Stents In Small Coronary Arteries Research Articles

First-generation paclitaxel- vs. second-generation zotarolimus-eluting stents in small coronary arteries: the BASKET-SMALL Pilot Study.

IntroductionEvent rates after percutaneous coronary interventions (PCI) are higher in small than large coronary vessels but may vary between different drug-eluting stent (DES) types.AimTo assess the efficacy of two different DES in small vessel disease.Material and methodsPatients with small vessel PCI were randomised 1 : 1 to a first-generation paclitaxel- vs. a second-generation zotarolimus-eluting stent. The primary endpoint was a composite of cardiac death, non-fatal myocardial infarction, and target vessel revascularisation after 2 years.ResultsOverall, 191 patients were enrolled: 100 with a paclitaxel- and 91 with a zotarolimus-eluting stent. Baseline characteristics were similar in both groups. After 2 years, rates of the primary endpoint were numerically higher for zotarolimus- than paclitaxel-eluting stents (9.9% vs. 5.0%, hazard ratio 2.09, 95% confidence interval (CI) 0.7–6.2, p = 0.19), which was mainly driven by higher rates of target vessel revascularisation (6.6% vs. 2.0%, hazard ratio 3.39, 95% CI: 0.68–16.78, p = 0.14). Based on this, a total of 1,019 patients would be necessary to demonstrate at least non-inferiority between the DES used.ConclusionsIn this pilot study, paclitaxel-eluting stents had a favourable efficacy profile in small vessel disease, although the numbers were too small to draw final conclusions. Based on the prohibitively high sample size for a randomized controlled trial between DES, other treatment options should be considered.

The EXTREME registry: Titanium-nitride-oxide coated stents in small coronary arteries

We sought to explore the immediate results of Titan2 stent implantation in small coronary arteries, as well as the incidence of major adverse cardiac events (MACE) at six months follow-up. The safety of Titan2 stent has been confirmed in several studies in real-life unselected populations. We enrolled 311 consecutive patients admitted for percutaneous intervention for at least one significant (50%) de novo lesion in a native small coronary artery (2.0-2.75 mm). All lesions were treated with Titan2 stent implantation. Patients were prospectively followed up for at least six months. The primary endpoint was MACE at six months follow-up [death, myocardial infarction (MI), or target vessel revascularization (TVR)]. Secondary endpoints included angiographic and clinical procedural success, in-hospital MACE, target lesion revascularization (TLR) during follow-up, and stent thrombosis. The mean age was 67.3 +/- 10.9 years (65.9% males). A total of 356 Titan2 stents were implanted in 353 lesions. Angiographic and clinical procedural success was achieved in 344 (97.5%) patients. No case of in-hospital MACE or acute stent thrombosis was reported. Clinical follow-up was completed for an average of 8 +/- 2 months. Two patients (0.7%) died, and 6 (2.1%) developed MI. TLR was performed in 12 (4.2%) and TVR in 16 (5.5%) patients, all were clinically driven. Cumulative MACE occurred in 20 (6.9%) patients. One patient suffered subacute stent thrombosis, but no late stent thrombosis. Titan2 stent implantation in small coronary arteries achieves excellent immediate outcome, with a low incidence of MACE at mid-term follow-up.

Clinical and angiographic comparison of everolimus-eluting and paclitaxel-eluting stents in small coronary arteries: A post hoc analysis of the SPIRIT III randomized trial

Drug-eluting stents with low late loss may be particularly beneficial in small coronary arteries. We therefore examined whether the everolimus-eluting stent is superior to the paclitaxel-eluting stent in patients treated with 2.5-mm stents in the SPIRIT III trial. The SPIRIT III trial was a prospective, multicenter, randomized (2:1; XIENCE V: TAXUS Express) trial in which 1002 patients were enrolled. One or more 2.5-mm stents were implanted in 160 patients in the XIENCE V arm, and 59 patients, in the TAXUS arm. Mean vessel diameter was 2.36 +/- 0.30 and 2.34 +/- 0.33 mm in the XIENCE V and TAXUS groups, respectively (P = .69). At 9 months, XIENCE V compared to TAXUS reduced the rates of major adverse cardiac events (cardiac death, myocardial infarction, or ischemic target lesion revascularization) from 12.5% to 3.2% (P = .02) and target vessel failure (cardiac death, reinfarction, or ischemic target vessel revascularization) from 16.1% to 5.2% (P = .02), the differences being driven primarily by reductions in target lesion revascularization (12.5% vs 1.3%; P = .002). In-stent late loss was significantly reduced by XIENCE V when compared to TAXUS (0.54 +/- 0.74 vs 0.11 +/- 0.43 mm, P = .01), as was In-segment binary angiographic restenosis (20.8% vs 4.1%, P = .02). In this post hoc analysis from the SPIRIT III trial, the XIENCE V 2.5-mm stent significantly reduced clinical and angiographic restenosis compared to the TAXUS 2.5-mm stent, further supporting the hypothesis that lower late loss is beneficial in small vessel disease.

