Good Midterm Clinical Outcomes Research Articles

Surgical hip dislocation technique through the femoral head fovea fenestration and impaction bone grafting for the treatment of non-traumatic osteonecrosis of the femoral head: a retrospective study

BackgroundOsteonecrosis of the femoral head (ONFH) often leads to the collapse of the femoral head, ultimately resulting in patients undergoing premature total hip arthroplasty (THA). The surgical hip dislocation (SHD) technique is a type of hip-preserving surgery aimed at delaying or avoiding THA. This study aims to evaluate the clinical efficacy of SHD techniques through femoral head fovea fenestration and impaction bone grafting for the treatment of non-traumatic ONFH.MethodsA retrospective analysis was conducted on the clinical data of 39 patients (39 hips) with non-traumatic ONFH who underwent SHD for treatment from 2016 to 2017. The Harris hip score (HHS) and the minimum clinically important difference (MCID) are used to evaluate clinical outcomes, while radiographic evaluations are conducted using X-rays. Kaplan-Meier survival analysis defined clinical failure as further THA, and conducted univariate survival analysis and Cox regression analysis. Any complications were recorded.ResultsAll patients were followed up for 24–72 months, with an average of (60 ± 13.0) months. At the last follow-up, based on the HHS, 25 patients (64.1%) reported excellent and good clinical outcomes. 29 patients (74.3%) achieved MCID. Imaging evaluation of the postoperative femoral head status showed that 6 cases improved, 20 cases remained stable, and 13 cases showed progressed. Out of 39 hips, 12 hips had postoperative clinical failure, resulting in a clinical success rate of 69.2%. Association Research Circulation Osseous (ARCO) stage, China-Japan Friendship Hospital (CJFH) classification, and postoperative crutch-bearing time are risk factors for clinical failure. Postoperative crutch-bearing time of less than 3 months is an independent risk factor for clinical failure. After surgery, there was one case of sciatic nerve injury and one case of heterotopic ossification. There were no infections or non-union of the greater trochanter osteotomy.ConclusionThe SHD technique through the femoral head fovea fenestration and impaction bone grafting provides a safe and effective method for treating non-traumatic ONFH, with good mid-term clinical outcomes. ARCO staging, CJFH classification, and postoperative crutch-bearing time are risk factors that affect clinical outcomes after surgery and lead to further THA. Insufficient postoperative crutch-bearing time is an independent risk factor for clinical failure.

Satisfactory mid-term clinical outcomes of endoscopic tenotomy for iliopsoas tendinopathy following total hip arthroplasty.

To report 5-year outcomes of endoscopic iliopsoas tenotomy in patients with iliopsoas tendinopathy following total hip arthroplasty (THA) and determine whether clinical scores are associated with cup position. Patients who underwent endoscopic iliopsoas tenotomy for iliopsoas tendinopathy following THA (2014-2017) were contacted. Indications for endoscopic iliopsoas tenotomy after THA were groin pain during active hip flexion, exclusion of other causes of groin pain, and no pain relief after 6 months of conservative treatment. Pretenotomy cup inclination and anteversion were measured on radiographs; axial and sagittal cup overhang were measured on computed tomography (CT) scans. Oxford hip score (OHS), modified Harris hip score (mHHS), and groin pain were assessed. The initial cohort comprised 16 men (17 hips) and 31 women (32 hips), aged 60.7 ± 10.6 years. Cup inclination and anteversion were, respectively, 46.2 ± 6.2° and 14.6 ± 8.4°, while axial and sagittal cup overhang were, respectively, 4.4 ± 4.0 mm and 6.9 ± 4.5 mm. At ≥5 years follow-up, fourhips underwent cup and stem revision, twounderwent isolated cup revision and oneunderwent secondary iliopsoas tenotomy. OHS improved by 23 ± 10 and mHHS improved by 31 ± 16. Posttenotomy groin pain was slight in 20.0%, mild in 17.5% and moderate in 12.5%. Regression analyses revealed that net change in mHHS decreased with sagittal cup overhang (β = -3.1; 95% confidence interval [CI] = -4.6 to -1.7; p < 0.001), but that there were no associations between cup position and net change in OHS. Endoscopic iliopsoas tenotomy provides good mid-term clinical outcomes in patients with iliopsoas tendinopathy following THA. Furthermore, improvements in mHHS were found to decrease with increasing sagittal cup overhang, in cases for which adequate preoperative imaging was available. Level IV.

