Copyright © 2000 by the European Society of Cardiology.
Stents in Total Occlusion for restenosis Prevention. The multicentre randomized STOP study
a Hadassah University Hospital, Jerusalem, Israel
b Assaf Harofeh Medical Center, Tzerifin, Israel
c HaEmek Medical Center, Afula, Israel
d Kaplan Hospital, Rehovot, Israel
e Rambam Medical Center, Haifa, Israel
revised May 11, 2000; accepted May 17, 2000
Abstract
Aims This multicentre randomized study set out to evaluate whether coronary stenting improves the results of successful balloon angioplasty for chronic total occlusion. Balloon angioplasty for chronic total occlusion has a high restenosis rate. Several reports have suggested that coronary stenting may decrease the likelihood of restenosis and reocclusion.
Methods and Results Patients with total coronary artery occlusions who had an optimal PTCA result were randomized either to no further treatment or additional stent implantation. The AVE microstent was used and all patients were scheduled for a 1-, 3-, and 6-month clinical follow-up. Repeat coronary angiography to assess the rate and pattern of restenosis was performed at 6 months or earlier if clinically indicated. Ninety-six patients were enrolled in this study. The mean age was 59·3±10·3 years and 15 were females. Forty-eight patients were randomized to the stent arm, receiving 52 stents (lengths 18–39mm). Stent implantation was successful in all and there were no major procedure-related complications. Sixty-nine patients (72%) were restudied after 6 months. The binary restenosis rates (50%), in the PTCA arm were 70·9% with a minimal lumen diameter of 1·01±0·79mm compared to 42·1% in the stent arm with a minimal lumen diameter of 1·63±1·02mm (P=0·034). Reocclusion occurred in 7·9% in the stent group compared to 16·1% in the PTCA group. Restenosis in the PTCA group was focal in 88% of patients and occurred at the point of total obstruction (within 5mm), compared to diffuse instent restenosis, which occurred in 54% of the patients in the stent group.
Conclusion Coronary stenting can significantly decrease the rate of restenosis and reocclusion of total occlusions. As restenosis in the stent group was more diffuse, care should be taken to implant short stents at the site of occlusion.
Key Words: Total occlusion, stents, restenosis
f1 Correspondence: Chaim Lotan MD, FACC, Director of Interventional Cardiology, Hadassah University Hospital, Jerusalem, Israel.
References
- Serruys PW, Umans V, Heyndrickx GR. Elective PTCA of totally occluded coronary arteries not associated with acute myocardial infarction: short-term and long-term results. Eur Heart J. 1985;6:2–12
[Abstract/Free Full Text] - Holmes DR Jr, Vlietstra RE, Reeder GS. Angioplasty in total coronary artery occlusion. J Am Coll Cardiol. 1984;3:845–849[Abstract]
- Meier B. Total coronary occlusion: a different animal? J Am Coll Cardiol. 1991;17:50B–57B[Medline]
- Safian RD, McCabe C, Sipperly ME, McKay RG, Baim DS. Initial success and long-term follow-up of percutaneous transluminal coronary angioplasty in chronic total occlusions versus conventional stenoses. Am J Cardiol. 1988;61:23G–28G[CrossRef][Medline]
- Bell MR, Berger PB, Bresnahan JF, Reeder GS, Bailey KR, Holmes DR Jr. Initial and long-term outcome of 354 patients following coronary balloon angioplasty of total coronary artery occlusions. Circulation. 1992;85:1003–1011
[Abstract/Free Full Text] - Stone GW, Rutherford BD, McConahay DR. Procedural outcome of angioplasty for total coronary artery occlusion: an analysis of 971 lesions in 905 patients. J Am Coll Cardiol. 1990;15:849–856[Abstract]
- Maiello L, Colombo A, Gianrossi R. Coronary angioplasty of chronic occlusions: factors predictive of procedural success. Am Heart J. 1992;124:581–584[CrossRef][ISI][Medline]
- Corcos T, Guerin Y, Favereau X. Stiff hydrophilic glidewire: a useful tool for percutaneous insertion of intraaortic balloon counterpulsation catheters. Catheter Cardiovasc Interv. 1999;46:497[CrossRef][ISI][Medline]
