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Outcomes of Percutaneous Coronary Interventions for Long Diffuse Coronary Artery Disease with Extremely Small
Chien-Te Ho1, Fu-Chih Hsiao1, Ying-Chang Tung1
1Cardiovascular Division, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan 33353, Taiwan.
Insights
A modified stenting technique for percutaneous coronary intervention (PCI) in diffuse coronary artery disease (CAD) with extremely small distal vessels (ESDV) demonstrated effective and safe outcomes. Long-term follow-up showed similar target vessel failure rates compared to non-ESDV patients.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Optimal percutaneous coronary intervention (PCI) strategies for long coronary lesions with extremely small lumens are not well-defined.
- Diffuse coronary artery disease (CAD) presents unique challenges, particularly when involving extremely small distal vessels.
Purpose of the Study:
- To assess the efficacy and safety of a modified stenting technique for diffuse CAD in patients with extremely small distal vessels (ESDV).
- To compare clinical outcomes between ESDV and non-ESDV groups undergoing PCI with long drug-eluting stents (DES).
Main Methods:
- Retrospective analysis of 736 patients undergoing PCI with long DES (≥38 mm).
- Patients were categorized into ESDV (distal vessel diameter ≤2.0 mm) and non-ESDV (>2.0 mm) groups.
- A modified stenting technique involved landing an oversized DES distally and maintaining partial expansion of the distal stent edge.
Main Results:
- High acute procedural success rates in both groups (95.8% ESDV vs. 96.5% non-ESDV) with minimal distal dissection.
- Median follow-up was 65 months.
- Target vessel failure (TVF) rates were comparable: 16.3% in ESDV vs. 12.1% in non-ESDV after propensity score matching.
Conclusions:
- PCI utilizing contemporary drug-eluting stents (DES) with the described modified technique is effective and safe for treating diffuse CAD in extremely small distal vessels.
- The modified stenting approach offers a viable solution for complex coronary anatomies, achieving comparable long-term safety and efficacy.
Background:
The optimal percutaneous coronary intervention (PCI) strategy and clinical outcomes of long lesions with an extremely small residual lumen remain unclear. This study aimed to assess the efficacy of a modified stenting strategy for diffuse coronary artery disease (CAD) with an extremely small distal residual lumen.
Methods:
736 Patients who received PCI using second-generation drug-eluting stents (DES) ≥38 mm long were retrospectively included and categorized into an extremely small distal vessel (ESDV) group (≤2.0 mm) and a non-ESDV group (>2.0 mm) according to the maximal luminal diameter of the distal vessel (dsDMax). A modified stenting technique was applied by landing an oversized DES in the distal segment with the largest luminal diameter and maintaining the distal stent edge partially expanded.
Results:
The mean dsDMax and stent lengths were 1.7 ± 0.3 mm and 62.6 ± 18.1 mm in the ESDV group and 2.7 ± 0.5 mm and 59.1 ± 16.0 mm in non-ESDV groups, respectively. The acute procedural success rate was high in both the ESDV and non-ESDV groups (95.8% and 96.5%, p = 0.70) with rare distal dissection (0.3% and 0.5%, p = 1.00). The target vessel failure (TVF) rate was 16.3% in the ESDV group and 12.1% in the non-ESDV group at a median follow-up of 65 months without significant differences after propensity score matching.
Conclusions:
PCI using contemporary DES with this modified stenting technique is effective and safe for diffuse CAD with extremely small distal vessels.
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