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Abstract
Background and Objectives
In the era of stents, lesion length remains an important predictor of restenosis. Drug-eluting stents (DESs) have significantly reduced in-stent restenosis (ISR), but results in long lesions are still lacking. Therefore, we investigated the impact of DESs on clinical outcomes in patients with diffuse coronary lesions.
Subjects and Methods
Between January 2004 and January 2005, 80 patients (94 lesions) with lesions >20 mm in length were treated with one or more DESs and underwent follow-up coronary angiography. The patients were divided into three groups: Group 1 was composed of those with lesions 21 to 35 mm in length, Group 2 was composed of those with lesions 36 to 50 mm in length, and Group 3 was composed of those with lesions ≥51 mm in length.
Results
The mean clinical follow-up duration was 9 months. On the 6-month follow-up angiogram, 6.4% of the lesions had binary ISR (5.0% in group 1, 8.7% in group 2, and 9.1% in group 3). The percent diameter stenosis was 6.0±18.15% in Group 1, 12.61±21.99% in Group 2, and 19.81±31.26% in Group 3(p< 0.05). Late lumen loss was 0.17±0.50 mm in Group 1, 0.39±0.66 mm in Group 2, and 0.59±0.93 mm in Group 3 (p<0.05). Lesion length was associated with an increase in percent diameter stenosis and late lumen loss (of 6.9% and 0.21 mm per 15 mm).
Figures and Tables
Fig. 1
Percent diameter stenosis among the 3 groups. Group 1 was composed of those patients who had lesions 21 to 35 mm in length, Group 2 was composed of those who had lesions 36 to 50 mm in length, and Group 3 was composed of those who had lesions ≥51 mm in length. *p<0.05. DS: diameter stenosis.
Fig. 2
Late lumen loss based on quantitative coronary angiography among the 3 groups. Group 1 was composed of those patients who had lesions 21 to 35 mm in length, Group 2 was composed of those who had lesions 36 to 50 mm in length, and Group 3 was composed of those who had lesions ≥51 mm in length. *p<0.05.
Table 1
Baseline characteristics and nine-month outcomes
Group 1 for those who had 21 to 35 mm in lesion length, Group 2 for those who had 36 to 50 mm in lesion length, Group 3 for those who had ≥51 mm in lesion length, Dyslipidemia: LDL-cholesterol ≥130 mg/dL. SA/UA/AMI: stable angina/unstable angina/acute myocardial infarction, MACE: major adverse cardiac events at nine months, MI: myocardial infarction, TVR: target vessel revascularization, LDL: low density lipoprotein
Table 2
Angiographic characteristics at baseline and after procedure
Group 1 was composed of those patients who had lesions 21 to 35 mm in length, Group 2 was composed of those who had lesions 36 to 50 mm in length, and Group 3 was composed of those who had lesions ≥51 mm in length. LAD: left anterior descending artery, LCX: left circumflex artery, RCA: right coronary artery, SES: sirolimus eluting stent, PES: paclitaxel eluting stent, PCI: percutaneous coronary intervention, RD: reference diameter, MLD: minimal lumen diameter, ISR: in stent restenosis
References
1. Gruentzig AR, Senning A, Siegenthaler WE. Non-operative dilatation of coronary artery stenosis: percutaneous transluminal coronary angioplasty. N Engl J Med. 1979. 301:61–68.
2. Popma JJ, Califf RM, Topol EJ. Clinical trials of restenosis after coronary angioplasty. Circulation. 1991. 84:1426–1436.
3. Kim KH, Jeong MH, Hong SN, et al. The clinical effects of drug-eluting stents for the treatment of coronary in-stent restenosis. Korean Circ J. 2005. 35:443–447.
4. Serruy PW, de Jaegere P, Kiemeneij F, et al. A comparison of balloon-expandable stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med. 1994. 331:489–495.
5. Fischman DL, Leon MB, Baim DS, et al. A randomized comparison of coronary-stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med. 1994. 331:496–501.
