Overlapping vs. one long stenting in long coronary lesions

Comparison of outcomes between single long stent and overlapping stents: a meta-analysis of the literature

OBJECTIVES

There is no consensus on whether to treat diffuse coronary artery lesions with a single long stent (SLS) or by overlapping two or more stents (OLS). The goal of this review was to compare the outcomes of these two approaches through a meta-analysis of the literature.

METHODS

We searched for relevant studies in MEDLINE, Scopus, EMBASE, Google Scholar, and the Cochrane Library. Our meta-analysis included 12 studies (n = 6414) that reported outcomes during the follow-up period.

RESULTS

Individuals who received OLS had a greater risk of cardiac mortality and target lesion revascularization (TLR) than those who received SLS (RR: 1.51, CI: 1.03-2.21, p = 0.03, I2 = 0% and RR: 1.64, CI: 1.02-2.65, p = 0.04, I2 = 38%, respectively). The fluoroscopy period in the OLS group was longer than in the SLS group (SMD: 0.35, CI: 0.25-0.46, p < 0.01, I2 = 0%). more contrast volume was sued for the OLS group; however, there was substantial variability in the pooled analysis (I2 = 95%). In terms of all outcomes, there were no differences between stent generation types.

CONCLUSION

In the first meta-analysis of mainly observational data comparing OLS vs. SLS for long coronary lesions, OLS had higher rates of cardiac mortality and TLR as well as longer fluoroscopy times compared to SLS.

Long-term results of stenting of long coronary artery stenosis with consecutive implantation of stents of different types with overlapping edges in patients with acute coronary syndrome without ST-segment elevation and multivessel coronary artery disease

Introduction. In urgent interventional cardiology practice, combinations of drug-eluting stents and bare-metal stents are sometimes forced to treat extended stenosis in a clinic-dependent artery. Objective. A comparison of long-term results of treatment of patients with coronary heart disease and multivessel coronary lesions, which performed stenting of the clinic-dependent artery by two successive partially overlapping stents using stents of the 3rd generation with drug coating or a combination of the 3rd generation stent with drug coating and a bare-metal stent for acute coronary syndrome without St segment elevation and later — complete functional myocardial revascularization by endovascular method. Methods. The minimum overall length sentiremos section was made 55 mm. In main group included 32 patients for whom revascularization clinic-dependent artery performed endovascular intervention with the use of 2 stents 3-generation drug-coated sirolimus and biodegradable polymer implanted overlap. In 30 patients (control group), clinic-dependent artery revascularization was also performed by a combination of implanted overlap stents, one of which was a 3rd generation stent with sirolimus drug coating and biodegradable polymer, and the other was a bare-metal stent. There were no statistically significant differences between the groups in clinical, demographic and operational characteristics. Results. The analysis of the results revealed a significant difference between the groups in the frequency of repeated revascularization of the target artery, which were observed more often in the control group. Conclusion. When performing an extended stenting of the clinic-dependent artery in patients with acute coronary syndrome without ST segment elevation, overlapping of the drug-coated stent and the bare-metal stent should be avoided, since the antirestenotic effect of the drug-coated stent is leveled when overlapping with the bare-metal stent, but this strategy can be used in case of full coverage of the stenotic lesion or closure of the dissection.

Dispersion of waves and transmission-reflection in blood vessels with structured stents

A new model is proposed for elastic waves induced by a pulsating flow in a stenotic artery containing several stents. Dispersion properties of the waves depend on the stent structure-this feature is addressed in the present paper. Several vascular stenting procedures include overlapping stents; this configuration is also included in the model. The dispersion and transmission properties are analysed; the analytical derivations are accompanied by illustrative numerical examples.

Successful Treatment of Symptomatic Intracranial Carotid Artery Stenosis Using a 24-mm Long Bare Metal Coronary Stent

BACKGROUND

Intracranial arterial atherosclerosis represents a common cause of stroke. Despite aggressive and optimal medical management, many patients will unfortunately suffer additional cerebrovascular events. The role of endovascular intervention for intracranial atherosclerotic disease continues to be uncertain, particularly in regard to extensive, symptomatic stenosis.

CASE DESCRIPTION

We present a case of a 42-year-old man with a complex medical history who presented with recurrent ischemic stroke in the ipsilateral hemisphere despite optimal medical management. Given the length of stenosis and the luminal size of the intracranial cavernous and petrous segments of the internal carotid artery, we used a bare metal coronary stent (4.0 mm × 24 mm). This represents one of the longest stents deployed for intracranial disease reported in the literature.

CONCLUSIONS

This case illustrates that a long coronary stent might be successfully used to manage extensive intracranial lesions. We also review the efficacy of using 1 very long stent versus multiple overlapping stents, with reference to the coronary angiography literature.

The efficacy of adjunctive balloon postdilation at the overlapping site of drug-eluting stent in diffuse long coronary lesion

BACKGROUND

Data regarding the efficacy of adjunctive balloon postdilation (ABP) at the site of two or more overlapping drug-eluting stent (DES) implantation in diffuse long lesion angioplasty are limited. This study was aimed to evaluate the efficacy of routine ABP to the overlapping DES sites in terms of clinical and angiographic outcomes.