The Efficacy of Drug Eluting Stents on Restenosis Reduction in Small Coronary Arteries

Background and Objectives:The previous studies have demonstrated the superiority of implanting drug eluting stent (DES) for restenosis reduction compared with the implantation of uncoated stents in small coronary arteries. However, the arteries in those studies tended to have short lesions. So, we evaluated the efficacy of a drug eluting stent in small coronary lesions with a relatively long length. Subjects and Methods: From July 2003 to March 2005, DESs (Cypher or Taxus) were implanted into 100 consecutive patients with 116 lesions that were less than 2.75 mm in diameter. All patients received aspirin indefinitely and clopidogrel for 6 months. The primary end point was 6 month angiographic in-segment restenosis, and the secondary end points were procedural success and any major adverse cardiac events (MACE: death, non fatal myocardial infarction and target lesion revascularization) at 9 months. Results:The mean age of the patients was 63 years, 53% were male, 24% were diabetics, 34% were current smokers and 55% had hypertension. A total of 121 DESs were implanted into 116 lesions (mean number of DESs/lesion: 1.1/lesion). The mean proximal and distal reference diameters were 2.21±0.39 and 2.01±0.40 mm, respectively. The mean lesion length was 19.14±7.89 mm. The mean preand postminimal lumen diameters were 0.73±0.42 mm and 2.26±0.41 mm, respectively. The mean size and length of the stents were 2.65±0.13 mm and 28.46±10.04 mm, respectively. The procedural success rate was 98.3%. The angiographic follow-up rate was 78.4%. The binary in-segment restenosis rate was 15.4% (14 lesions). The MACE at 9 months was 8.0%. Conclusion:DES implantation in small coronary lesions with a relatively long length demonstrated favorable results. However, a larger scale study is needed to clarify the efficacy of the DES in small coronary arteries. (Korean Circulation J 2006;36:450-457)

Coronary stenting in small vessels

One year ago, we published a meta-analysis demonstrating that coronary stenting is superior to balloon angioplasty with provisional stenting in small coronary arteries.1 We already responded clearly2 to the three criticisms raised by Agostoni et al. 3 in a letter to the editor. According to Agostoni et al. ,2 one limitation of our meta-analysis is that the primary endpoint was angiographic restenosis.3 We are very surprised about this comment, because angiographic restenosis was the primary endpoint of all the studies included …

Coronary stenting versus balloon angioplasty in small vessels: A meta-analysis from 11 randomized studies

ObjectivesA meta-analysis of 11 randomized trials was done to compare stenting versus balloon angioplasty (BA) in small coronary vessels. BackgroundRandomized studies on coronary stenting (CS) in small vessels have yielded controversial results. MethodsEleven randomized trials on CS versus BA in small vessels, including angiographic re-evaluation at six months, were analyzed. ResultsThe BeStent (Medtronic Instent, Minneapolis, Minnesota) was used in four studies, the Multi-Link (Guidant, Advanced Cardiovascular Systems Inc., Santa Clara, California) in three trials, and the NIR (Boston Scientific Corp., Boston, Massachusetts), JoStent (Jomed International AB, Helsingborg, Sweden), Tenax (Biotronik, Berlin, Germany), and BioDivysio (Abbott Vascular Devices, Redwood City, California) in the remaining four trials. Overall, 3,541 patients were included (1,672 allocated to BA and 1,869 to stent). The rate of cross-over from balloon to stent in the pooled population was 19%, and unsuccessful stent deployment occurred in 2% of the patients allocated to stent. The pooled rates of restenosis were 25.8% and 34.2% in patients allocated to stent and balloon, respectively (p = 0.003) (risk ratio [RR] 0.77; 95% confidence interval [CI] 0.65 to 0.92). A smaller reference vessel diameter at baseline was associated with a higher risk reduction in the restenosis rate (y = −3.551 + 1.826 [x]; p = 0.012). Patients allocated to stent had lower rates of major adverse cardiac events (15.0% vs. 21.8%, p = 0.002; RR 0.70; 95% CI 0.57 to 0.87) and new target vessel revascularizations (12.5% vs. 17.0%, p = 0.004; RR 0.75, 95% CI 0.61 to 0.91). ConclusionsElective stenting is superior to provisional stenting in small coronary arteries. This benefit is more evident in smaller coronary arteries.

