Final angiographic and clinical results of the latin America small vessel randomized study (LASMAL trial)

Prospective randomized study of the restenotic process in small coronary arteries using a Carbofilm™ coated stent in comparison with plain old balloon angioplasty:

“…A metaanalysis of 11 randomized studies published by Moreno [22] showed an advantage for stenting in small coronary vessels particularly after suboptimal angioplasty [23–36].…”

Coronary stenting versus balloon angioplasty in small vessels

“…Second, the absolute reduction in restenosis rate in small vessels (8.4%) seems to be lower than in Ͼ3-mm vessels (10% to 15%) (1-3). In some trials on CS in small vessels, the number of patients was calculated assuming a 15% to 20% absolute reduction in restenosis rate and a lower rate of cross-over from balloon to stent (7,8,14).…”

“…In the ISAR-SMART, all patients received abciximab (8). In most studies, however, glycoprotein IIb/IIIa inhibitors were not used (10), were discouraged and allowed only when necessary (11,12), or were used as local standards (9) or according to the physician's preference (14,15). Angiographic analysis and definitions.…”

Análise comparativa da hiperplasia intimal após o implante de stents com e sem sirolimus em artérias coronárias de pequeno calibre

“…Apesar da existência de vários estudos randomizando o tratamento com o balão versus o implante de stent em pacientes com vasos pequenos [30][31][32][33][34][35][36][37][38][39][40] Entretanto, não devemos esquecer que, independentemente do instrumental utilizado na intervenção destas coronárias, o pequeno diâmetro do vaso é o maior preditor angiográfico independente de reestenose [19][20][21] .…”

“…A perda luminal no interior do stent, obtida pela diferença entre os diâmetros mínimos da luz imediatamente após o procedimento e na fase tardia, é uma medida angiográfica da hiperplasia intimal intra-stent. Nos pacientes com vasos pequenos e após angioplastia com balão, ela varia na literatura de 0,22mm a 0,67mm, sendo após o implante de stents, de 0,51mm a 1,12 mm [30][31][32][33][34][35][36][37][38][39][40][41] . Já, a análise volumétrica pelo ultra-som intracoronário pode mensurar de forma ainda mais precisa essa quantidade de hiperplasia após o implante dos stents.…”