Long Coronary Lesions Requiring Long Stents 20 mm. Analysis And Outcome In Patients Treated At Queen Alia Heart Institute

Abstract

Objective: To determine the outcome after using long coronary stents >20 mm for long coronary lesions among patients treated at Queen Alia Heart Institute. Methods: This is a descriptive, and a retrospective non randomized study which was conducted at Queen Alia Heart Institute on 900 adult patients who underwent coronary angiography and intervention for either stable or unstable angina pectoris during the period between 2006 to 2011. Those patients had coronary intervention using a single long stent for each long lesion (>20 mm). Their follow up was analyzed and the outcome of these long stents was studied for in stent restenosis or in stent total occlusion in each specific coronary artery. A specially designed form was used to record the following data in the involved patients: age, gender, size and type of coronary stent (drug eluting or bare metal), the presence of diabetes mellitus, hypertension or hypercholesterolemia, and the status of the left ventricle. Results: The total number of patients who had long coronary stent intervention was 900 cases. Four hundred eighty patients (53.3%) had restudy cardiac catheterization within 6-8 months, which showed instent restenosis or instent total occlusion in 90 patients. Males constituted the majority (88.9%) of the affected patients. Smoking was the commonest (83.3%) factor associated with instent restenosis followed by Diabetes Mellitus (61.1%). About half the cases of long instent restenosis was found in left anterior descending artery, whereas right coronary artery and circumflex artery had almost equal ratios: 23.3% and 22.2% respectively. Long instent restenosis was commoner (33.3%) in ostial lesions and was the least (14.5%) in mid segment lesions. Bare metal stents were associated with the majority (77.8%) of cases of instent restenosis. About two thirds of the affected patients had small caliber stents (2.5 and 2.75 mm diameter). Conclusion: Instent restenosis or instent total occlusion in long coronary stents is a well recognized and not uncommon clinical entity. Men are more commonly affected than women. Ostial left anterior descending artery is more affected than other coronaries. Smoking, Diabetes Mellitus and the use of bare metal stents of small sized caliber (≤ 2.75 mm) were common in our study patient population and associated with increased incidence of long instent restenosis