Predictors of restenosis after implantation of 2.5 mm stents in small coronary arteries.

The results of stent implantation for small coronary disease have been inconclusive. The purpose of the present study was to evaluate the factors in predicting the risk of angiographic restenosis after 2.5-mm stent implantation for small coronary arteries. The study group comprised 134 consecutive patients who had a reference small coronary artery with diameter from 1.8 mm to 2.5 mm on quantitative coronary angiography and who had been successfully treated by stent implantation with a 2.5-mm stent. Of the 134 patients, 55 had angiographic restenosis (41%). The rate of target lesion revascularization was 32%. Diabetes mellitus, acute coronary syndrome, lesion length, bifurcation lesion, lower left ventricular ejection fraction (LVEF), stent strut, stent/artery ratio, and stent length were identified as predictors of restenosis by univariate analysis. Subsequent multivariate analysis revealed that lower LVEF (odds ratio (OR) 3.37, p=0.01), bifurcation lesion (OR 2.47, p=0.04), thicker stent strut (OR 2.30, p=0.04), and longer stent length (OR 1.05, p=0.02) were significant predictors of restenosis. Two pre-interventional factors (reduced left ventricular function and bifurcated lesion) and 2 procedure-related factors (thickness of stent strut and total stent length) were identified as predictors of restenosis. These factors should be taken into account when deciding on the percutaneous coronary intervention strategy for small coronary artery disease.

Effectiveness of stents in small coronary arteries

This study was prospectively randomized to assess the efficacy and safety of Jo heparin-coated stent deployment in small vessels compared with balloon angioplasty. In 202 patients, restenosis in balloon and stent arms was 49% and 30%, respectively.

2555 The efficacy of a strategy based on optimal cutting balloon angioplasty with provisional stenting in small coronary arteries: a randomized comparison with primary stenting

2555 The efficacy of a strategy based on optimal cutting balloon angioplasty with provisional stenting in small coronary arteries: a randomized comparison with primary stenting

Clinical Benefit of Small Vessel Stenting: One-year Follow-up of the SISCA Trial

Objective : To assess the long-term clinical benefit of elective stenting as compared with percutaneous transluminal coronary angioplasty (PTCA) in small coronary arteries. Design : The Stenting in Small Coronary Arteries (SISCA) trial was a randomized trial comparing elective stenting with PTCA in coronary arteries with a reference diameter of 2.1-3.0 mm. The heparin-coated beStent was used. Control angiography was performed after 6 months, and the patients were followed clinically for 12 months. Results : At 6 months the clinical outcome was significantly better in the stent group as compared with the PTCA group, with an event-free survival in 90.5 and 76.1% ( p = 0.016), respectively. From 6 to 12 months, event-free survival was unchanged in both groups, demonstrating a sustained long-term clinical benefit of elective stenting. Conclusion : Angioplasty in small coronary arteries is associated with a favorable clinical outcome after 1 year. The clinical benefit of elective stenting using the Hepamed ® -coated beStent is maintained beyond 6 months, without any tendency towards late events. Thus, elective stenting should be considered as an option when treating small coronary arteries.

Stenting in small coronary arteries (SISCA) trial: A randomized comparison between balloon angioplasty and the heparin-coated beStent

OBJECTIVESThe purpose of this study was to assess the clinical and angiographic benefits of elective stenting in coronary arteries with a reference diameter of 2.1 to 3.0 mm, as compared with traditional percutaneous transluminal coronary angioplasty (PTCA).BACKGROUNDThe problems related to small-vessel stenting might be overcome using modern stents designed for small vessels, combined with effective antiplatelet therapy.METHODSIn five centers, 145 patients with stable or unstable angina were randomly assigned to elective stenting treatment with the heparin (Hepamed)-coated beStent or PTCA. Control angiography was performed after six months. The primary end point was the minimal lumen diameter (MLD) at follow-up. Secondary end points were the restenosis rate, event-free survival and angina status.RESULTSAt follow-up, there was a trend toward a larger MLD in the stent group (1.69 ± 0.52 mm vs. 1.57 ± 0.44 mm, p = 0.096). Event-free survival at follow-up was significantly higher in the stent group: 90.5% vs. 76.1% (p = 0.016). The restenosis rate was low in both groups (9.7% and 18.8% in the stent and PTCA groups, respectively; p = 0.15). Analyzed as treated, both the MLD and restenosis rate were significantly improved in patients who had stents as compared with PTCA.CONCLUSIONSIn small coronary arteries, both PTCA and elective stenting are associated with good clinical and angiographic outcomes after six months. Compared with PTCA, elective treatment with the heparin-coated beStent improves the clinical outcome; however, there was only a nonsignificant trend toward angiographic improvement.