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Elective stenting for type B and C lesions: immediate results and follow-up angiographic restenosis
D S Gambhir1, V Trehan, P Rastogi
1Department of Cardiology, GB Pant Hospital, New Delhi.
Insights
Elective coronary artery stenting effectively treats complex type B and C lesions, showing excellent immediate results and good clinical outcomes. Angiographic restenosis occurred in about one-fifth of patients, lower than with balloon angioplasty.
Area of Science:
- Interventional Cardiology
- Cardiovascular Medicine
- Medical Device Technology
Background:
- Coronary artery disease (CAD) management involves addressing complex lesions.
- Type B and C lesions present treatment challenges in CAD.
- Stent technology offers a potential solution for complex coronary lesions.
Purpose of the Study:
- To evaluate the efficacy and safety of elective stenting for type B and C coronary artery lesions.
- To assess immediate procedural success and clinical outcomes post-stenting.
- To determine the rate of angiographic restenosis following elective stenting.
Main Methods:
- A prospective study of 73 patients with CAD undergoing elective stenting for type B and C lesions between January and December 1995.
- Utilized various stent types (Wiktor, Palmaz-Schatz, Gianturco-Roubin, Microstent, Freedom) based on lesion characteristics.
- Employed a high-pressure deployment strategy, with follow-up including clinical assessment and repeat angiography.
Main Results:
- Successful stent deployment in 100% of treated lesions, reducing stenosis from 92% to -5%.
- No major complications (myocardial infarction, emergency bypass, death); minor complications in 12.3% of patients.
- At mean follow-up of 26 weeks, 74% were asymptomatic; angiographic restenosis observed in 20.7% of patients at 6 months.
Conclusions:
- Elective stenting is a successful treatment for type B and C coronary artery lesions, yielding excellent immediate results.
- Clinical outcomes are favorable, with a significant proportion of patients remaining asymptomatic post-procedure.
- The observed rate of angiographic restenosis is comparable to or lower than that reported for balloon angioplasty in complex lesions.
Abstract:
From January to December 1995, 73 out of 174 patients with coronary artery disease underwent elective stenting for type B and C lesions. The age ranged from 35 to 73 years (mean +/- SD : 52.1 +/- 12.6) and the majority (91.7%) were males. Of the 74 vessels treated, the target vessel was LAD in 49 (66.4%), LCx in 13 (17.6%), RCA in 8 (10.8%) and SVG in 4 (5.2%). Based upon the ACC/AHA task force classification, 58 (79.5%) patients had type B1, 9 (12.3%) B2 and 6 (8.2%) had type C lesions. A total of 89 stents were deployed to treat 76 lesions with a range of 1 to 3 stents per lesion. A single stent was required for 67 lesions, 2 stents for 8 and 3 stents for 2 lesions. The stents used were Wiktor (29), Palmaz-Schatz (26), Gianturco-Roubin (24), Microstent (6) and Freedom (4), depending upon the anatomical and morphological characteristics with the lesion. Using high pressure strategy, the stents were deployed successfully in all (100%) with a reduction in luminal diameter stenosis from 92 +/- 5.4 to -5 +/- 6 percent. There was no subacute stent thrombosis despite nonusability of oral anticoagulation in 95.9 percent patients. None had any major complication in the form of acute myocardial infarction, need for emergency bypass graft surgery or death. Minor complications were encountered in 9 (12.3%) patients. At a mean follow-up of 26 +/- 14 weeks, 74 percent of the patients were asymptomatic. Out of 31 patients who had completed 6 months after the procedure, repeat angiography was performed in 29 (93.5%) at a mean duration of 29 +/- 6 weeks. The angiographic restenosis was found in 6 (20.7%) patients. In conclusion, type B and C lesions can be treated successfully using elective stenting with excellent immediate results and clinical outcome. Angiographic restenosis, which develops in about one-fifth of patients, appears to be much lower than reported after balloon angioplasty for these complex lesions.