Long Lesion의 관동맥 협착에서 Long Stent

Abstract

Background : Coronary stenting is known to reduce the rates of restenosis in focal lesions, but the efficacy of stents for long lesions have not been thoroughly defined. To evaluate the immediate and follow-up results of three different types of stents in lesions longer than 20mm, consecutive series of patients (pts) were reviewed. Methods : Between February 1996 and January 1997, 123 patients (male 68.3%, mean age 57±10 years) with a total of 130 lesions underwent long stent : stenting. Excluding multiple stents and unplanned use for acute closure fifty-three pts (56 lesions) were treated with the Microstent II (M-II) ; 30 pts (31 lesions) received the Less Shortening Wallstent (WA) ; and 40 pts (43 lesions) were treated by the Gianturco-Roubin II stent (GRII ). Results : With the clinical success defined as <30% residual stenosis without death, CABG, Q-wave MI was achieved in 93% with the M- II , 94% with the WA and 95% with the GR-lI . Stent thrombosis occurred 0% in M- II , 1.5% in WA and 2.3% in GR- II . Clinical success and stent thrombosis rates were not different between the three types of stents. Follow-up (FU) quantitative angiography was obtained from 34 pts (64%) in M- II , 25 lesions (83%) in WA and 26 pts (65%) in GR- II after 6 months. Restenosis rate defined as > 50% diameter stenosis at FU was 26% in M- II, 32% in WA and 38% in GR- II ; there was no significant difference between the three stents. Target lesion revascularization (TLR) defined as CABG or target lesion PTCA at FU was 17.6% in M- II , 12% in WA and 23.1% in GR- II . Restenosis rate correlated closely with lesion length (p-value=0.03, Odds ratio=1.096) and small post-stent luminal diameter (p-value=0.002, Odds ratio=0.063) in a multivariable analysis. Conclusion : Coronary stenting for long lesions can be safely performed with acceptable complication rates using any of the three types of stents. Restenosis and late outcome was not related to type of stent.