Shortening the stent length reduces restenosis with bare metal stents: matched pair comparison of short stenting and conventional stenting

Abstract

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...

Treatment of Stenoses of Vertebral Artery Origin Using Short Drug-Eluting Coronary Stents: Improved Follow-Up Results

“…In addition, experience in coronary stent placement confirms that the restenosis rate can be reduced by implanting short stents. 20 In the present study, we report midterm clinical and angiographic follow-up results in 52 ostial vertebral artery lesions treated with short balloon-expandable paclitaxel-eluting stents, placed exactly at the orifice of the vertebral artery and deployed with high inflation pressure. To our knowledge, this is the highest number of patients treated with DES so far.…”

Combining short stent implantation and drug-eluting stenting for routine use yields a low restenosis rate

“…In a prospective study of 400 consecutive patients who underwent short stenting of their coronary artery lesions, we compared immediate and long-term results with a matched-pair control group of patients treated earlier with conventional-length stents. We found a significantly lower restenosis rate after short stenting, with no difference in the procedural success rates [ 7 ]. Vessel size was the only predictor of ISR after short stenting.…”

“…Our criteria for selecting a short BMS implant versus a DES implant for study participants were based on results from a non-randomized study performed earlier at our institution [ 7 ]. Selection of the stent device was based on operators' visual interpretation of vessel dimensions.…”

“…[ 6 ]. In another prospective study, we observed that short stenting significantly reduced the restenosis rate as compared to conventional stenting, which involves placement of the stent over the entire stenotic segment of a vessel [ 7 ]. In this latter study, vessel size only was found to predict restenosis after short stenting.…”

The accuracy of length measurements using different intravascular ultrasound motorized transducer pullback systems

“…During bare-metal stent implantation, there is a trend toward limiting stent length to reduce stenosis [3,4] Conversely, with drug-eluting stents, the trend is to cover as much of the lesion as possible and to end the stent in the artery segment with the largest lumen and least plaque to minimize acute complications (stent thrombosis) and restenosis [5][6][7][8] Selecting the correct drug-eluting stent length the first time should be cost-effective compared with ad hoc implantation of additional stents as necessary [9,10] Accurate longitudinal measurements are also necessary for studies using volumetric IVUS analysis as an endpoint for in-stent restenosis and atherosclerosis progression/regression. Although other approaches are possible, current IVUS length measurements are dependent on the accuracy of motorized transducer pullback.…”