Corrective use of the 2.5-mm GFX stent for suboptimal angioplasty results in small coronary arteries

Cutting balloon angioplasty is superior to balloon angioplasty or stent implantation for small coronary artery disease

The aim of this study is to demonstrate initial results and long-term outcomes of patients after receiving cutting balloon angioplasty (CBA), balloon angioplasty (BA), or stenting for small vessel diseases. We studied a total of 327 lesions of small coronary disease treated either by CBA (n=87), BA (n=130), or stenting (n=110) in two affiliated institutes. A small coronary artery was defined as a reference vessel <2.5 mm using quantitative coronary angiography (QCA). Angiographic restenosis was encountered in 31% of the CBA, 46.5% of the BA, and 43.9% of the stent (p=0.048). Major adverse cardiac events (death, myocardial infarction, and target lesion revascularization) at follow-up were significantly lower in the CBA compared to other groups (CBA, 20.3%; BA, 37.3%; stent, 33.3%; p=0.036). The CBA procedure provided superior angiographic and clinical outcomes to the stenting or BA. The CBA may be a cost-effective and reasonable approach for the treatment of lesions in small coronary diseases.

Effectiveness of stents in small coronary arteries

This study was prospectively randomized to assess the efficacy and safety of Jo heparin-coated stent deployment in small vessels compared with balloon angioplasty. In 202 patients, restenosis in balloon and stent arms was 49% and 30%, respectively.

Early and late outcome of stenting in a consecutive series of patients with coronary lesions in vessels less than 2.8 mm in diameter

In an attempt to determine the early and late outcomes of small vessel stenting, we retrospectively evaluated our database on 51 consecutive patients (41 males, mean age, 57.1 +/- 10.1 years) who underwent stenting of at least one significant lesion in a coronary artery with a reference vessel diameter (RVD) <2.8 mm between March 1999 and March 2001. Sixty balloon expandable tubular stents were implanted in 57 lesions (29 Type B2/C, mean RVD: 2.54 +/- 0.16 mm) without intravascular ultrasound guidance under a heparin-aspirin-ticlopidine regimen. The mean diameter stenosis (DS) decreased from 75.8 +/- 13.6% to 4.2 +/- 1.9% (P<0.0001) with stenting at a mean deployment pressure of 13.6 +/- 1.7 atm and a final balloon to RVD ratio (FB/RVD) of 1.08 +/- 0.03. All stents were deployed successfully. Acute stent thrombosis occurred in 3 patients (6%), one died, and 2 developed non-Q-wave myocardial infarction (procedural success 94%). Clinical follow-up, available in 48 patients, revealed a 29% target lesion revascularization rate, a 2% myocardial infarction rate, and a 71% event-free survival at a mean of 11.6 months. Angiographic follow-up, available in 40 patients, showed a DS of 48.8 +/- 31.3% and a binary restenosis rate of 50% at a mean of 7.7 months. The FB/RVD ratio was significantly lower in the group with restenosis than in the group without (1.06 +/- 0.02 vs 1.1 +/- 0.05, P = 0.04). Subgroup analysis yielded a significantly greater rate of restenosis in diabetics with complex (Type B2/C) lesion morphology compared to nondiabetics with simple (Type A/B1) lesions (75% vs 21%, P < 0.05). In conclusion, stenting in vessels <2.8 mm was found to be associated with a high rate of acute stent thrombosis and in-stent restenosis. Further analysis detected a subgroup of patients without diabetes or complex lesions who could be stented with an acceptable in-stent restenosis rate.

Stenting very small coronary narrowings (< 2 mm) using the biocompatible phosphorylcholine-coated coronary stent

Published data regarding stenting very small arteries are still limited. The BiodivYsio stent is a new stent coated with phosphorylcholine, a biocompatible molecule designed to reduce the formation of thrombus and potentially the risk of restenosis. The feasibility, safety, and efficacy of implantation of the 2.0 mm coated coronary stent were prospectively studied. We studied 97 patients from three centers who underwent elective, urgent, or bailout implantation of 106 BiodivYsio mini-stents (2.0 mm) in 101 lesions. Forty percent of lesions had unfavorable characteristics (type B2 or C) and 16% had thrombus and/or chronic total occlusion. Successful stent deployment was achieved in 100/101 lesions (99%). MLD increased from 0.49 +/- 0.31 mm to 1.89 +/- 0.41 mm and diameter stenosis decreased from 89% +/- 7% to 5.6% +/- 6%. Small vessel stenting was the only procedure in 71% patients. There was one acute stent thrombosis case. During 6-month follow-up, none died, one had MI, and one was referred to CABG due to nontarget lesion progression. Angiographic restenosis that required target lesion revascularization was performed in 8/18 that had catheterization due to chest pain or significant ischemia. Most patients improved in their clinical symptoms. The rate of major adverse cardiac events was 4.1% at 30-day and 10.3% at 6-month follow-up. This initial clinical experience indicates that the implantation of 2.0 mm stents coated with phosphorylcholine appears to be safe and efficacious in the treatment of complex coronary lesions and is associated with low target vessel revascularization rate in spite of the very small vessel diameter.