The length of the stented segment is an independent predictor of restenosis

Kobayashi, Y.; DeGregorio, J.; Reimers, Bernhard; DiMario, Carlo; Finci, Léo; Colombo, Antonio

doi:10.1016/s0735-1097(98)82231-6

Cited by 57 publications

(71 citation statements)

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“…Restenosis rates were significantly higher in the group treated with BMS. The restenosis rate of 34.7% that was observed in this group does not compare favorably to restenosis rates that have been previously reported for coronary interventions with BMS placement in less complex lesion subsets [1][2][3][4]. This higher restenosis rate occurred despite the fact that the BMS group had stent lengths that were significantly shorter and stent diameters that were significantly larger compared to the DES group.…”

Section: Discussioncontrasting

confidence: 81%

“…Surprisingly, neither group showed any association between stent length and restenosis. This is an unexpected finding since several previous studies have shown a correlation between stent length and/or placement of multiple stents with restenosis, particularly with BMS [1][2][3][4][5][6][7][8][9][10][11][12]. Many of these studies evaluated early generation BMS, comparisons were made to short, focal coronary lesions, and the definition of "long lesions" was conservative compared to our study.…”

Section: Discussionmentioning

confidence: 47%

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Treatment of diffuse coronary artery disease with long lengths (≥30 mm) of intracoronary stents

Jeong

Luu

Minisi

2011

IMAS

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Percutaneous coronary intervention (PCI) using intracoronary stents is a mainstay in the treatment of acute coronary syndromes and symptomatic chronic coronary artery disease (CAD). Randomized studies documenting the safety and efficacy of intracoronary stents have largely been performed in patients with coronary lesions that are focal and less complex. However, in real world practice, the morphology of CAD is highly variable. It is not uncommon to attempt PCI in lesions that are very diffuse and require either long stent lengths or the use of multiple overlapping stents. Although the acute angiographic results of these procedures are usually favorable, we have observed that coronary vessels and/or bypass grafts treated with long stents or multiple overlapping stents are frequently occluded at the time of repeat catheterization. Therefore, we became interested in determining the safety and efficacy of this stenting strategy. The primary goal of this study was to examine the long-term procedural success of treating diffuse CAD with one or multiple overlapping intracoronary stents whose total length is ≥30 mm. Based on our previous experience, we hypothesized that the restenosis rate in patients treated with long or multiple overlapping stents would be high when compared to previously reported restenosis rates. Materials and Methods Study patientsThe patient population consisted of consecutive series of 312 patients who had been treated with ≥30 mm of stent(s) in a single coronary vessel from January of 2000 to December of 2006 at McGuire Veterans Administration Medical Center. Retrospective review of institutional PCI registry was performed with identification of patients who received ≥30 mm total length of either bare metal or drug eluting stent(s) in a single coronary vessel. Baseline patient characteristics, procedural details, and angiographic information were collected. The local institutional review board approved the study protocol and waived the requirement for informed consent based on CFR 46.116d1-4. Abstract: The interventional treatment of diffuse coronary artery disease often requires the placement of long lengths of intracoronary stents. We have anecdotally observed that target vessel failure rates seem high in these patients. Therefore, we examined long-term angiographic and clinical outcomes in patients treated with long lengths of intracoronary stent. A total of 312 consecutive patients who received ≥30 mm of stent(s) in a single coronary vessel were identified. Bare metal stents (BMS) were placed in 118 of these patients and drug eluting stents (DES) were used in 175 patients. Nineteen patients who received both BMS and DES were excluded from comparative analysis. The mean number of stents placed was 2.4±0.92 and the mean stent length was 45.7±18.2 mm. For the entire cohort, the restenosis rate was 20.8%. Restenosis rates were significantly higher in the BMS group compared to the DES group (34.7% vs. 11.4%; p<0.0001). The rates of major adverse cardiac events were significantly lower in the DES ...

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Section: Discussioncontrasting

confidence: 81%

Section: Discussionmentioning

confidence: 47%

Treatment of diffuse coronary artery disease with long lengths (≥30 mm) of intracoronary stents

Jeong

Luu

Minisi

2011

IMAS

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“…4 -6 Long lesions are a challenging subset because they are traditionally associated with poor outcome after balloon angioplasty or stenting. [1][2][3][4][5][6] The only randomized study to …”

Section: Discussionmentioning

confidence: 99%

Intravascular Ultrasound Guidance Improves Angiographic and Clinical Outcome of Stent Implantation for Long Coronary Artery Stenoses

Oemrawsingh

Mintz²,

Schalij³

et al. 2003

Circulation

260

145

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Background-Long coronary lesions treated with stents have a poor outcome. This study compared the 6-month outcome of stent implantation for long lesions in patients randomized to intravascular ultrasound (IVUS; nϭ73) or angiographic guidance (nϭ71). Methods and Results-Stenoses Ͼ20 mm in length and a reference diameter that permitted a stent diameter Ն3 mm were eligible. Primary end points were 6-month minimal lumen diameter (MLD) and the combined end point of death, myocardial infarction, and target-lesion revascularization (TLR). Baseline clinical and angiographic data were comparable in both groups. At 6 months, MLD in the IVUS group (1.82Ϯ0.53 mm) was larger than in the angiography group (1.51Ϯ0.71 mm; Pϭ0.042). TLR and combined end-point rates at 6 months were 4% (nϭ3) and 6% (nϭ4) in the IVUS group and 14% (nϭ10) and 20% (nϭ14) in the angiography group, respectively (Pϭ0.037 for TLR and Pϭ0.01 for combined events). Restenosis (Ͼ50% diameter stenosis) was found in 23% of the IVUS group and 45% of the angiography group (Pϭ0.008). At 12 months, TLR and the combined end point occurred in 10% (nϭ7) and 12% (nϭ9) of the IVUS group and 23% (nϭ17) and 27% (nϭ19)

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“…In this study, we used this technique of IVUS-guided "spot stenting" to the transplant arteriopathy lesions. 14 Unfortunately, the angiographic restenosis rate in the small group of patients who were restudied was 100% at a mean of 4.9 months. This restenosis rate is high compared with conventional balloon angioplasty for cardiac allograft arteriopathy.…”

Section: Cutting Balloon Angioplasty For Allograft Arteriopathymentioning

confidence: 97%