Midterm Outcomes of Primary and Secondary Use of an Endoanchor System for Thoracic and Abdominal Aortic Endovascular Aortic Repair

PurposeTo assess the safety, technical success, and midterm outcomes of endoanchor (Heli-FX, Medtronic, Santa Rosa, California) deployment in thoracic endovascular aortic repair (TEVAR) or abdominal endovascular aortic repair (EVAR). Materials and MethodsThis single-institution, retrospective study of all endoanchor procedures was performed from February 1, 2017 to March 30, 2021. All procedures were performed percutaneously by interventional radiologists. Clinical information and outcome data were retrieved from electronic medical records. Fifty patients (14% females, n = 7; 86% males, n = 43; median age, 79 years [range, 56–93 years]) underwent Endoanchor procedures, with 349 Endoanchors implanted; 33 procedures were primary deployments (at initial stent deployment) and 17 were secondary deployments (previous stent deployment). For the primary group (4 TEVARs and 29 EVARs), indications were prophylactic (n = 30), hostile neck (n = 28), hostile distal landing zone (n = 2), and intraprocedural type 1a endoleaks (n = 3). For the secondary group (4 TEVARs and 13 EVARs), indications were graft migration (n = 8), seal zone expansion without proven endoleak (n = 7) (proximal [n = 4] or distal seal [n = 3]), and proven type 1a endoleak (n = 2). ResultsMedian number of endoanchors deployed per procedure was 7 (range, 3–10). Median time to deploy endoanchors was 22 minutes (range, 8–46 minutes). The technical success rate of Endoanchor was 99.7% (348/349). The 30-day mortality rate was 0%. The overall adverse event rate was 6% (n = 3). Reinterventions were performed in 12% of patients (n = 6). Median follow-up was 38 months (range, 2–71 months). Overall survival at 1 and 3 years was 95% and 85%, respectively. Overall freedom from type 1a endoleak at 1 and 3 years was 96% and 93%, respectively. ConclusionsEndoanchor procedures are safe with excellent technical success rate and good midterm clinical outcomes.

A New Potential Complication in 2-Level Anterior Cervical Discectomy and Fusion with Zero-Profile Devices: Collapse of the Middle Cervical Vertebra

The objective of this study was to describe a new potential complication, collapse in the middle cervical vertebra of consecutive 2-level anterior cervical discectomy and fusion (ACDF), and discuss its possible mechanism. Clinical and radiologic outcome data from 27 consecutive 2-level ACDF patients using zero-profile devices were collected at 1, 3, 6, and 12months postoperatively, as well as the last follow-up. Dysphagia was assessed using the Bazaz score, and clinical outcomes were analyzed using the neck disability index and Japanese Orthopaedic Association score. Radiographic evaluation included measurements of the overall and surgical segment curvature, identification of collapse, and assessment of the ratio of anterior height and wedge of the upper, middle, and lower vertebrae in the surgical segment. The application of zero-profile devices to treat consecutive 2-level cervical spondylosis mostly resulted in good midterm clinical outcomes. Surprisingly, as evidenced by the significantly decreased anterior height and wedge ratio of the middle cervical vertebra, collapse was noted immediately in the middle vertebra in 4 patients at 1month (n=3) and 3months (n=1). The collapse increased for no more than 6months, and there was no deterioration of clinical and radiological outcomes at the last follow-up. Collapse in the middle cervical vertebra of consecutive 2-level ACDF with the application of zero-profile devices can occur in the early postoperative period, which may be due to axial stress concentration and blood supply damage in the middle cervical vertebral body.

Transcatheter Valve-in-Valve Procedures for Bioprosthetic Valve Dysfunction in Patients With Rheumatic vs. Non-Rheumatic Valvular Heart Disease.

