Percutaneous Intervention in Diffuse Coronary Disease: Overlapping Versus Single Very Long Stent Technique. Results
Martín Negreira-Caamaño1, José Abellán-Huerta2, Fernando Lozano-Ruiz-Poveda2
1Cardiology Department, University General Hospital of Ciudad Real, Spain.
Insights
Using a single very long stent (VLS) for diffuse coronary artery disease (dCAD) treatment resulted in better outcomes than overlapping stents (OS). VLS procedures were shorter, used less contrast, and had fewer major adverse cardiovascular events.
Area of Science:
- Interventional Cardiology
- Cardiovascular Disease Research
Background:
- Diffuse coronary artery disease (dCAD) treatment poses challenges.
- Stent length and overlap are linked to adverse outcomes.
- Limited comparative data exists for very long stents versus overlapping stents in dCAD.
Purpose of the Study:
- To compare the clinical outcomes of single very long stent (VLS) versus multiple overlapping stents (OS) in dCAD treatment.
- To evaluate procedural efficiency and long-term safety between VLS and OS strategies.
Main Methods:
- Retrospective analysis of 724 dCAD lesions: 275 treated with VLS (≥40 mm) and 449 with OS (≥2 stents).
- Assessment of procedural characteristics including contrast volume, fluoroscopy time, and procedure duration.
- Survival analysis to compare major adverse cardiovascular events (MACE) over a median 31-month follow-up.
Main Results:
- VLS procedures required significantly less contrast, fluoroscopy time, and were shorter than OS procedures.
- The VLS group demonstrated a lower incidence of MACE (4.4% vs 10.7%, P < .01), primarily due to a reduced target lesion revascularization (TLR) rate (1.1% vs 4.7%, P < .01).
- Overlapping stents (OS) emerged as an independent predictor of MACE.
Conclusions:
- Single very long stent (VLS) use in dCAD is associated with superior clinical outcomes compared to overlapping stents (OS).
- VLS strategy offers procedural advantages and reduces the risk of major adverse cardiovascular events in dCAD treatment.
Background:
Both stent length and stent overlap are associated with worse outcomes in the percutaneous treatment of diffuse coronary artery disease (dCAD). However, evidence comparing these issues is scarce. We aimed to compare the results between the use of single very long stent (VLS) and ≥2 overlapping stents (OS) in the treatment of dCAD.
Methods:
Seven hundred twenty-four consecutive lesions were included: 275 treated with a single VLS (≥40 mm) and 449 with ≥2 OS. Procedural characteristics were assessed, and survival analysis was performed to compare the incidence of major adverse cardiovascular events (MACE; composite of cardiovascular death, nonfatal myocardial infarction, target lesion revascularization [TLR], or stent thrombosis) during a median follow-up of 31 months.
Results:
Procedures with VLS required less contrast volume (268 ± 122 vs 302 ± 113 cm3; P < .01), fluoroscopy time (16 ± 8 vs 21 ± 16 minutes; P < .01), and procedure duration (37 ± 18 vs 47 ± 27 minutes; P < .01) than the OS procedures. The VLS group showed lower incidence of MACE (4.4% vs 10.7%; P < .01), driven mainly by lower TLR rate (1.1% vs 4.7%; P < .01). The use of OS was an independent predictor of MACE.
Conclusions:
In this study, the use of VLS for the treatment of dCAD was associated with better outcomes compared to OS.
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