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

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Abstract

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.

About the authors

Aleksandr V. Bocharov

Kostroma regional clinical hospital named after Korolev E.I.

Author for correspondence.
Email: bocharovav@mail.ru
ORCID iD: 0000-0002-6027-2898
SPIN-code: 6073-1445
ResearcherId: C-6324-2019

Cand. Med. Sc., Chief of Department, Endovascular Surgeon

Russian Federation, Kostroma

Leonid V. Popov

National Medical and Surgical Center named after N.I. Pirogov

Email: popovcardio@mail.ru
ORCID iD: 0000-0002-0530-3268

doctor of medical Sciences, Professor, head of the Department of cardiac surgery

Russian Federation, Moscow

References

  1. Kastrai A, Elezi S, Dirschinger J, et al. Influence of lesion length on restenosis after coronary stent placement. Am J Cardiol. 1999;83(12):1617-1622. doi: 10.1016/s0002-9149(99)00165-4.
  2. Ryan TJ, Bauman WB, Kennedy JW, et al. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American Heart Association/American College of Cardiology Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Committee on Percu-taneous Transluminal Coronary Angioplasty). Circu-lation. 1993;88(6):2987-3007. doi: 10.1161/01.cir.88.6.2987.
  3. Stone GW, Ellis SG, Cox DA, et al. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med. 2004;350(3):221-231. doi: 10.1056/NEJMoa032441.
  4. Degertekin M, Arampatzis CA, Lemos PA, et al. Very long sirolimus-eluting stent implantation for de novo coronary lesions. Am J Cardiol. 2004;93(7):826-829. doi: 10.1016/j.amjcard.2003.12.018.
  5. Tsagalou E, Chieffo A, Iakovou I, et al. Multiple overlapping drug-eluting stents to treat diffuse disease of the left anterior descending coronary artery. J Am Coll Cardiol. 2005;45(10):1570-1573. doi: 10.1016/j.jacc.2005.01.049.
  6. Bauters C, Hubert E, Prat A, et al. Predictors of restenosis after coronary stent implantation. J Am Coll Cardiol. 1998;31(6):1291-1298. doi: 10.1016/s0735-1097(98)00076-x.
  7. Hoffman R, Herrman G, Silber S, et al. Randomized comparison of success and adverse event rates and cost effectiveness of one long versus two short stents for treatment of long coronary narrowings. Am J Cardiol. 2002;90(5):460-464. doi: 10.1016/s0002-9149(02)02514-6.
  8. Pan M, de Lezo JS, Medina A, et al. Influence of stent treatment strategies in the long-term outcome of patients with long diffuse coronary lesions. Cathter Cardiovasc Interv. 2003;58(3):293-300. doi: 10.1002/ccd.10439.
  9. Lee CW, Park KH, Kim YH, et al. Clinical and angiographic outcomes after placement of multiple overlapping drug-eluting stents in diffuse coronary lesions. Am J Cardiol. 2006;98(7):918-922. doi: 10.1016/j.amjcard.2006.05.011.
  10. Wilson GJ, Polovick JE, Huibregtse BA, Poff BC. Overlapping paclitaxel-eluting stents: long-term effects in a porcine coronary artery model. Cardiovasc Res. 2007;76(2):361-372. doi: 10.1016/j.cardiores.2007.07.004.
  11. Kereiakes DJ, Wang H, Popma JJ, et al. Periprocedural and late consequences of overlapping Cypher sirolimus-eluting stents: pooled analysis of five clinical trials. J Am Coll Cardiol. 2006;48(1): 21-31. doi: 10.1016/j.jacc.2006.02.058.
  12. Thakkar AS, Dave BA. Revolution of drug-eluting coronary stents: an analysis of market leaders. Eur Med J. 2016;4(1):114-125.
  13. Mancini GB. Quantitative coronary arteriographic methods in the interventional catheterization laboratory: an update and perspective. J Am Coll Cardiol. 1991;17(6 Suppl B):23В-33В. doi: 10.1016/0735-1097(91)90935-3.
  14. Cook S, Wenaweser P, Togni M, et al. Incomplete stent apposition and very late stent throm-bosis after drug-eluting stent implantation. Circu-lation. 2007;115(18):2426-2434. doi: 10.1161/CIRCULATIONAHA.106.658237.
  15. Бабунашвили А.М., Юдин И.Е., Дундуа Д.П., и др. Стенты с лекарственным покрытием при лечении диффузных атеросклеротических поражений коронарных артерий // Болезни сердца и сосудов. Приложение к журналу Consilium medicum. — 2006. — Т.1. — №4. — С. 56-62. [Babunashvili AM, Judin IE, Dundua DP, et al. Stenty s lekarstvennym pokrytiem pri lechenii diffuznyh ateroskleroticheskih porazhenij koronarnyh arterij. Bolezni serdca i sosudov. Prilozhenie k zhurnalu Consilium medicum. 2006;1(4):56-62. (In Russ).]
  16. Lee SH, Jang Y, Oh SJ, et al. Overlapping vs one long stenting in long coronary lesions. Catheter Cardiovasc Interv. 2004;62(3):298-302. doi: 10.1002/ccd.20091.
  17. Aoki J, Ong AT, Rodriguez Granillo GA, et al. «Full metal jacket» (stented length > or = 64 mm) using drug-eluting stents for de novo coronary artery lesions. Am Heart J. 2005;150(5):994-999. doi: 10.1016/j.ahj.2005.01.050.
  18. Balakrishnan B, Tzafriri AR, Seifert P, et al. Strut position, blood flow, and drug deposition: implications for single and overlapping drug-eluting stents. Circulation. 2005;111(22):2958-2965. doi: 10.1161/CIRCULATIONAHA.104.512475.
  19. Burzotta F, Siviglia M, Altamura L, et al. Outcome of overlapping heterogenous drug-eluting stents and of overlapping drug-eluting and bare metal stents. Am J Cardiol. 2007;99(3):364-368. doi: 10.1016/j.amjcard.2006.08.039.

Copyright (c) 2019 Bocharov A.V., Popov L.V.

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