METHODS

We enrolled 88 patients (55 men, mean age 63.51+/-10.24 years), and 93 lesions with diffuse long lesion were treated with DES. The clinical and angiographic outcomes up to 6 months of 35 patients in the without routine ABP group were compared with those of 53 patients in the with ABP group.

RESULTS

Baseline clinical characteristics, procedural characteristics, angiographic lesion length, lesion type and DES type were similar between the two groups. Late loss and binary restenosis at 6 months were similar between the two groups. The death, Q-wave myocardial infarction and the major adverse cardiac events were similar between the two groups (7.9 vs. 9.1% in ABP group, P=NS), but there was a trend toward lesser target lesion and vessel revascularization in no ABP group (2.6 vs. 9.0% in no ABP group, P=0.09).

CONCLUSION

The routine ABP at the overlapping site of DES implantations in a diffuse long coronary lesion showed no significant benefits in terms of angiographic and clinical outcomes compared with those of patients without routine ABP.

Comparison of clinical outcomes of overlapping sirolimus- versus paclitaxel-eluting stents in patients undergoing percutaneous coronary intervention

Sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) implantation for the treatment of single coronary lesions has proved to be effective and durable. However, the safety and efficacy of overlapping drug-eluting stents for the treatment of long lesions have not been well established. In total, 114 patients who received overlapping drug-eluting stents were identified, 55 of whom received overlapping SESs and 59 received overlapping PESs. Baseline clinical and angiographic characteristics were balanced. In-hospital complications were similar between the 2 groups. At 30-day and 6-month follow-ups, all clinical outcomes were also similar. In addition, the event-free survival rate was comparable (p = 0.71). Implantation of overlapping drug-eluting stents for the treatment of long, native coronary lesions is feasible and effective. In conclusion, in this observational study, clinical outcomes appeared similar in patients treated with overlapping SES implantation compared with those treated with overlapping PES implantation.

Periprocedural and late consequences of overlapping Cypher sirolimus-eluting stents: pooled analysis of five clinical trials

OBJECTIVES

The purpose of this research was to determine the relative safety and efficacy of multiple (> or =2) overlapping Cypher sirolimus-eluting stents (SES) (Johnson & Johnson, New Brunswick, New Jersey).

BACKGROUND

Overlapping coronary stents are common. The periprocedural and late clinical and angiographic consequences of overlapped coronary stents are not clearly defined, particularly for drug-eluting stents.

METHODS

All patients enrolled into five clinical trials of the SES were analyzed. Three of these trials were prospective randomized comparisons of the SES to the bare-metal stent (BMS), and two were prospective non-randomized trials of SES-treated patients with historical controls. All clinical and angiographic outcomes in overlap-stent-treated patients were compared by stent type and with single-stent-treated patients for the same stent device.

RESULTS

In all, 575 patients with stent overlap (337 SES, 238 BMS) and 1,162 patients with single stents (697 SES, 465 BMS) were analyzed. Stent overlap was associated with a greater late lumen loss in stent and more frequent angiographic restenosis regardless of stent type. Among overlap-stent-treated patients, the SES provided similar magnitude of restenosis benefit as observed for single-stent-treated patients. Overlapped SES was not associated with an increase in myocardial infarction.

CONCLUSIONS

The strategy of SES overlap, when required, is both safe and efficacious in reducing restenosis with no increase in the incidence of myocardial infarction or major adverse cardiovascular events, when compared with a bare metal coronary stent prosthesis.

Impact of overlapping drug-eluting stents in patients undergoing percutaneous coronary intervention

BACKGROUND

Sirolimus-eluting stent (SES) implantation for the treatment of single coronary lesions is proven to be effective and durable. However, the safety and efficacy of overlapping SES for the treatment of long lesions have not been well established.

OBJECTIVES

We conducted a retrospective analysis to compare the clinical outcomes of overlapping versus nonoverlapping SES.

METHODS

Fifty-five patients who received overlapping SES were compared with 39 patients who received nonoverlapping SES.

RESULTS

The baseline clinical and angiographic characteristics were balanced between the two study groups. The in-hospital complications were similar between groups, except that non-Q-wave myocardial infarction was significantly higher in the Overlapping SES group when compared with the Nonoverlapping SES group (23.6% vs. 7.7%, P = 0.04). This higher rate of myonecrosis is due to periprocedural side branch compromises, including side branch narrowing, occlusion, and flow reduction. At 30 days and 6 months follow-up, all clinical outcomes were similar between the study groups. In addition, the event-free survival rate was similar between groups (P = 0.87).

CONCLUSIONS

The implantation of overlapping SES for the treatment of long, native coronary lesions is feasible and effective but is associated with an increased rate of periprocedural myonecrosis. This phenomenon is caused primarily by side branch compromises, but does not have any adverse impact on late clinical events.