedical Engineering

Background:

• Bare metal stents (BMS) in chronic total coronary occlusions (CTOs) show higher rates of restenosis and reocclusion than in subtotal stenoses.
• Drug-eluting stents (DES) have shown potential for improved performance in CTO interventions.

Purpose of the Study:

• To compare the mid-term angiographic and clinical outcomes of sirolimus-eluting stent (SES) versus BMS implantation after successful CTO recanalization.
• To evaluate the efficacy of SES in reducing restenosis and reocclusion in CTO patients.

Main Methods:

• A multicentre, randomized trial involving 152 patients with CTOs older than 1 month.
• Randomization to SES (78 patients) or BMS (74 patients) implantation post-recanalization.
• Follow-up included in-segment minimal luminal diameter (MLD) at 8 months and clinical endpoints (death, MI, TLR, TVR) at 24 months, with 6 months of clopidogrel therapy.

Main Results:

• SES group showed significantly larger MLD (1.98 vs. 0.98 mm), lower late luminal loss (-0.06 vs. 1.11 mm), and reduced restenosis (9.8% vs. 67.7%) and reocclusion (0% vs. 17%) compared to BMS.
• At 24 months, SES group had fewer major adverse cardiac events (17.6% vs. 50.0%), primarily due to lower rates of target lesion revascularization (8.1% vs. 44.9%) and target vessel revascularization (14.9% vs. 44.9%).

Conclusions:

• Sirolimus-eluting stents are markedly superior to bare metal stents in managing chronic total coronary occlusions.
• SES significantly reduces restenosis, reocclusion, and the need for repeat revascularization at 24 months.
• The findings support the use of SES for improved clinical outcomes in CTO interventions.