Long-term clinical outcomes after coronary angioplasty using long stents in small coronary vessels.

The role of coronary stenting in challenging situations, such as small vessels and long lesions, remains controversial. The aim of this study was to examine the procedural, in-hospital, and long-term clinical outcomes of patients undergoing angioplasty with long stents in small coronary vessels. We evaluated the procedural success rate and clinical outcomes in 252 consecutive subjects treated by means of the implantation of a single coronary stent in vessels with a mean reference diameter of < 2.5 mm; 128 patients received a short stent (< or = 16 mm) and 124 a long stent (> or = 18 mm). Lesion morphology was more complex in patients treated with long stents (P < 0.05). The mean stent length was 14 +/- 2 mm in the short-stent group and 25 +/- 3 mm in the long-stent group (P < 0.001). The overall procedural success rate (98.4% vs. 97.6%; P = NS) and the rate of major in-hospital adverse events (death, acute myocardial infarction, or target vessel revascularization; 1.6% vs. 2.4%; P = NS) was similar in the two groups. After 11.7 +/- 7 months of follow-up, there was no difference in the incidence of mortality and myocardial infarction (5% vs. 6.6%; P = NS), but revascularization tended to occur more frequently in the patients treated with long stents (21.7% vs. 13.9%; P = NS). In conclusion, the procedural success rate of single short or long stents in small coronary vessels was similar. Although the incidence of target vessel revascularization tended to be higher in the patients treated with longer stents, 2-year event-free survival was equivalent in the two groups (65% vs. 70%; P = NS).

Patterns of in-stent restenosis after placement of NIR gold-coated stents in unselected patients.

The aim of this study was to assess the incidence and angiographic patterns of in-stent restenosis 6 months after the implantation of NIR gold-coated stents in an unselected patient population. One hundred and sixteen consecutive patients were treated with the implantation of 149 NIR gold-coated stents. The majority of the patients (52%) had unstable angina or acute myocardial infarction. The baseline lesion morphology was complex in 78% of cases; the mean lesion length was 18 +/- 5 mm. The procedural success rate was 97%. Subacute stent thrombosis occurred in three patients (2.6%). During the 6-month follow-up, there were 2 deaths and 22 subjects (19.5%) underwent target vessel revascularization. The 6-month event-free survival was 60%. The angiographic restenosis rate was 32%. In 83% of the cases, the morphology of the restenosis was proliferative; in the remaining 17%, it presented as total occlusion. In conclusion, the restenosis rate after NIR gold-coated stent implantation in high-risk patients is similar to that reported using other stent designs. However, restenosis was always diffuse, involving the overall stent length and extending beyond the margins, thus indicating a greater proliferative neointimal response to this device.