Incidence and predictors of late total occlusion following coronary stenting

Abstract

To determine the incidence and predictors of total occlusion in-stent restenosis, we reviewed three randomized stent vs. stent trials and one stent registry, which provided 955 coronary artery lesions with 6-month angiographic follow-up. Fifteen (1.6%) of the 955 stented lesions were totally occluded at 6-month follow-up. Most patients with total occlusion presented with recurrent angina at the time of repeat angiography (60.0%) while no patient presented with an acute ST segment elevation myocardial infarction. The univariate predictors of total occlusion following elective coronary stenting included stenting for restenosis after a previous percutaneous intervention (P = 0.001), longer stent length (P < 0.001), longer lesion length (P < 0.001), smaller reference vessel diameter (P = 0.022), smaller preprocedure minimum lumen diameter (MLD; P = 0.004), and smaller postprocedure MLD (P = 0.036). Stepwise multiple logistic regression analysis demonstrated that stenting for restenotic lesions (P = 0.004), longer stent length (P < 0.001), and smaller preprocedure MLD (P = 0.012) were independent predictors of total occlusion following coronary stenting.

Coronary artery spatial distribution of acute myocardial infarction occlusions

“…The extremely low frequency of thrombosis occurring in stented segments suggests that the scarred stented coronary segment generally does not provide the adequate milieu for local atherosclerotic plaque. 41,42 Similar to the risk reduction for myocardial infarction seen with arterial bypass graft surgery compared with conventional percutaneous coronary intervention for diabetic patients at high risk of myocardial infarction, 43 in which the bypass grafts themselves provided a parallel, more stable conduit beyond the proximal native coronaries at risk for future thrombosis, 8 the use of prophylactic stenting might provide a similar benefit by replacing the high-risk zones with a controlled vascular scar.…”

Successful use of the frontrunner catheter in the treatment of in‐stent coronary chronic total occlusions

“…A recent study reports that, albeit a relatively low incidence of 1.6%, CTOs from ISR are symptomatic in 60% of the patients [6]. Interestingly, the majority of the symptomatic patients present with stable angina, while only a minority of them display unstable syndrome.…”

“…Given that most patients with CTOs caused by ISR are excluded from major clinical trials, there is little published data on the procedural aspects of interventions in this patient population. Limited reports in the literature and our own experience suggest that they are a challenging subset, with low rate of success, mostly due to difficulty in crossing the lesion with conventional guidewires [6,7].…”

“…The most exuberant type of ISR results in complete obliteration of the stent lumen and gives rise to chronic total occlusion (CTO). Although this is the least common type of ISR, it is associated with significant morbidity [5,6]. Given that most patients with CTOs caused by ISR are excluded from major clinical trials, there is little published data on the procedural aspects of interventions in this patient population.…”

Effects of Angiotensin-Converting Enzyme Inhibitors or an Angiotensin Receptor Blocker in Combination With Aspirin and Cilostazol on In-stent Restenosis

“…Since the restenosis rate increases in lesions having previously undegone coronary intervention, 22) we can not exclude the possibility that it might have influenced the apparently low restenosis rate in the basal group. Effects of ACE inhibitor on in-stent restenosis: Among previous reports that assessed the effects of ACE inhibitors on in-stent restenosis, none confirmed their preventive effect angiographically, though one paper using intravascular ultrasound (IVUS) analysis showed that an ACE inhibitor attenuated reductions of the Vol 47 No 2 minimal lumen area and lumen volume at the stenting site.…”