Background: Bioprosthetic heart valve has limited durability and lower long-term performance especially in rheumatic heart disease (RHD) patients that are often subject to multiple redo operations. Minimally invasive procedures, such as transcatheter valve-in-valve (ViV) implantation, may offer an attractive alternative, although data is lacking. The aim of this study was to evaluate the baseline characteristics and clinical outcomes in rheumatic vs. non-rheumatic patients undergoing ViV procedures for severe bioprosthetic valve dysfunction.Methods: Single center, prospective study, including consecutive patients undergoing transcatheter ViV implantation in aortic, mitral and tricuspid position, from May 2015 to September 2020. RHD was defined according to clinical history, previous echocardiographic and surgical findings.Results: Among 106 patients included, 69 had rheumatic etiology and 37 were non-rheumatic. Rheumatic patients had higher incidence of female sex (73.9 vs. 43.2%, respectively; p = 0.004), atrial fibrillation (82.6 vs. 45.9%, respectively; p < 0.001), and 2 or more prior surgeries (68.1 vs. 32.4%, respectively; p = 0.001). Although, device success was similar between groups (75.4 vs. 89.2% in rheumatic vs. non-rheumatic, respectively; p = 0.148), there was a trend toward higher 30-day mortality rates in the rheumatic patients (21.7 vs. 5.4%, respectively; p = 0.057). Still, at median follow-up of 20.7 [5.1–30.4] months, cumulative mortality was similar between both groups (p = 0.779).Conclusion: Transcatheter ViV implantation is an acceptable alternative to redo operations in the treatment of patients with RHD and severe bioprosthetic valve dysfunction. Despite similar device success rates, rheumatic patients present higher 30-day mortality rates with good mid-term clinical outcomes. Future studies with a larger number of patients and follow-up are still warranted, to firmly conclude on the role transcatheter ViV procedures in the RHD population.

Reverse total shoulder arthroplasty in massive rotator cuff tears: does the Hamada classification predict clinical outcomes?

IntroductionReverse total shoulder arthroplasty (RTSA) is a widely recognized treatment to reduce pain and improve shoulder function for patients in various disease stages of cuff tear arthropathy (CTA). However, it remains unclear whether outcomes after RTSA depend on the preoperative stage of CTA. Therefore, this study evaluated whether the Hamada classification influences midterm clinical outcomes after RTSA.Materials and methodsIn this multicenter observational study, patients underwent inverted bearing RTSA for massive rotator cuff tears or CTA. Shoulders were grouped into those with (Hamada grades 4a, 4b, and 5) and those without (Hamada grades 1, 2, and 3) glenohumeral arthritis. Clinical outcomes, including range of motion, Constant score, American Shoulder and Elbow Surgeons score, and visual analog scale for pain and satisfaction, were determined preoperatively and at 24 and > 30 months. All complications were recorded, and survival free from any implant component revision was calculated.ResultsOverall, 202 patients (211 shoulders) were treated with RTSA at a mean age of 75.8 ± 6.6 years (range 41.9–91.6 years). Of these, 144 patients (151 shoulders) were available for a mean follow-up of 79.9 ± 24.7 months (range 30.2–132.3 months). No significant between-group differences were found for clinical outcomes at 24 and > 30 months (P > 0.05). Furthermore, the Hamada classification did not correlate with clinical outcomes at 24 (P = 0.98) and > 30 months (P = 0.29). Revision-free implant component survival was similar between groups (P = 0.17). Postoperative complications were found in 11 shoulders, of which 10 required revision.ConclusionsInverted bearing RTSA was found to be an effective treatment with similarly good midterm clinical outcomes, similar revision rates, and high implant survival rates in every stage of massive rotator cuff tears. Overall, the preoperative Hamada classification did not influence clinical outcomes or complications after RTSA.

Revision of Total Knee Arthroplasties Performed in Young, Active Patients with Posttraumatic Arthritis and Osteoarthritis.

Rates of total knee arthroplasty (TKA) in younger patients are rising significantly. A recent study performed at our institute illustrated the excellent survivorship of TKAs in patients younger than 55 years at a mean follow-up period of 25 years. This study reports on the 25 knees in this series that required revision surgery. Twenty-five revisions were performed in 24 patients. Indication for revision, clinical outcomes, and radiographs were reviewed at their most recent follow-up. Revisions were performed in 5 cases of infection, 2 cases of fracture/trauma, 17 cases of wear/loosening, and 1 case of instability. The average duration from primary TKA to revision surgery for the 25 knees was 12.5 years (range, 2-26 years). Follow-up was obtained in 24 of 25 TKAs. Nine of the 24 patients (10 knees) had died at the time of follow-up. The average duration from revision surgery to follow-up examination for the remaining knees was 10.5 years. Using the Knee Society scoring system, the average knee score was 89.0 points and the average functional score was 75.6 points. The mean Tegner activity score was 4.6 which exceeded the mean score for unrevised TKAs (2.9). The average range of motion was 119 degrees. None of the knee radiographs showed evidence of component loosening. Young patients who undergo TKA that require revision surgery had good mid-term clinical outcomes. This information is important in completing the clinical picture and outcomes associated with young patients undergoing TKA.

