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

Abstract

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 ...