Elective coronary stenting after recanalization for chronic total occlusion: clinical and angiographic follow-up results.

ABSTRACT

Percutaneous transluminal coronary angioplasty (PTCA) for chronic totally occluded coronary arteries is associated with a significant residual stenosis and a high incidence of restenosis. Between March 1995 to February 1997, recanalization of chronic total occlusion (CTO) was attempted in 95 patients, of whom 79 (83.1%) were dilated successfully using balloon angioplasty, rotablation or both. Forty two patients underwent elective stent implantation to evaluate the influence of stenting on immediate results and clinical as well as angiographic outcome on long-term follow-up. There were 39 males and 3 females, with a mean age of 51 +/- 8 years. The majority (69.1%) had multivessel disease. The target vessel was LAD in 25 (58.1%), RCA in 12 (27.9%), LCx-OM in 5 (11.6%) and ramus in 1 (2.3%). After recanalization and adequate predilatation, various types of stents were deployed successfully at the target site in all patients, using high pressure intrastent balloon dilatation. The luminal diameter stenosis reduced to 47 +/- 15 percent after balloon angioplasty and < 10 percent in all, after stent implantation. There were no in-hospital major complications, including subacute stent thrombosis, myocardial infarction, need for emergency bypass graft surgery or death. The follow-up data is available in 36 patients, ranging from 1-22 months (mean 7.4 +/- 4.7; median 6). Of these, 32 (88.8%) were free of angina at their last visit, 3 (8.3%) required target lesion revascularization and 2 patients died, one at 3 weeks and the other at 6 months after the procedure. The event-free survival, estimated by the Kaplan-Meier survival curve was 97.3, 82.8 and 77.25 percent at one, 6, and 12 months, respectively after stenting. Out of 29 eligible patients, 20 underwent repeat coronary angiography after 6 months, which revealed restenosis in 5 (25%). In conclusion, our study shows that elective coronary stenting following successful recanalization of chronic total occlusion produces an excellent immediate result and reduces the recurrence of angina, target lesion revascularization and angiographic restenosis on long-term follow-up.