Clinical Outcomes and Radiologic Changes After Microsurgical Bilateral Decompression by a Unilateral Approach in Patients With Lumbar Spinal Stenosis and Grade I Degenerative Spondylolisthesis With a Minimum 3-Year Follow-Up

A retrospective study. To analyze the clinical outcomes and radiologic changes after microsurgical bilateral decompression via a unilateral approach in patients with lumbar spinal stenosis (LSS) and degenerative spondylolisthesis (DS). Satisfactory short-term results have been observed after minimally invasive decompressive procedures, but intermediate-term and long-term outcomes have not been assessed. It is not yet clear whether decompressive laminectomy with concomitant fusion is the optimal surgical treatment for spinal stenosis combined with mild DS. We, therefore, evaluated minimum 3-year clinical outcomes and radiologic changes in patients with LSS and grade 1 DS, who underwent microsurgical bilateral decompression via a unilateral approach, without fusion. We assessed 21 consecutive patients who underwent surgery conducted by a single surgeon of our hospital, between 2005 and 2007. The Oswestry Disability Index was determined preoperatively, just before discharge, and at last follow-up. Plain dynamic x-rays were used to determine slip percentages. Average patient age and clinical and radiologic follow-up periods were 67 years, 49.3 months, and 18 months, respectively. Preoperative, immediate postoperative, and last follow-up average Oswestry Disability Indices were 59.52±9.00, 50.19±7.23, and 26.19±12.42, respectively. However, 1 patient experienced aggravated symptoms and later underwent a fusion procedure. Of the 22 levels with spondylolisthesis, 15 had no sagittal motion as the difference in slip percentage on dynamic x-rays, but 7 showed sagittal motion. Average slip percentages increased from 13.90±5.41% to 14.60±5.78% for levels without sagittal motion on dynamic x-ray, and from 13.12±3.48% to 18.58±4.55% for levels with sagittal motion. Despite small case series with retrospective design and the absence of a control group, our study suggests that bilateral decompression via a unilateral approach in patients with LSS and grade 1 DS showed good mid-term clinical outcomes, despite an increase in slip percentage.However, more marked increases in slippage were observed in patients with sagittal motion in spondylolisthesis levels on preoperative dynamic x-ray, than in patients without sagittal motion. Therefore, bilateral decompression via a unilateral approach can aggravate symptoms related to instability in patients with preoperative sagittal motion on dynamic x-ray, and needs a longer term follow-up than in our study.

Impact of the Repositionable C3 Excluder System on the Endovascular Treatment of Abdominal Aortic Aneurysms With Unfavorable Neck Anatomy

Purpose: To analyze the midterm clinical outcomes among patients with favorable and unfavorable neck morphology for endovascular aneurysm repair (EVAR), specifically the impact of the repositionable C3 Excluder stent-graft on type I endoleak in patients with unfavorable neck. Methods: A retrospective review was conducted of 249 patients (mean age 74.3 years; 241 men) who underwent successful EVAR from January 2000 to December 2014 using either the traditional Excluder (n=140) or the C3 repositionable system (n=109). Unfavorable proximal aortic neck anatomy was defined by length <15 mm, angulation >60°, >50% circumferential thrombus, or >50% neck calcification. By these criteria, unfavorable neck anatomy was present in 71 (28.5%) patients (41 traditional Excluder and 30 C3 Excluder). The main endpoint was the incidence of type Ia endoleak and the need for a proximal cuff according to the type of neck anatomy. Comparisons between groups are reported as the odds ratio (OR) and 95% confidence interval (CI). Results: A proximal extension cuff for type Ia endoleak was needed in 4 (2.2%) patients with favorable neck anatomy compared to 7 (9.9%) patients with unfavorable neck (OR 4.76, 95% CI 1.3 to 16.8, p=0.014). Among the patients with unfavorable neck, a proximal cuff was implanted in 6/41 (14.6%) traditional Excluder stent-grafts vs 1/30 (3.3%) in the C3 Excluder group (OR 4.39, 95% CI 0.55 to 34.58, p=0.23). Median follow-up was 30.5 and 38 months for favorable vs unfavorable neck groups, respectively (p=0.29). Only 1 case of type Ia endoleak was registered at 6.5 years’ follow-up (traditional Excluder), with no device migration. Conclusion: Both Excluder stent-grafts provide good midterm clinical outcomes after EVAR in patients with unfavorable neck anatomy. Investigation of a larger cohort will be needed to identify if the C3 Excluder device offers any improvement over the traditional Excluder in terms of freedom from endoleaks.

