Randomized Comparison of Sirolimus-Eluting and Everolimus-Eluting Coronary Stents in the Treatment of Total Coronary Occlusions

Abstract

Second-generation DESs have provided better platforms, new drugs, and new polymers, with the objective of improve deliverability and even safety of these devices. Among them, Background-Patients with coronary total occlusions are at especially high risk for restenosis and new revascularizations.Sirolimus-eluting stents dramatically improved the clinical outcome of this subset of patients in randomized trials, but other drug-eluting stents, mainly the everolimus-eluting stent (currently the most frequently used stent), have not yet been evaluated in patients with coronary total occlusions. The objective was to compare the second-generation everolimuseluting stent with the first-generation sirolimus-eluting stent in patients with coronary total occlusions. Methods and Results-A total of 207 patients with coronary total occlusions and estimated time since occlusion >2 weeks were randomized to everolimus-or sirolimus-eluting stent. The primary end point was in-stent late loss at 9-month angiographic follow-up (noninferiority trial). Clinical follow-up was performed at 1 and 12 months. In-stent late loss at 9 months was 0.29±0.60 versus 0.13±0.69 mm in patients allocated to sirolimus-and everolimus-eluting stent, respectively. The observed difference in in-stent late loss between both groups was -0.16 mm (95% confidence interval, 0.04 to -0.36 mm; P for noninferiority <0.01). The rate of binary angiographic restenosis was 10.8% and 9.1% in patients allocated to sirolimus-and everolimus-eluting stent, respectively (P=0.709), whereas the rate of vessel reocclusion was 3.2% and 1.1%, respectively (P=0.339). At 12 months, the rate of major adverse events was 15.9% versus 11.1% with sirolimusand everolimus-eluting stent, respectively (P=0.335), and probable or definitive stent thrombosis occurred in 3.0% and 0.0% of patients, respectively (P=0.075). Conclusions-In

Meta-Analysis of Long-Term Clinical Outcomes of Everolimus-Eluting Stents

“…Third, the effect of EES relative to SES could be more pronounced in complex coronary artery disease. 26,27 However, because of the lack of patient-level data, the present analysis could not address the effect in patients with complex coronary artery disease, such as chronic total occlusion, bifurcation, hemodialysis, and long lesion. Finally, SES has already disappeared from the commercial market.…”

Zotarolimus compared with everolimus eluting stents‐angiographic and clinical results after recanalization of true coronary chronic total occlusions

“…The total stent length was 43.4 AE 21.5 mm for ZES compared with 44.6 AE 20.2 mm for SES, again clearly lower compared with our population. In the CIBELS trial (Randomized Comparison of Sirolimus-Eluting and EverolimusEluting Coronary Stents in the Treatment of Total Coronary Occlusions) patients with TIMI 0 or I and an estimated occlusion time of more than 2 weeks were enrolled [21]. Total stent length was 47.5 AE 24.6 mm [21].…”

“…In the CIBELS trial (Randomized Comparison of Sirolimus-Eluting and EverolimusEluting Coronary Stents in the Treatment of Total Coronary Occlusions) patients with TIMI 0 or I and an estimated occlusion time of more than 2 weeks were enrolled [21]. Total stent length was 47.5 AE 24.6 mm [21]. In the PEPCAD-CTO registry we compared the paclitaxelcoated balloon (PCB) plus bare-metal stent for true CTOs with a TIMI 0 flow and duration of occlusion of more than 3 months with the paclitaxel eluting stent (PES) [22].…”

Update in Chronic Total Occlusion Percutaneous Coronary Interventions

“…Long-term outcomes after CTO-PCI are favorable, with most studies demonstrating low rates of restenosis and target lesion revascularization (,10% at 1 year), [43][44][45][46][47][48][49][50][51] although some studies with highly complex lesions have reported higher restenosis rates. 52 First-generation drugeluting stents (DES) significantly reduced the risk of restenosis compared with bare metal stents.…”