- Hamburger JN, Serruys PW, Scabra-Gomes R. Recanalization of total coronary occlusion using a laser guidewire (the European TOTAL Surveillance Study). Am J Cardiol. 1997;80:1419–1423[CrossRef][ISI][Medline]
- Kinoshita, I, Kathoh, O, Nariyama, J, Coronary angioplasty of chronic total occlusion with bridging collateral vessels. Immediate and follow up outcome from a large single center experience. J Am Coll Cardiol, 1995, 26, 409, 15
- Violaris AG, Melkert R, Serruys PW. Long-term luminal renarrowing after successful elective coronary angioplasty of total occlusions: a quantitative angiographic analysis. Circulation. 1994;91:2140–2150
- Berger PB, Holmes DR, Ohman EM. Restenosis, reocclusion and adverse cardiovascular events after successful balloon angioplasty of occluded Versus Non-occluded Coronary Arteries. J Am Coll Cardiol. 1996;27:1–7[Abstract]
- Medina A, Melian F, Suarez de Lezo J. Effectiveness of coronary stenting for the treatment of chronic total occlusion in angina pectoris. Am J Cardiol. 1994;73:1222–1224[CrossRef][ISI][Medline]
- Goldberg S, Colombo A, Maiello L, Borrione M, Finci L, Almagor Y. Intracoronary stent insertion after balloon angioplasty of chronic total occlusions. J Am Coll Cardiol. 1995;26:713–719[Abstract]
- Sirnes PA, Golf S, Myreng Y. Stenting in chronic coronary occlusion (SICCO): a randomized, controlled trial of adding stent implantation after successful angioplasty. J Am Coll Cardiol. 1996;28:1444–1451[Abstract]
- Rubartelli P, Niccoli L, Verna E. Stent implantation versus balloon angioplasty in chronic coronary occlusions: results from the GISSOC Trial. J Am Coll Cardiol. 1998;32:90–96
[Abstract/Free Full Text] - Buller CE, Dzavik V, Carere RG. Primary stenting versus balloon angioplasty in occluded coronary arteries: the Total Occlusion Study of Canada (TOSCA). Circulation. 1999;100:236–242
[Abstract/Free Full Text] - Hoher M, Wohrle J, Grebe OC. A randomized trial of elective stenting after balloon recanalization of chronic total occlusions. J Am Coll Cardiol. 1999;34:722–729
[Abstract/Free Full Text] - Dorros G, Cowley MJ, Simpson J. Percutaneous transluminal coronary angioplasty: report of complications from the National Heart, Lung, and Blood Institute PTCA Registry. Circulation. 1983;67:423–430
- Rozenman Y, Gilon D, Welber S. Influence of coronary angioplasty on the progression of coronary atherosclerosis. Am J Cardiol. 1995;76:1126–1130[CrossRef][ISI][Medline]
- Rozenman Y, Sapoznikov D, Mosseri M. Long term angiographic follow up of coronary balloon angioplasty in patients with Diabetes Mellitus. A clue to the explanation of the BARI study. J Am Coll Cardiol. 1997;30:1430–1435
- 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] - Bauters C, Hubert E, Prat A. Predictors of restenosis after coronary stent implantation. J Am Coll Cardiol. 1998;31:1291–1298
[Abstract/Free Full Text] - Kornowski R, Mehran R, Hong MK. Procedural results and late clinical outcome after placement of three or more stents in single coronary lesions. Circulation. 1998;97:1355–1361
[Abstract/Free Full Text] - Sanborn TA. Recanalization of arterial occlusions: pathologic basic and contributing factors. J Am Coll Cardiol. 1989;13:1558–1560[ISI][Medline]
- De Gregorio J, Colombo A. Spot stenting with IVUS guidance for the treatment of long lesions and small vessels. Intl J Cardiovasc Interven. 1998;1:119–129
- Schomig A, Neumann FJ, Kastrati A. A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronary artery stents. N Engl J Med. 1996;334:1084–1092
[Abstract/Free Full Text] - Topol EJ, Ferguson JJ, Weisman HF. Long-term protection from myocardial ischemic events in a randomized trial of brief integrin beta3 blockade with percutaneous coronary intervention. EPIC Investigator Group. Evaluation of Platelet IIb/IIIa Inhibition for Prevention of Ischemic Complication. JAMA. 1997;278:479–484[Abstract]
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|
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