Comparison of standard versus modified stenting technique for treatment of tapered coronary artery lesions.

Dan Ke,Lianglong Chen,Chaogui Lin,Xi He

doi:10.31083/j.rcm2203101

Abstract

Tapered coronary artery lesions (TCALs) are often seen clinically, optimal stenting of TCALs remains challengeable. This study sought to compare clinical outcomes between the modified single stenting (MSS) and conventional overlapped stenting (COS) in treatment of TCALs. 150 patients were treated with MSS (MSS group), another 150 patients were matched with propensity score matching from 5055 patients treated with COS (COS group). Quantitative coronary angiography was performed to measure minimal lumen diameter (MLD), late lumen loss (LLL). The primary endpoint was immediate angiographic success, one-year cumulative major cardiac adverse events (MACEs) composing cardiac death, target vessel myocardial infarction (TVMI), target lesion/vessel revascularization (TLR/TVR) or stent thrombosis (ST). Post-procedural in-stent MLD (2.96 ± 0.34 versus 3.08 ± 0.33, P = 0.004) was smaller and diameter stenosis (11.7 ± 4.0% versus 9.0 ± 4.8%, P = 0.003) was higher in MSS group than COS group. At 1-year follow-up, in-stent MLD (2.76 ± 0.38 mm versus 2.65 ± 0.60 mm, P = 0.003) was reduced, LLL (0.20 ± 0.26 mm versus 0.42 ± 0.48 mm, P = 0.001), diameter stenosis (24.02 ± 20.94% versus 19.68 ± 11.75%, P = 0.028) and binary restenosis (18.7% versus 10.0%, P = 0.047) were increased in COS group. Angiographic success (96.7% versus 98.0%, P = 0.723) was similar between MSS group and COS group. At 1-year, the cumulative MACEs (12.0% versus 22.7%, P = 0.022) and TLR/TVR (10.0% versus 18.7%, P = 0.047) were reduced in MSS group as compared to COS group, there was no difference in cardiac death, TVMI and ST between the groups. Compared to conventional overlapped stenting, modified single stenting for TCALs is associated with similar angiographic success, fewer one-year cumulative MACEs and less treatment cost.

Highlights

The tapered coronary artery lesions (TCALs) are frequently seen in many clinical scenarios
2.2.2 Conventional overlapped stenting (COS) Overlapped stenting with two stents or more was adopted to adapt to TCAL anatomy
A total of 150 patients were enrolled and treated with modified single stenting (MSS); another 150 patients were matched as controls based on the propensity score matching of baseline clinical and lesion characteristics from 5055 pa

Summary

Introduction

The tapered coronary artery lesions (TCALs) are frequently seen in many clinical scenarios (e.g., long lesions with or without branches, bifurcation lesions, and unusual lesions with positive remodeling, ectasia or aneurism). Banka VS et al [3], determined the degree of taper between 1 cm proximal and distal to the stenosis. They found that 23% arteries showed ≥1 cm taper, 19% arteries showed 0.5–0.99 mm taper, and 8% arteries showed reverse taper [3]. These findings indicate that the dimensions naturally taper along the length of coronary arteries [2, 3]. In cases involving stenosis or occlusions in major parts of a long vessel, natural tapering may create dilemma for optimal balloon sizing and optimal stent sizing during PCI [4]

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