Copyright © 2000 by the European Society of Cardiology.
Randomized comparison of coronary stenting with optimal balloon angioplasty for treatment of lesions in small coronary arteries
Department of Medicine, Asan Medical Center, University of Ulsan, Seoul, Korea
revised September 13, 1999; accepted September 28, 1999
Abstract
Aims Angioplasty of lesions in small coronary arteries remains a significant problem because of the increased risk of restenosis. The aim of this study was to compare the efficacy of elective coronary stent placement and optimal balloon angioplasty in small vessel disease.
Methods One hundred and twenty patients with lesions in small coronary arteries (de novo, non-ostial lesion and reference diameter <3mm) were randomly assigned to either balloon angioplasty or elective stent pacement (7-cell NIR stent). The primary end-point was restenosis at 6 months follow-up. Optimal balloon angioplasty was defined as diameter stenosis 
30% and the absence of major dissection after the angioplasty, and crossover to stenting was allowed.
Results Baseline clinical and angiographic characteristics were similar in the two groups. Procedure was successful in all patients, and in-hospital events did not occur in any patient. However, 12 patients in the angioplasty group were stented because of suboptimal results or major dissection. Postprocedural lumen diameter was significantly larger in the stent group than in the angioplasty group (2·44±0·36mm vs 2·14±0·36, P<0·05, respectively), but late loss was greater in the stent group (1·12±0·67mm vs 0·63±0·48, P<0·01, respectively). The angiographic restenosis rate was 30·9% in the angioplasty group, and 35·7% in the stent group (P=ns). Clinical follow-up was available in all patients (15·9±5·7 months) and clinical events during the follow-up were similar in both groups.
Conclusions These results suggest that optimal balloon angioplasty with provisional stenting may be a reasonable approach for treatment of lesions in small coronary arteries.
Key Words: Balloon angioplasty, stent, small coronary arteries.
f1 Correspondence: Seung-Jung Park, MD, PhD, Division of Cardiology, Asan Medical Centre, University of Ulsan, 388-1 Pungnap-dong, Songpa-gu, Seoul, 138-736, Korea.
References
- Holmes DR, Hirshfeld J, Faxon D. ACC expert consensus document in coronary artery stents: Document of the American College of Cardiology. J Am Coll Cardiol. 1998;32:1471–1482
[Free Full Text] - Akiyama T, Moussa I, Reimers B. Angiographic and clinical outcome following coronary stenting of small vesses: a comparison with coronary stenting of large vessels. J Am Coll Cardiol. 1998;32:1610–1618
[Abstract/Free Full Text] - Savage MP, Fischman DL, Rake R. Efficacy of coronary stenting versus balloon angioplasty in small coronary arteries. J Am Coll Cardiol. 1998;31:307–311
[Abstract/Free Full Text] - Elezi S, Kastrati A, Neumann FJ, Hadamitzky M, Dirschinger J, Schömig A. Vessel size and long-term outcome after coronary stent placement. Circulation. 1998;98:1875–1880
[Abstract/Free Full Text] - Koning R, Chan C, Eltchaninoff H. Primary stenting of de novo lesions in small coronary arteries: A prospective, pilot study. Cathet Cardiovasc Diagn. 1998;45:235–238[CrossRef][Web of Science][Medline]
- Nunes G, Pinto I, Mattos L. Coronary stent implantation in vessels smaller than 3mm is associated with high restenosis rate (Abstr). Eur Heart J. 1997;17:173
- Foley DP, Melkert R, Serruys PW. Influence of coronary vessel size on renarrowing process and late angiographic outcome after successful balloon angioplasty. Circulation. 1994;90:1239–1251
[Abstract/Free Full Text] - Rodriguez A, Ayala F, Bernardi V. Optimal coronary balloon angioplasty with provisional stenting versus primary stent (OCBAS). J Am Coll Cardiol. 1998;32:1351–1357
[Abstract/Free Full Text] - Holmes DR, Kip KE, Yeh W, Kelsey SF, Detre KM, Williams DO. J Am Coll Cardiol. 1998;32:590–595
[Abstract/Free Full Text] - Abizaid A, Laird JR, Wu H. Aggressive ultrsound-guided balloon PTCA with provisional stenting: a promising technique to treat patients with left anterior descending lesions (Abstr). Circulation. 1998;98:451
- Narins CR, Holmes DR, Topol EJ. A call for provisional stenting: the balloon is back. Circulation. 1998;97:1298–1305
[Free Full Text] - Huber MS, Mooney JF, Madison J, Mooney MR. Use of a morphologic classification to predict clinical outcome after dissection from coronary angioplasty. Am J Cardiol. 1991;68:467–471[CrossRef][Web of Science][Medline]
- Fischman DL, Leon MB, Baim DS. A randomized comparison of coronary stent placement and balloon angioplasty in the treatment of coronary artery disease. N Engl J Med. 1994;331:496–501
[Abstract/Free Full Text] - Serruys PW, de Jaegere P, Kiemeneij F. A comparison of balloon-expandable-stent implantation with balloon angioplasty in patients with coronary artery disease. N Engl J Med. 1994;331:489–495
[Abstract/Free Full Text] - Hoffmann R, Mintz GS, Pichard AD, Kent KM, Satler LF, Martin MB. Intimal hyperplasia thickness at follow-up is independent of stent size: a serial intravascular ultrasound study. Am J Cardiol. 1998;82:1168–1172[CrossRef][Web of Science][Medline]
