Objective: To investigate the effect of reducing stent length on the rate of target lesion restenosis. Design: In a prospective investigation, acute and long term results of a short stenting procedure were analysed by quantitative angiography and compared with results of a conventional stenting procedure selected according to a matched pairs analysis. Patients: Short stents were implanted in 400 consecutive patients with 464 lesions and conventional stents in 430 patients. Demographic and lesion characteristics were comparable between groups. Interventions: In short stenting, the shortest stent length to cover only segments with . 30% reduction in vessel diameter was used. In conventional stenting, full coverage of a stenotic vessel segment was intended. Main outcome measures: The mean stent lengths of the short stent group (9.8 (4) mm) and the conventional stent group (16.3 (7) mm) differed significantly (p , 0.0001); all other procedural and angiographic parameters were the same. Procedural success was similar for both groups. Control angiography after six months was conducted in 92% of patients. Results: Short stenting resulted in both less restenosis (68 of 431 (15.8%)) than conventional stenting (93 of 381 (24.4%), p = 0.007) and less late lumen loss (0.6 (0.6) mm v 0.75 (0.5) mm, p = 0.0001). Residual stenosis (, 45%) in adjacent vessel segments after short stenting did not affect the restenosis rate. Only the implantation of a ( 9 mm stent predicted the absence of restenosis in a multivariate analysis. Conclusion: Shortening the length of bare metal stents reduces the restenosis rate as compared with conventional stenting. However, the superiority of DES has been proved for only a few lesion characteristics. Another restriction for the liberal use of DES is their costs. A recently published cost effectiveness analysis for the use of DES showed that treatment with DES would save costs for patients with a bare metal stent target vessel revascularisation (TVR) rate . 20%.2 Although the length of the DES does not seem to influence the restenosis rate, the length of bare metal stents was found to predict restenosis independently.3 4 Furthermore, much longer stents were used than necessary to cover the target lesion in most lesions as reported in an analysis of several interventional trials of bare metal stents. 5 In a previous study, we could show that, with a single short stent (9 mm), 52% of all treated coronary lesions could be treated successfully, yielding a low restenosis rate. 6 In the present study we compared the strategy of implanting the shortest stent length, covering only the clinically relevant parts of a lesion, with conventional stenting-that is, a stent sized to cover the target lesion completely. METHODS ObjectivesThe study was designed to investigate, prospectively, both the short term and long term results of inserting the shortest possible stent into lesions requiring a stent. Immediately adjacent plaques causing less than 30% diameter stenosis were left unstented. Possible effects of thi...
Stent length predicts restenosis. The feasibility of using a short stent (<10 mm) routinely was investigated in 331 consecutive patients treated for 424 coronary artery lesions. A single short stent provided suitable coverage and achieved a residual stenosis <30%, with or without predilatation, in 252/424 lesions (59.4%). Longer stents were implanted in 58/424 lesions (13.7%), while only percutaneous transluminal coronary angioplasty was performed in 114/242 lesions (26.9%). Angiographic success and procedural success were achieved in 250/252 lesions (99.2%). Restenosis occurred in 36/231 lesions (15.6%) after short stenting, in 10/53 lesions (18.9%) after long stents, in 21/88 lesions (23.9%) after percutaneous transluminal coronary angioplasty, and in 67/372 lesions (18.0%) controlled angiographically. Only small vessel diameter predicted restenosis after short stenting. Thus, a single short stent implanted directly or after predilatation is sufficient to achieve an acceptable angiographic result in more than in nearly 60% of all treated lesions. Short stenting results in a low restenosis rate.
Background: 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.
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