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[Multiple overlapping Wiktor stenting for the treatment of diffuse lesions of small coronary arteries]
M Hyogo1, A Azuma, M Tsukamoto
1Second Department of Internal Medicine, Kyoto Prefectural University of Medicine.
Insights
Multiple overlapping Wiktor stents are useful for diffuse coronary artery lesions in small vessels, despite a higher restenosis rate. Careful patient observation is crucial due to frequent restenosis after this procedure.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Biomedical Engineering
Background:
- Small coronary arteries (< 3.0 mm) with diffuse lesions pose treatment challenges.
- Plain old balloon angioplasty (POBA) can result in suboptimal outcomes or threatened closure.
- Overlapping stenting is a potential strategy for complex lesions.
Purpose of the Study:
- To evaluate the effectiveness of multiple overlapping Wiktor stenting in small coronary arteries (< 3.0 mm) with diffuse lesions.
- To compare outcomes between overlapping stenting for diffuse lesions and single stenting for discrete lesions.
Main Methods:
- A study of 48 patients with small coronary arteries (< 3.0 mm) treated with Wiktor stents after POBA.
- Patients were divided into two groups: diffuse lesions (Group D, n=18) treated with overlapping stents and discrete lesions (Group S, n=30) treated with a single stent.
- Follow-up angiography was performed at 6 months to assess restenosis and target lesion revascularization.
Main Results:
- Stenting was successful in all Group D patients; one Group S patient experienced subacute thrombosis.
- Restenosis rates were significantly higher in Group D (72%) compared to Group S (30%) (p=0.01).
- Target lesion revascularization was also significantly higher in Group D (67%) versus Group S (30%) (p=0.03).
Conclusions:
- Multiple overlapping Wiktor stenting is a useful strategy for diffuse lesions in small coronary arteries (< 3.0 mm) with suboptimal POBA results.
- Despite its utility, this technique is associated with a high rate of restenosis, necessitating careful patient monitoring.
- The overlapping stent portions showed greater lumen diameter and net gain but similar restenosis rates compared to non-overlapping segments.
Abstract:
This study evaluated the usefulness of multiple overlapping stenting for the treatment of a diffuse lesion in a single and small coronary artery. We studied 48 consecutive patients with a lesion of a vessel with reference diameter < 3.0 mm who received Wiktor stent implants due to suboptimal result or threatened closure after plain old balloon angioplasty (POBA). The patients were divided into 2 groups: Group D, 18 patients with a diffuse lesion with length > or = 15.0 mm who were treated with 2 overlapping Wiktor stents; and Group S, 30 patients with a discrete lesion who were treated with a single Wiktor stent. Two patients with a discrete lesion were not included in Group S because of failure of stenting. Stenting was successful in all patients in Group D. One patient in Group S developed subacute thrombosis after stenting. Follow-up angiography was performed after 6 months. Before treatment, the lesion lengths in Groups D and S were 24.2 +/- 10.0 and 9.2 +/- 4.4 mm, the reference diameters were 2.56 +/- 0.32 and 2.69 +/- 0.33 mm, and the minimal lumen diameters were 0.42 +/- 0.34 and 0.53 +/- 0.40 mm, respectively, with no significant difference in the latter 2 parameters. Restenosis occurred in 72% and 30% (p = 0.01) and revascularization of the target lesion was successful in 67% and in 30% (p = 0.03), in Groups D and S, respectively, both significantly higher in Group D. Follow-up study revealed that the minimal lumen diameter and the net gain were significantly greater in the overlapping portion of the 2 stents than in the proximal and distal portions in Group D, with no significant difference in restenosis rate between these 3 portions. Multiple overlapping stenting using Wiktor stents is useful for diffuse lesions with unfavorable results after POBA even if the affected vessel is smaller than 3.0 mm. However, patients should be carefully observed because restenosis occurs frequently.