Late clinical outcomes of cordis tantalum coronary stenting without anticoagulation

Immediate and late clinical and angiographic outcomes after GFX coronary stenting: is high-pressure balloon dilatation necessary?

BACKGROUND

The GFX stent is a balloon-expandable stent made of sinusoidal element of stainless steel. The adjunct high-pressure balloon dilatations were usually recommended in routine stenting procedure.

HYPOTHESIS

The aim of this study was to evaluate the immediate and long-term clinical and angiographic outcomes and to investigate the necessity of high-pressure balloon dilatation during GFX stenting.

METHODS

In all, 172 consecutive patients underwent single 12 or 18 mm GFX stent implantation in 188 native coronary lesions. Two types of stenting technique were used: (1) stent size of a final stent-to-artery ratio of 1:1 (inflation pressure > 10 atm, high-pressure group), and (2) stent size of 0.5 mm bigger than reference vessel (inflation pressure < or = 10 atm, low-pressure group). The adjunct high-pressure balloon dilatations were performed only in cases of suboptimal results.

RESULTS

The adjunct high-pressure balloon dilatation was required in 11 of 83 lesions (13%) in the high-pressure group and in 7 of 105 lesions (7%) in the low-pressure group (p = 0.203). Procedural success rate was 100%. There were no significant differences of in-hospital and long-term clinical events between the two groups. The overall angiographic restenosis rate was 17.7%; 18.4% in the high-pressure group and 17.1% in the low-pressure group (p = 0.991).

CONCLUSIONS

The GFX stent is a safe and effective device with a high procedural success rate and favorable late clinical outcome for treatment of native coronary artery disease. Further randomized trials may be needed to compare stenting techniques in GFX stent implantation.

Intravascular ultrasonic predictors of angiographic restenosis after long coronary stenting

The intravascular ultrasound (IVUS) criteria for stent optimization have not been determined in stenting long lesions. We evaluated the predictors of angiographic restenosis and compared it with stent lumen cross-sectional area (CSA) and stent length between short (stent length <20 mm) and long (> or =20 mm) coronary stenting. IVUS-guided coronary stenting was successfully performed in 285 consecutive patients with 304 native coronary lesions. Six-month follow-up angiogram was performed in 236 patients (82.8%) with 246 lesions (80.9%). Results were evaluated using conventional (clinical, angiographic, and IVUS) methods. The overall angiographic restenosis rate was 22.8% (56 of 246 lesions) (short stent 17.6% vs. long stent 32.2%, p = 0.009). Using multivariate logistic regression analysis, the independent predictors of angiographic restenosis were the IVUS stent lumen CSA (odds ratio 1.51, 95% confidence intervals 1.18 to 1.92, p = 0.001) and stent length (odds ratio 0.95, 95% confidence intervals 0.91 to 1.00, p = 0.039). The angiographic restenosis rate was 54.8% for stent lumen CSA of <5.0 mm2 (short stent 37.5% vs. long stent 73.3%, p = 0.049), 27.4% for CSA between 5.0 and 7.0 mm2 (short stent 24.1% vs. long stent 31.7%, p = 0.409), 10.5% for CSA between 7.0 and 9.0 mm2 (short stent 10.0% vs. long stent 12.5%, p = 0.772), and 11.4% for stent lumen CSA of > or =9.0 mm2 (short stent 10.4% vs. long stent 13.3%, p = 0.767) (p = 0.001). Compared with short coronary stenting, long coronary stenting is effective treatment modality to cover long lesions with comparable long-term clinical outcomes in cases of stent lumen CSA of > or =7.0 mm2. Regardless of the stent length, the most important factor determining angiographic restenosis was the IVUS stent lumen CSA in relatively large coronary artery lesions.

Immediate results and late clinical outcomes after new CrossFlex coronary stent implantation

This study evaluates the safety and efficacy of the new CrossFlex stent in the treatment of native coronary artery disease. The CrossFlex stent is a flexible, balloon-expandable new device with an excellent flexibility, radial strength, conformability, and radio-opacity. Little data are available concerning the clinical and angiographic outcomes of this device. The CrossFlex stent was implanted in 209 consecutive patients with 226 lesions. Follow-up angiography was performed at 6 months, and clinical evaluation was undertaken at regular intervals after stent implantation. Procedural success was achieved in all lesions without in-hospital complications. Angiographic follow-up data were available in 153 of the 187 eligible lesions (follow-up rate, 82%), and the overall angiographic restenosis rate was 16.3%. Minimal lumen diameter immediately after stent placement was the only predictor of angiographic restenosis. Clinical follow-up was obtained in all patients at 10.5 +/- 5.2 months. There were 4 deaths (1 cardiac in origin, the others noncardiac in origin), and 1 nonfatal myocardial infarction (nonstented artery) during follow-up. Target lesion revascularization was required in 15 patients (7%), and the overall event-free survival rate (death, myocardial infarction, and repeat revascularization) was 87% at the end of the follow-up period. The CrossFlex stent is a safe and effective device with a high procedural success rate, and a favorable late clinical outcome for treatment of native coronary artery disease. Further randomized trials are needed to compare the CrossFlex stent with standard slotted-tube stents.