Paclitaxel-eluting stents

Concurrent implantation of sirolimus- and paclitaxel-eluting stents in the same vessel

OBJECTIVE

To assess the safety and efficacy of concurrent implantation of sirolimus-eluting (SES) and paclitaxel-eluting (PES) stents in the same coronary artery.

BACKGROUND

When it is impossible to deliver multiple drug eluting stents (DES) of the same type, the operator must opt to implant a different DES or a bare metal stent. There are currently no published data evaluating this approach.

METHODS

We identified all cases in which one or more SES and PES were implanted in either the same lesion or adjacent segments of the same vessel during a single procedure between March 2003 and March 2005. Endpoints analyzed were; in-hospital major adverse cardiac events (MACE), and follow-up MACE (including stent thrombosis).

RESULTS

We identified 44 patients with 89 lesions. This was a complex cohort of patients with a median of 3.5 stents implanted, 3 lesions and 2 vessels treated and a median stent length implanted of 80.5 mm, while 83% of the lesions were type B2/C. Eight patients had peri-procedural myocardial infarction. During follow-up; 1 cardiac death occurred, no patients had a myocardial infarct or stent thrombosis, 11 underwent target lesion and vessel revascularization (25%) and 13 had a major adverse cardiac event (29.5%).

CONCLUSIONS

In this cohort of patients, the concurrent use of SES and PES in the same vessel was associated with outcomes in keeping with the complexity of disease treated. Our data show that it is not unreasonable to implant different DES in the same vessel, although we would not advocate this as routine practice.