Combining short stent implantation and drug-eluting stenting for routine use yields a low restenosis rate
Tóm tắt
Stent length serves as a predictor of restenosis in use of bare metal stents (BMS). This has been demonstrated in a feasibility study that used a single short BMS implant (<9 mm) in a high proportion of lesions; the study observed a low rate of restenosis. We performed a pilot prospective study to investigate in a series of consecutive patients the immediate and long-term effects of implantation of either 1) a single short BMS for all lesions with low probability of restenosis or 2) a drug-eluting stent (DES) for all other lesions. The 200 patients studied had 236 coronary artery lesions that were treated with short BMS in 168/236 patients (71.2%) and with DES in 68/236 patients (28.8%). Angiographic success was achieved in 230/236 lesions (97.5%) and procedural success in 194/200 patients (97.0%). Restenosis occurred in 15/153 lesions (9.8%) after short BMS, in 3/62 lesions (4.8%) after DES, and in 18/215 of all lesions (8.4%) angiographically controlled after six to eight months. Target vessel revascularization was performed in 16/218 lesion (7.4%). Most of the coronary artery lesions in this small group of consecutive patients were treated sufficiently with a single BMS implant. This differential approach of treating suitable lesions in medium- to large-sized vessels with a single short BMS device and treating all other lesions with a DES implant resulted in a low incidence of restenosis.
Tài liệu tham khảo
Hill RA, Dundar Y, Bakhai A, Dickson R, Walley T: Drug-eluting stents: an early systematic review to inform policy. Eur Heart J. 2004, 25 (11): 902-919. 10.1016/j.ehj.2004.03.023.
O'Neill WW, Leon MB: Drug-eluting stents: costs versus clinical benefit. Circulation. 2003, 107 (24): 3008-3011. 10.1161/01.CIR.0000079018.84618.0E.
Greenberg D, Bakhai A, Cohen DJ: Can we afford to eliminate restenosis? Can we afford not to?. J Am Coll Cardiol. 2004, 43 (4): 513-518. 10.1016/j.jacc.2003.11.020.
Cutlip DE, Chauhan MS, Baim DS, Ho KK, Popma JJ, Carrozza JP, Cohen DJ, Kuntz RE: Clinical restenosis after coronary stenting: perspectives from multicenter clinical trials. J Am Coll Cardiol. 2002, 40 (12): 2082-2089. 10.1016/S0735-1097(02)02597-4.
Mauri L, O'Malley AJ, Cutlip DE, Ho KK, Popma JJ, Chauhan MS, Baim DS, Cohen DJ, Kuntz RE: Effects of stent length and lesion length on coronary restenosis. Am J Cardiol. 2004, 93 (11): 1340-6, A5.. 10.1016/j.amjcard.2004.02.027.
Dietz U, Holz N, Dauer C, Meinert R, Lambertz H: Short stent implantation for routine use is feasible in a high proportion of coronary interventions and yields a low restenosis rate. Cardiology. 2005, 103 (4): 212-218. 10.1159/000085200.
Dietz U, Holz N, Dauer C, Lambertz H: Shortening the stent length reduces restenosis with bare metal stents: matched-pair comparison of short stenting and conventional stenting. Heart. 2005
Hausleiter J, Jost S, Nolte CW, Dirschinger J, Kastrati A, Stiel GM, Wunderlich W, Fischer F, Linderer T, Hausmann D, Schomig A: Comparative in-vitro validation of eight first- and second-generation quantitative coronary angiography systems. Coron Artery Dis. 1997, 8 (2): 83-90.
Dietz U, Rupprecht HJ, Brennecke R, Fritsch HP, Woltmann J, Blankenberg S, Meyer J: Comparison of QCA systems. Int J Card Imaging. 1997, 13 (4): 271-280. 10.1023/A:1005768523234.
Herrington DM, Walford GD: Optimal frame selection for QCA. Advances in Quantitative Coronary Arteriography. Edited by: Reiber JHC SPW. 1993, The Netherlands , Kluwer Academic Publishers, 125-135.
Reiber JH, van Eldik Helleman P, Visser Akkerman N, Kooijman CJ, Serruys PW: Variabilities in measurement of coronary arterial dimensions resulting from variations in cineframe selection. Cathet Cardiovasc Diagn. 1988, 14 (4): 221-228.
Kastrati A, Mehilli J, Dirschinger J, Pache J, Ulm K, Schuhlen H, Seyfarth M, Schmitt C, Blasini R, Neumann FJ, Schomig A: Restenosis after coronary placement of various stent types. Am J Cardiol. 2001, 87 (1): 34-39. 10.1016/S0002-9149(00)01268-6.
Serruys PW, Kay IP, Disco C, Deshpande NV, de Feyter PJ: Periprocedural quantitative coronary angiography after Palmaz-Schatz stent implantation predicts the restenosis rate at six months: results of a meta-analysis of the BElgian NEtherlands Stent study (BENESTENT) I, BENESTENT II Pilot, BENESTENT II and MUSIC trials. Multicenter Ultrasound Stent In Coronaries. J Am Coll Cardiol. 1999, 34 (4): 1067-1074. 10.1016/S0735-1097(99)00308-3.
Kereiakes D, Linnemeier TJ, Baim DS, Kuntz R, O'Shaughnessy C, Hermiller J, Fink S, Lansky A, Nishimura N, Broderick TM, Popma J: Usefulness of stent length in predicting in-stent restenosis (the MULTI-LINK stent trials). Am J Cardiol. 2000, 86 (3): 336-341. 10.1016/S0002-9149(00)00928-0.
Kobayashi Y, De Gregorio J, Kobayashi N, Akiyama T, Reimers B, Finci L, Di Mario C, Colombo A: Stented segment length as an independent predictor of restenosis. J Am Coll Cardiol. 1999, 34 (3): 651-659. 10.1016/S0735-1097(99)00303-4.
Antoniucci D, Valenti R, Santoro GM, Bolognese L, Trapani M, Cerisano G, Boddi V, Fazzini PF: Restenosis after coronary stenting in current clinical practice. Am Heart J. 1998, 135 (3): 510-518. 10.1016/S0002-8703(98)70329-1.
Colombo A, De Gregorio J, Moussa I, Kobayashi Y, Karvouni E, Di Mario C, Albiero R, Finci L, Moses J: Intravascular ultrasound-guided percutaneous transluminal coronary angioplasty with provisional spot stenting for treatment of long coronary lesions. J Am Coll Cardiol. 2001, 38 (5): 1427-1433. 10.1016/S0735-1097(01)01557-1.
Komatsu R, Ueda M, Naruko T, Kojima A, Becker AE: Neointimal tissue response at sites of coronary stenting in humans: macroscopic, histological, and immunohistochemical analyses. Circulation. 1998, 98 (3): 224-233.
Inoue T, Sohma R, Miyazaki T, Iwasaki Y, Yaguchi I, Morooka S: Comparison of activation process of platelets and neutrophils after coronary stent implantation versus balloon angioplasty for stable angina pectoris. Am J Cardiol. 2000, 86 (10): 1057-1062. 10.1016/S0002-9149(00)01159-0.
Mehran R, Dangas G, Abizaid A, Lansky AJ, Mintz GS, Pichard AD, Satler LF, Kent KM, Waksman R, Stone GW, Leon MB: Treatment of focal in-stent restenosis with balloon angioplasty alone versus stenting: Short- and long-term results. Am Heart J. 2001, 141 (4): 610-614. 10.1067/mhj.2001.113998.