Subpedicle Decompression and Vertebral Reconstruction for Thoracolumbar Magerl Incomplete Burst Fractures via a Minimally Invasive Method

Retrospective. To evaluate the clinical and radiographical results. The evolution of posterior approach for burst fractures was from long-segment to short-segment and then to monosegmental fixation. Decompression of the spinal cord is performed by anterior or posterior approaches. The technique attempts to decompress the spinal cord by a paramedian subpedicle approach, and simultaneous vertebral reconstruction with pile-up titanium spacers (subpedicle decompression and body augmentation [SpBA]) was developed. Eighty patients with symptomatic single thoracolumbar Magerl incomplete burst fractures were included. After manual reduction, transpedicle body augmentation and shortsegment fixation (TpBA group) were performed in 38 patients and SpBA in 42 cases. The mean follow-up was 52.6 ± 18.7 (TpBA) and 42.1 ± 7.8 (SpBA) months, and the age was 57.9 ± 7.2 and 59.1 ± 8.3 years. Clinical and radiographical outcomes were analyzed. The operation time was 66 ± 11 (TpBA) versus 34.5 ± 5.5 (SpBA) minutes. The initial anterior vertebral correction was 46.8 ± 12.2% (TpBA) versus 53.2 ± 15.0% (SpBA) (P = 0.03) and the final correction was 44.0 ± 10.8% versus 51.5 ± 15.3% (P = 0.01). Initial corrections of the lateral Cobb angle were 22.3° ± 2.6° versus 22.8° ± 2.7° and the final corrections were 19.1° ± 3.4° versus 20.5° ± 2.9°. The VAS score was 7.7 ± 1.2 versus 7.9 ± 1.2 preoperatively and 2.2 ± 0.7 versus 1.8 ± 0.6 (P = 0.02) at the final visit. Seventy-five patients maintained or recovered to Frankel grade E. Three patients in the TpBA group and 2 in the SpBA group improved from grade C to D. Technical complications included 1 root overstretch in the SpBA group and one incomplete decompression in the TpBA group. SpBA is a safe and fast technique to treat Magerl incomplete burst fractures and leads to good clinical results. N/A.

Unprotected Left Main Stenting in the Real World

Cardiac surgery is the reference treatment for patients with left main (LM) disease, although percutaneous coronary intervention with drug-eluting stents is emerging as a possible alternative. The objective of this registry was to evaluate the 2-year outcome of elective percutaneous coronary intervention for unprotected LM disease with paclitaxel-eluting stents. A total of 291 patients were prospectively included from 4 centers. Acute myocardial infarction and cardiogenic shock were the only exclusion criteria. Patients were 69+/-11 years old, 29% were diabetic, and 25% had 3-vessel disease. For distal LM lesions (78%), the provisional side-branch T-stenting approach was used in 92% of cases and final kissing balloon inflation in 97%. Angiographic success was obtained in 99.7% of cases. At 2-year follow-up, the total cardiac death rate was 5.4% (1 EuroSCORE point was associated with a 15% [95% confidence interval 2.9% to 28.2%, P=0.013] higher risk of cardiac death), target-lesion revascularization was 8.7%, and incidence of Q-wave or non-Q-wave myocardial infarction was 0.9% and 3.1%, respectively. The combined end point occurred in 15.8% of cases and stroke in 0.7%. The incidence of definite and probable LM stent thrombosis was 0.7%, whereas the incidence of any stent thrombosis was 3.8%, with a higher risk in patients with side-branch stenting in the presence of LM bifurcation lesions (hazard ratio 9.6, 95% confidence interval 1.2 to 77.7, P=0.035). Unprotected LM stenting with paclitaxel-eluting stents, with a strategy of provisional side-branch T-stenting for distal lesions, provides excellent acute angiographic results and good mid-term clinical outcomes, with a 15.8% rate of major adverse cardiac events at 2-year follow-up.

