Elective stenting in small coronary arteries: Results of the Italian prospective multicenter registry MICROSCOPE

Flavio Airoldi, Carlo Di Mario, Patrizia Presbitero, Luigi Maiello, Addolorata Carcagnì, Alessandro Bortone, Alberto Cremonesi, Fausto Castriota, Arian Frasheri, Antonio Rubino, Vincenzo Pernice, Paolo Rubartelli, Bernhard Reimers, Antonio Colombo

Research output: Contribution to journalArticlepeer-review

Abstract

Background. The role of stent implantation in small coronary arteries is still controversial. The MICROSCOPE study (Ministenting in small coronary arteries, a prospective evaluation) is a multi-center registry addressed to prospectively evaluate the immediate and mid-term clinical and angiographic results of elective stenting of lesions located in coronary arteries with an angiographic reference diameter ≤ 2.75 mm. Methods. A total of 146 patients (160 lesions) were included in the study. The percentage of complex lesions (B2 and C lesions) was 49.3%. The clinical indications for stent implantation were: stable angina (55.0 %), unstable angina (24.6%), and clinical evidence of myocardial ischemia in asymptomatic patients (20.4%); 60% of patients had multivessel disease. Stent deployment could be performed in 96.2% of lesions. The baseline reference diameter was 2.12 ± 0.36 mm. In all cases the Ministent (Cordis, a J&J Company, Miami, FL, USA), specifically designed for small coronary arteries, was employed. The stent was pre-mounted on low profile balloons available in three different diameters (2.25, 2.50 and 2.75 mm) and three different lengths (11, 15 e 26 mm). Results. The primary endpoint of successful stent-assisted angioplasty in all study vessels without major adverse cardiac events was achieved in 95.8% of the patients. The minimal lumen diameter increased from 0.64 ± 0.24 to 2.02 ± 0.43 mm and the dimensions of the stenosis (expressed as a percentage of the diameter of the coronary vessel) decreased from 68.6 ± 10.8 to 16.2 ± 10.7% (<30% standard deviation in all cases). After the procedure all the patients received double antiplatelet therapy for 4 weeks. Post-procedural complications were limited to 2 patients (1.3%) who had a non-Q wave myocardial infarction at 6 months of follow-up; 13 patients (11%) required target lesion revascularization. No patient died following the procedure. Angiographic control was performed in 44% of lesions. The minimal lumen diameter decreased to 1.12 ± 0.47 mm and the percent stenosis increased to 45.9 ± 23.2%. The incidence of binary restenosis (stenosis ≥ 50%) was 41%. Conclusions. Elective stenting of small coronary arteries with the Ministent can be safely performed and is associated with a low incidence of acute or subacute stent thrombosis. The mid-term results indicate a high rate of angiographic restenosis but a low need of target vessel revascularization. These data suggest that stenting cannot be considered the treatment of choice for unselected lesions located in coronary arteries with a small reference diameter, but represents a safe solution if unsatisfactory results are obtained with balloon angioplasty alone.

Original languageEnglish
Pages (from-to)406-411
Number of pages6
JournalItalian Heart Journal
Volume3
Issue number7
Publication statusPublished - Jul 1 2002

Keywords

  • Coronary stenosis
  • Stenting

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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