ABSTRACT
Balloon angioplasty of long coronary stenoses has been reported to be associated with a lower rate of acute clinical and procedural success and a higher rate of restenosis compared to short lesions. Intracoronary stenting has been shown to reduce restenosis, however, instent restenosis remains a major clinical problem despite improved stent flexibility and wall coverage and operator experience. The purpose of this study was to identify clinical, angiographic, and procedural predictors of restenosis after coronary stent placement in lesions longer than 15 millimeter. We analyzed the 6 month angiographic outcome of 378 patients [420 lesions]. All patients with successful coronary stent deployment and 6 month follow up were eligible for this study. Quantitative coronary coronary angiography [QCA] and intravascular ultrasound [IVUS] analyses were obtained immediately after stent deployment, and QCA at 6 months follow up. Restenosis was observed in 33.3% of lesions. By univariate analysis, stent length, number of stents per patient and per lesion, final IVUS lumen cross sectional area [CSA], and patients with multivessel disease were identified as the potential predictors of restenosis. Multivariate analysis identified final lumen CSA [OR= 0.85;95% CI=0.74-0.98, p=0.031] and stent length [OR=1.04;95% CI= 1.02-106, p=0.0001] as the only independent predictors of restenosis. Coronary stenting is associated with acceptable restenosis rate in this highly vulnerable cohort of lesions. Achieving an optimal final stent lumen CSA, and minimizing stent length as possible may help to reduce incidence of restenosis in this high risk group of lesions