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Elective coronary stenting after recanalization for chronic total occlusion: clinical and angiographic follow-up
D S Gambhir1, R Sudha, S Singh
1Department of Cardiology, GB Pant Hospital, New Delhi.
Insights
Elective coronary stenting after recanalizing chronic total occlusions (CTO) significantly improves immediate results and reduces restenosis and angina recurrence. This study shows stenting is safe and effective for CTO treatment.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Chronic total occlusions (CTO) in coronary arteries present challenges with high rates of residual stenosis and restenosis after angioplasty.
- Percutaneous transluminal coronary angioplasty (PTCA) alone for CTO has limitations, necessitating improved treatment strategies.
Purpose of the Study:
- To evaluate the efficacy and safety of elective coronary stenting after successful recanalization of chronic total occlusions.
- To assess the impact of stenting on immediate procedural outcomes, long-term clinical events, and angiographic restenosis.
Main Methods:
- Retrospective analysis of 95 patients undergoing CTO recanalization (March 1995-February 1997), with 42 receiving elective stent implantation.
- Procedures included balloon angioplasty, rotablation, and high-pressure intrastent balloon dilatation.
- Clinical and angiographic follow-up data were collected, including repeat coronary angiography in eligible patients.
Main Results:
- Successful recanalization was achieved in 83.1% of patients; stenting was performed in 42 patients with no in-hospital major complications.
- Luminal diameter stenosis decreased from 47% after balloon angioplasty to <10% after stenting.
- At a mean follow-up of 7.4 months, 88.8% of patients were angina-free, with a 1-year event-free survival of 77.25%. Angiographic restenosis occurred in 25% of stented lesions.
Conclusions:
- Elective coronary stenting following successful CTO recanalization yields excellent immediate results.
- Stenting effectively reduces angina recurrence, target lesion revascularization, and angiographic restenosis.
- Coronary stenting is a safe and beneficial adjunctive therapy for managing chronic total occlusions.
Abstract:
Percutaneous transluminal coronary angioplasty (PTCA) for chronic totally occluded coronary arteries is associated with a significant residual stenosis and a high incidence of restenosis. Between March 1995 to February 1997, recanalization of chronic total occlusion (CTO) was attempted in 95 patients, of whom 79 (83.1%) were dilated successfully using balloon angioplasty, rotablation or both. Forty two patients underwent elective stent implantation to evaluate the influence of stenting on immediate results and clinical as well as angiographic outcome on long-term follow-up. There were 39 males and 3 females, with a mean age of 51 +/- 8 years. The majority (69.1%) had multivessel disease. The target vessel was LAD in 25 (58.1%), RCA in 12 (27.9%), LCx-OM in 5 (11.6%) and ramus in 1 (2.3%). After recanalization and adequate predilatation, various types of stents were deployed successfully at the target site in all patients, using high pressure intrastent balloon dilatation. The luminal diameter stenosis reduced to 47 +/- 15 percent after balloon angioplasty and < 10 percent in all, after stent implantation. There were no in-hospital major complications, including subacute stent thrombosis, myocardial infarction, need for emergency bypass graft surgery or death. The follow-up data is available in 36 patients, ranging from 1-22 months (mean: 7.4 +/- 4.7; median: 6). Of these, 32 (88.8%) were free of angina at their last visit, 3 (8.3%) required target lesion revascularization and 2 patients died, one at 3 weeks and the other at 6 months after the procedure. The event-free survival, estimated by the Kaplan-Meier survival curve was 97.3, 82.8 and 77.25 percent at one, 6, and 12 months, respectively after stenting. Out of 29 eligible patients, 20 underwent repeat coronary angiography after 6 months, which revealed restenosis in 5 (25%). In conclusion, our study shows that elective coronary stenting following successful recanalization of chronic total occlusion produces an excellent immediate result and reduces the recurrence of angina, target lesion revascularization and angiographic restenosis on long-term follow-up.