Immediate and follow-up results after long stent implantaton in diffuse long coronary lesions / 대한내과학회지

BACKGROUND: The results and restenosis after long stent implantation for diffuse long coronary lesion has not been fully evaluated. We evaluated immediate and follow-up results of single long coronary stenting for long coronary disease. METHODS: This study report on the use of follow-up examination is possible 48 patients with 50 lesions after stenting in total 70 patients with 72 lesions with long lesion. Diffuse long coronary lesion was defined as a lesion length longer than 20mm. Mean follow-up duration was 8.7+/-2.9 months and mean patients age was 58+/-10 years. Total patients was infused 8000-10000IU heparin and added bolus 3000-5000IU heparin for activating clotting time(ACT) was over 250 seconds during procedure. Restenosis was defined over 50% diameter stenosis in 6 months follow-up angiographic study. RESULTS: Angiographic success was achieved 68/70 patients(97.1%) in this study. Mean reference diameter was 3.14+/-0.1mm and baseline, final, follow-up minimal luminal diameter(MLD) was 0.6+/-0.4mm, 3.0+/-0.4mm, 1.6+/-0.3mm on each occasion and each % diameter stenosis(% DS) was 78.7+/-0.4%, 4.9+/-0.4%, 47.4%+/-0.5% present. The overall significantly increased in diabetics patients(7/21 vs 3/29 p=0.04) and in long lesion length patients(33.9+/-4mm vs 30.4+/-0.4mm p=0.02) but, clinical diagnosis and indication of stenting, lesional location, stent length, stent size, reference diameter size were not associated with restenosis rate. CONCLUSION: Single long stent implantation for diffuse long coronary lesion shown excellent success rate but high restenosis rate present. The restenosis rate was significantly associated with diabetics and lesion length Some further study for improving restenosis rate is needed.

Early Outcome of Long Coronary Stent Implantation

BACKGROUND: Percutaneous transluminal coronary angioplasty(PTCA) for long coronary lesion is known to be associated with low success rate,suboptimal outcome,high complication and restenosis rates. Here we report the early clinical and angiographic results of long coronary stent implantations for long coronary lesions. METHOD: We analyzed the clinical,angiographic features and early results after stent implantations in 46 patients who were implanted long coronary stent(> or =20mm in length)among 174 stented patients at Chonnam University Hospital from Jan.through Nov.1996. RESULT: 1) Age was 59+/-7(35-78) years,and sex ratio was 2.5:1(33 male:13 female). clinical diagnosis was as follows; 24 patients with unstable angina, 21 with acute myocardial infarction, 1 with stable angina and 6 with old myocardial infarction. Left ventricular ejection fraction by left venriculogram was 58+/-10(27-87)%. 2) Involved numbers of vessel were single in 27 patients, two in 14 patients, and three in 5 patients. Target stented coronary arteries were 28 left anterior descending arteries, 17 rigtt coronory arteries, and 1 left circumflex artery. Morphologic types of target lesions were type C in 26 patients, type B2 in 20, and diameter stenosis(DS) was 76+/-13%, minimal luminal diameter(MLD) 1.0+/-0.3mm, length 21+/-6(10-38)mm. Indications for stent were 28 denovo lesions, 10 restenoses, 5 suboptimal PTCAs and 3 bailout procedures. Twenty six Microstents 2, 15 Wallstents, 4 Freedom stents, and 1 Wictor stent were used. Stent diameter was 3.2+/-0.3(2.5-5.0)mm and length 30+/-3(20-49)mm, stent diameter/reference diameter(RD) ratio 1.0+/-0.1, and stent minus lesion length 9.0+/-3.7mm. 3) Stents were deployed successfully in all 46 patients. No procedure-related death, myocardial infarction, emergency bypass surgery, and laboratory evidences of acute or subacute stent thrombosis were observed. 4) DS was decreased to 3.5+/-7.5%, MLD was increased to 3.2+/-0.3mm(p<0.0001, respectively). Acute gain was 2.2+/-0.4mm(71.8+/-15.6%,p<0.0001). CONCLUSION: We observed high success rate without major complications in long stent implantations for long coronary arterial lesions. Long-term follow-up should be required to prove long coronary stent as a better treatment modality to reduce acute complications and late restenosis.