Clinical outcomes of dexamethasone‐eluting stent implantation in ST‐elevation acute myocardial infarction

The aim of our study was to evaluate the safety and midterm clinical results of dexamethasone-eluting stent (DexES) implantation in ST-segment elevation acute myocardial infarction (STEMI). Inflammation plays a pivotal role in both inestabilization of coronary atherosclerotic plaques and development of restenosis after stent placement. Antiinflammatory agents may attenuate those mechanisms and improve clinical outcomes. There is little information about clinical results of DexES and no data are available about their utilization during percutaneous coronary intervention (PCI) in STEMI. Consecutive patients with STEMI that underwent primary or rescue PCI in our institution were treated with DexES. Clinical follow-up with routine realization of noninvasive test for detection of myocardial ischemia and coronariography if necessary, were performed. The objective of the study was to evaluate the rate of MACE (death, reinfarction, or target lesion revascularization) during midterm follow-up. The procedure was successful in 96.7% of cases. There were no in-hospital deaths or reinfarctions. One acute stent thrombosis occurred and no subacute thrombosis were observed. During a mean follow-up period of 384 days, cardiac-related death was 1.1%, there were no reinfarctions or late stent thrombosis and target lesion revascularization rate was 4.2%. We conclude that utilization of DexES for PCI in STEMI is safe and provides good midterm clinical outcomes.

Sirolimus-eluting stents versus paclitaxel-eluting stents for saphenous vein graft intervention

We sought to determine the safety and efficacy of using multiple overlapping drug-eluting stents (DES) in patients with diffuse left anterior descending coronary artery (LAD) disease.Diffuse LAD disease represents a therapeutic challenge. Results after coronary artery bypass surgery are suboptimal, whereas the use of bare metal stents is limited by high rates of restenosis. The introduction of DES prompted treatment of long diffuse disease with multiple overlapping stents.All consecutive patients with de novo diffuse LAD disease treated with more than 60-mm long DES from April 2002 to March 2004 were analyzed.The study population consisted of 66 patients. Thirty-nine patients were treated with sirolimus-eluting stents (SES), average length 84 ± 22 mm, and 27 patients with paclitaxel-eluting stents (PES), average length 74 ± 14 mm. The number of stents implanted per patient was 2.8 ± 0.7, whereas the mean total stent length for the LAD treatment was 80 ± 20 mm. Angiographic as well as procedural success was achieved in 95% of cases. Eleven (16.6%) patients had in-hospital non-Q-wave myocardial infarction (five SES and six PES), and one patient developed intraprocedural stent thrombosis. All patients had clinical follow-up, and 52 patients (79%) had an angiographic follow-up at six months. Hierarchical major adverse cardiac event rate was 15% (7.5% for SES and 7.5% for PES). No patients died, one patient had non-Q-wave myocardial infarction (non-index vessel), and 10 patients (15%) underwent target vessel revascularization.The implantation of multiple overlapping DES in patients with a diffusely diseased LAD is relatively safe and associated with good midterm clinical outcomes.

Multiple Overlapping Drug-Eluting Stents to Treat Diffuse Disease of the Left Anterior Descending Coronary Artery

We sought to determine the safety and efficacy of using multiple overlapping drug-eluting stents (DES) in patients with diffuse left anterior descending coronary artery (LAD) disease. Diffuse LAD disease represents a therapeutic challenge. Results after coronary artery bypass surgery are suboptimal, whereas the use of bare metal stents is limited by high rates of restenosis. The introduction of DES prompted treatment of long diffuse disease with multiple overlapping stents. All consecutive patients with de novo diffuse LAD disease treated with more than 60-mm long DES from April 2002 to March 2004 were analyzed. The study population consisted of 66 patients. Thirty-nine patients were treated with sirolimus-eluting stents (SES), average length 84 +/- 22 mm, and 27 patients with paclitaxel-eluting stents (PES), average length 74 +/- 14 mm. The number of stents implanted per patient was 2.8 +/- 0.7, whereas the mean total stent length for the LAD treatment was 80 +/- 20 mm. Angiographic as well as procedural success was achieved in 95% of cases. Eleven (16.6%) patients had in-hospital non-Q-wave myocardial infarction (five SES and six PES), and one patient developed intraprocedural stent thrombosis. All patients had clinical follow-up, and 52 patients (79%) had an angiographic follow-up at six months. Hierarchical major adverse cardiac event rate was 15% (7.5% for SES and 7.5% for PES). No patients died, one patient had non-Q-wave myocardial infarction (non-index vessel), and 10 patients (15%) underwent target vessel revascularization. The implantation of multiple overlapping DES in patients with a diffusely diseased LAD is relatively safe and associated with good midterm clinical outcomes.