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Intracoronary stent insertion after balloon angioplasty of chronic total occlusions
S L Goldberg1, A Colombo, L Maiello
1Division of Cardiology, Harbor-UCLA Medical Center, Torrance 90509, USA.
Insights
Implanting stents after balloon angioplasty for chronic total occlusions (CTO) shows good medium-term results. This approach offers favorable restenosis rates and symptom relief for CTO patients.
Area of Science:
- Interventional Cardiology
- Vascular Medicine
Background:
- Percutaneous transluminal coronary angioplasty (PTCA) for chronic total occlusions (CTOs) has a high restenosis rate (50-68%).
- Intravascular stents reduce restenosis in subtotal stenoses, but their benefit in successfully opened CTOs is unproven.
Purpose of the Study:
- To evaluate the medium-term effectiveness of intracoronary stent implantation in chronic total occlusions (CTOs) after successful balloon angioplasty.
- To assess restenosis rates and clinical outcomes following stenting of opened CTOs.
Main Methods:
- Retrospective analysis of patients with CTOs treated with Palmaz-Schatz stents after balloon angioplasty.
- Clinical and angiographic follow-up at a mean of 6 months post-stenting.
Main Results:
- Successful stent deployment in 98% of 60 CTOs across 59 patients; 5% complication rate (subacute thrombosis).
- Angiographic follow-up (88% of patients) showed a 20% restenosis rate and one reocclusion.
- 77% of patients remained symptom-free at a mean of 14 months post-stenting.
Conclusions:
- Intracoronary stenting of opened CTOs is associated with favorable angiographic restenosis and symptom relief.
- A randomized trial comparing balloon angioplasty with stent-assisted angioplasty for CTOs is warranted.
Objectives:
This retrospective analysis was performed to assess the medium-term effectiveness of implanting intracoronary stents into chronic total occlusions that are successfully opened by balloon angioplasty.
Background:
The value of percutaneous transluminal coronary angioplasty of chronic total occlusions is limited by a very high restenosis rate of 50% to 68%. Intravascular stents have been shown to reduce restenosis in a subset of patients with subtotal stenoses. It has not been demonstrated that the placement of stents into successfully opened chronic total coronary artery occlusions leads to lower rates of restenosis.
Methods:
A consecutive series of patients with chronic total coronary occlusions successfully opened by balloon angioplasty received Palmaz-Schatz stents. Patients underwent clinical and angiographic follow-up at a mean of 6 months after stent insertion. Angiographic and clinical results were retrospectively analyzed.
Results:
Fifty-nine patients underwent stenting of 60 chronic total coronary occlusions, with a 98% rate of successful stent deployment. Complications occurred in 5% of cases, all with subacute thrombosis. Angiographic follow-up was obtained in 88% of patients at a mean of 6 months and demonstrated an angiographic restenosis rate of 20%, with only one reocclusion. Among several variables examined, only the presence of a procedure-related moderate to severe dissection was associated with higher follow-up percent diameter stenoses and clinical events. At a mean of 14 months after stent insertion, 77% of patients remained free of symptoms or clinical events.
Conclusions:
The implantation of intracoronary stents into vessels with opened chronic total coronary occlusions is associated with favorable rates of angiographic restenosis and relief of symptoms. A randomized clinical trial comparing balloon angioplasty with stent-assisted balloon angioplasty in the treatment of chronic total coronary occlusions is indicated.