6. Holmes DR Jr, Leon MB, Moses JW, et al. Analysis of 1-year clinical outcomes in the SIRIUS trial: a randomized trial of a sirolimus-eluting stent versus a standard stent in patients at high risk for coronary restenosis. Circulation. 2004. 109:634–640.
7. Bauters C, Hubert E, Prat A, et al. Predictors of restenosis after coronary stent implantation. J Am Coll Cardiol. 1998. 31:1291–1298.
8. Kim YH, Park SW, Cheong SS, et al. Long stent implantation in long coronary lesions: immediate and follow-up results. Korean Circ J. 1998. 28:902–908.
9. Kastrati A, Schomig A, Elezi S, et al. Predictive factors of restenosis after coronary stent placement. J Am Coll Cardiol. 1997. 30:1428–1436.
10. Seung KB. Drug eluting stent and percutaneous coronary intervention. Korean Circ J. 2003. 33:857–860.
11. Lemos PA, Serruys PW, van Domburg RY, et al. Unrestricted utilization of sirolimus-eluting stents compared with conventional bare stent implantation in the "real world". Circulation. 2004. 109:190–195.
12. Moses JW, Leon MB, Popma JJ, et al. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med. 2003. 349:1315–1323.
13. Stone GW, Ellis SG, Cox DA, et al. A polymerbased, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med. 2004. 350:221–231.
14. Colombo A, De Gregorio J, Moussa I, et al. Intravascular ultrasound-guided percutaneous transluminal coronary angioplasty with provisional spot stenting for treatment of long coronary lesions. J Am Coll Cardiol. 2001. 38:1427–1433.
15. Warth D, Leon MB, O'Neill W, Zacca N, Polissar NL, Buchbinder M. Rotational atherectomy multicenter registry: acute results, complications and 6-month angiographic follow-up in 709 patients. J Am Coll Cardiol. 1994. 24:641–648.
16. Appelman YE, Piek JJ, Strikwerda S, et al. Randomised trial of excimer laser angioplasty versus balloon angioplasty for treatment of obstructive coronary artery disease. Lancet. 1996. 347:79–84.
17. Serruys PW, Foley DP, Suttorp MJ, et al. A randomized comparison of the value of additional stenting after optimal balloon angioplasty for long coronary lesion: final results of the additional value of NIR stents for treatment of long coronary lesion (ADVANCE) study. J Am Coll Cardiol. 2002. 39:393–399.
18. Mauri L, O'Malley AJ, Popma JJ, et al. Comparison of thrombosis and restenosis risk from stent length of sirolimus-eluting stents versus bare metal stents. Am J Cardiol. 2005. 95:1140–1145.
19. Mehran R, Dangas G, Abizaid AS, et al. Angiographic patterns of in-stent restenosis: classification and implications for long-term outcomes. Circulation. 1999. 100:1872–1878.
20. Morice MC, Serruys PW, Sousa JE, et al. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med. 2002. 346:1773–1780.
21. De Scheerder IK, Wang K, Kostopoulos K, Dens J, Desmet W, Piessens JH. Treatment of long dissections by use of a single long or multiple short stents: clinical and angiographic follow-up. Am Heart J. 1998. 136:345–351.
22. Hoffmann R, Herrmann G, Silber S, et al. Randomised comparison of success and adverse event rates and cost effectiveness of one long versus two short stents for treatment of long coronary narrowings. Am J Cardiol. 2002. 90:460–464.
23. Lee SH, Jang Y, Oh SJ, et al. Overlapping versus one long stenting in long coronary lesions. Catheter Cardiovasc Interv. 2004. 62:298–302.
24. Degertekin M, Arampatzis CA, Lemos PA, et al. Very long sirolimus-eluting stent implantation for de novo coronary lesions. Am J Cardiol. 2004. 93:826–829.
25. Kerr AJ, Stewart RA, Low CJ, Restieaux NJ, Wilkins GT. Long stenting in native coronary arteries: relation between vessel size and outcome. Cathet Cardiovasc Diagn. 1998. 44:170–174.
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