Stents (Bare-metal, Drug-eluting)
Spot Stenting Versus Complete Lesion Coverage in the Treatment of Diffuse Coronary Artery Stenosis
Jia Min Chua1, Patrick Zhan Yun Lim1, Syed Saqib Imran1, Michael Mao-Chen Liang1, Pinakin Vijaykumar Parekh1, Saket Subhash Junagade1
Khoo Teck Puat Hospital, Singapore1
Full stenting of diffuse coronary lesions results in complete coverage of coronary lesions but longer stent length. In turn, longer stent length is a risk factor for stent thrombosis and restenosis. Focal stenting, which selectively covers the most severely stenotic segment, reduces total stent length but may result in stent landing in an area with mild to moderate plaque burden. For long diffuse coronary lesions (>20mm), it has not been determined which is the recommended approach. We compare the one-year clinical outcomes of patients with focal versus full stenting in long coronary lesions using a second-generation DES.
We evaluated the one-year clinical outcomes of 301 diffuse coronary lesions (defined as>20mm), which were treated either by full stenting (n=107) or focal stenting(n=194). The primary end-point was target vessel failure (TVF) at 12 months, a composite of cardiac death, target vessel-related myocardial infarction, and target vessel revascularization (TVR).
Focal stenting resulted in a lower rate of TVF at 1 year compared to full stenting (1.0%vs 6.0%, p=0.02). 9 events of TVF were recorded in the study. 7 occurred in the full stenting group and 2 in the focal stenting group. 4 of these events were due to in-stent restenosis, all of which occurred in the full stenting group. The other 5 events were due to death from cardiovascular causes. The risk for 1-yearTVF was 85% lower in patients who were treated with focal stenting as compared to full stenting (HR 0.15, 95% CI 0.03-0.75, p=0.007).
The focal stenting group had fewer number of stents implanted (1.08 ± 0.2 vs 2.2 ±0.7) and shorter total stent length (35.5 ± 9.0mm vs 66.3 ± 20.0mm). This study did not identify any independent predictors of TVF including age, renal function, haemoglobin, total stent length or number of stents.
Focal stenting resulted in a lower rate of cardiac death, target vessel-related myocardial infarction, and target vessel revascularization at 1 year compared to full stenting.