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Implantation of Human-Sized Coronary Stents into Rat Abdominal Aorta Using a Trans-Femoral Access
Published on: November 19, 2020
Long-term follow-up of covered stent implantation for various coronary artery diseases
Daisuke Hachinohe1,2,3, Azeem Latib1,2,4, Alessandra Laricchia1
1Interventional Cardiology Unit, San Raffaele Scientific Institute, Milan, Italy.
Insights
Long-term follow-up of coronary covered stents (CS) shows early and increasing cardiac events. Implantation in coronary artery aneurysms (CAA) is safer than in coronary artery perforations (CAP) or saphenous vein grafts (SVG).
Area of Science:
- Cardiovascular medicine
- Interventional cardiology
- Biomaterials in medicine
Background:
- Limited long-term data exists for coronary covered stents (CS).
- Previous studies have not compared CS outcomes based on specific lesion indications.
Purpose of the Study:
- To assess long-term clinical outcomes following coronary covered stent (CS) implantation.
- To compare CS outcomes across different indications, including saphenous vein graft (SVG), coronary artery perforation (CAP), and coronary artery aneurysm (CAA).
Main Methods:
- Retrospective study of 190 patients (212 lesions) who received CS between May 1997 and February 2017.
- Clinical outcomes were evaluated and compared using the Gehan-Breslow-Wilcoxon test.
- Median follow-up duration was 6.0 years.
Main Results:
- CS was primarily used for SVG (51.4%), CAP (25.0%), and CAA (11.8%).
- Major adverse events like target vessel occlusion (16.6% at 1 year, 38.6% at 10 years) and stent thrombosis (8.9% at 1 year, 17.8% at 10 years) increased over time.
- Outcomes were superior in CAA compared to CAP and SVG, with no target vessel MI, occlusion, or stent thrombosis observed in CAA.
Conclusions:
- Coronary covered stent (CS) implantation is associated with early and progressively increasing clinical events.
- CS implantation for coronary artery aneurysms (CAA) demonstrates favorable outcomes with fewer adverse events.
- CS implantation for coronary artery perforation (CAP) and saphenous vein grafts (SVG) carries a significant risk of long-term cardiac events.
Objectives:
The aims of this study were to evaluate the long-term clinical outcomes after coronary covered stent (CS) implantation and to compare the results according to the indications.
Background:
To date, data on the long-term follow-up of coronary CS are limited, and no studies have been conducted to compare outcomes on the basis of specific lesions treated.
Methods:
A total of 190 consecutive patients (212 lesions) implanted with CS and surviving until discharge between May 1997 and February 2017 were enrolled in this retrospective study. Clinical outcomes were evaluated and compared using the Gehan-Breslow-Wilcoxon test.
Results:
CS was mainly used for the treatment of a saphenous vein graft (SVG) (51.4%), followed by coronary artery perforation (CAP) (25.0%) and coronary artery aneurysm (CAA) (11.8%). The median follow-up duration was 6.0 (interquartile range: 1.6-13.5) years. Target vessel myocardial infarction (MI), target vessel occlusion, target lesion revascularization, and stent thrombosis, frequently occurred in the early follow-up period (7.3%, 16.6%, 21.5%, and 8.9% at 1 year, respectively) and continued to increase throughout the long-term follow-up (14.8%, 38.6%, 38.7%, and 17.8% at 10 years, respectively). Target vessel occlusion, target vessel MI, and ST were not identified in CAA with superiority to CAP (Gehan-Breslow-Wilcoxon p-value = 0.010, 0.047, and 0.046, respectively). SVG had a higher rate of target vessel occlusion than CAA (p = 0.004).
Conclusions:
Clinical events after CS implantation frequently occurred in the early period and steadily increased in the long-term period. CS implantation in CAA was associated with fewer adverse cardiac events and may lead to safe and acceptable outcomes. However, CS implanted in CAP and SVG are associated with a high risk of long-term cardiac events.
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