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  M. Togni, S. Eber, J. Widmer, M. Billinger, P. Wenaweser, S. Cook, R. Vogel, C. Seiler, F. R. Eberli, W. Maier, et al. Impact of Vessel Size on Outcome After Implantation of Sirolimus-Eluting and Paclitaxel-Eluting Stents: A Subgroup Analysis of the SIRTAX Trial J. Am. Coll. Cardiol., September 18, 2007; 50(12): 1123 - 1131. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Colombo and A. Chieffo Drug-Eluting Stent Update 2007: Part III: Technique and Unapproved/Unsettled Indications (Left Main, Bifurcations, Chronic Total Occlusions, Small Vessels and Long Lesions, Saphenous Vein Grafts, Acute Myocardial Infarctions, and Multivessel Disease) Circulation, September 18, 2007; 116(12): 1424 - 1432. [Full Text] [PDF]
|
|
|
|
 |
|
 J. Mehilli, A. Dibra, A. Kastrati, J. Pache, J. Dirschinger, A. Schomig, and for the Intracoronary Drug-Eluting Stenting to Abr Randomized trial of paclitaxel- and sirolimus-eluting stents in small coronary vessels Eur. Heart J., February 1, 2006; 27(3): 260 - 266. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Mauri, E. J. Orav, and R. E. Kuntz Late Loss in Lumen Diameter and Binary Restenosis for Drug-Eluting Stent Comparison Circulation, June 28, 2005; 111(25): 3435 - 3442. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Agostoni, G. G.L. Biondi-Zoccai, G. L. Gasparini, M. Anselmi, G. Morando, M. Turri, A. Abbate, E. P. McFadden, C. Vassanelli, P. Zardini, et al. Is bare-metal stenting superior to balloon angioplasty for small vessel coronary artery disease? Evidence from a meta-analysis of randomized trials Eur. Heart J., May 1, 2005; 26(9): 881 - 889. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Moreno, C. Fernandez, F. Alfonso, R. Hernandez, M. J. Perez-Vizcayno, J. Escaned, M. Sabate, C. Banuelos, D. J. Angiolillo, L. Azcona, et al. Coronary stenting versus balloon angioplasty in small vessels: A meta-analysis from 11 randomized studies J. Am. Coll. Cardiol., June 2, 2004; 43(11): 1964 - 1972. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. J Nordmann, P. Hengstler, B. M Leimenstoll, T. Harr, J. Young, and H. C Bucher Clinical outcomes of stents versus balloon angioplasty in non-acute coronary artery disease: A meta-analysis of randomized controlled trials Eur. Heart J., January 1, 2004; 25(1): 69 - 80. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. Kwon, D. Choi, S.-H. Choi, Bon Kwon Koo, Y. Jang, W.-H. Shim, and S.-Y. Cho Coronary Stenting After Rotational Atherectomy in Diffuse Lesions of the Small Coronary Artery: Comparison with Balloon Angioplasty Before Stenting Angiology, July 1, 2003; 54(4): 423 - 431. [Abstract] [PDF]
|
|
|
|
 |
|
 J. M. Brophy, P. Belisle, and L. Joseph Evidence for Use of Coronary Stents: A Hierarchical Bayesian Meta-Analysis Ann Intern Med, May 20, 2003; 138(10): 777 - 786. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Haude, T. F.M. Konorza, U. Kalnins, A. Erglis, K. Saunamaki, H. D. Glogar, E. Grube, R. Gil, A. Serra, H. G. Richardt, et al. Heparin-Coated Stent Placement for the Treatment of Stenoses in Small Coronary Arteries of Symptomatic Patients Circulation, March 11, 2003; 107(9): 1265 - 1270. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Cisowski, J. Drzewiecki, A. Drzewiecka-Gerber, A. Jaklik, W. Kruczak, M. Szczeklik, and A. Bochenek Primary stenting versus MIDCAB: preliminary report-Comparision of two methods of revascularization in single left anterior descending coronary artery stenosis Ann. Thorac. Surg., October 1, 2002; 74(4): S1334 - 1339. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. V. Chirieac, T. A. Pearson, A. G. Bostom, B. Sharaf, N. Miele, G. Schnyder, and Z. G. Turi B Vitamins and Restenosis after Coronary Angioplasty N. Engl. J. Med., April 4, 2002; 346(14): 1093 - 1095. [Full Text] [PDF]
|
|
|
|
 |
|
 A H Gershlick Intracoronary stenting: developments since the NICE report Heart, March 1, 2002; 87(3): 187 - 190. [Full Text] [PDF]
|
|
|
|
|
|
A. Kastrati, H. Schuhlen, and A. Schomig Stenting for small coronary vessels: a contestable winner J. Am. Coll. Cardiol., November 15, 2001; 38(6): 1604 - 1607. [Full Text] [PDF]
|
|
|
|
|
|
S. Doucet, M. J. Schalij, M. C.M. Vrolix, D. Hilton, P. Chenu, B. de Bruyne, W. Udayachalerm, A. Seth, L. Bilodeau, J. H.C. Reiber, et al. Stent Placement to Prevent Restenosis After Angioplasty in Small Coronary Arteries Circulation, October 23, 2001; 104(17): 2029 - 2033. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Koning, H. Eltchaninoff, P. Commeau, K. Khalife, M. Gilard, J. Lipiecki, P. Coste, M. Bedossa, T. Lefevre, P. Brunel, et al. Stent Placement Compared With Balloon Angioplasty for Small Coronary Arteries: In-Hospital and 6-Month Clinical and Angiographic Results Circulation, October 2, 2001; 104(14): 1604 - 1608. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Roguin and R. Beyar Small vessel stenting is safe, but still waiting for a well-proven antirestenotic effect Eur. Heart J., November 1, 2000; 21(21): 1732 - 1734. [PDF]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||