Use of multiple overlapping sirolimus-eluting stents for treatment of long coronary artery lesions

Results from a single-center registry in 318 consecutive patients

Peter E. Ruchin, Daniela Trabattoni, Franco Fabbiocchi, Piero Montorsi, Alessandro Lualdi, Paolo Ravagnani, Luca Grancini, Stefano Galli, Giovanni Teruzzi, Giuseppe Calligaris, Stefano De Martini, Antonio L. Bartorelli

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Drug-eluting stents (DES) are superior to bare metal stents in the prevention of restenosis and target lesion revascularization (TLR). This has led to a more aggressive use of DES in everyday interventional cardiology practice. Methods: All consecutive patients who underwent coronary artery stenting with greater than 34 mm of overlapping, sirolimus-eluting stent (SES) were reviewed from a prospectively created database. A prespecified group of patients with greater than 60 mm of SES was also followed. Results: 318 patients were followed up at a minimum of 6 months and a mean of 9 months. The mean target lesion stented length was over 55 mm. Use of IVUS was 19.8%. Forty patients (12.6%) suffered a peri-procedural CK-MB rise. The MACE rate at 9 months was 17% with 12.6% being periprocedural myocardial infarction (MI). Clinically driven TLR was 4.4% and cardiac death was 1.3%. There were 4 cases defined as late stent thrombosis. The independent predictors of periprocedural MI were the presence of a major side branch and longer target lesion stented length, with stable angina being a negative predictor. The independent predictors of in-stent restenosis were unstable angina and target lesion number per patient. There was a trend to increased MACE in the subgroup with longer than 60 mm of SES length. Conclusion: The use of multiple, overlapping SES is safe and effective with an acceptably low follow up MACE rate. A significant peri-procedural CK-MB rise appears to be a risk of long segment stenting. Whether this translates to long-term sequelae needs further investigation.

Original languageEnglish
Pages (from-to)231-237
Number of pages7
JournalInternational Journal of Cardiology
Volume134
Issue number2
DOIs
Publication statusPublished - May 15 2009

Fingerprint

Sirolimus
Stents
Registries
Coronary Vessels
Drug-Eluting Stents
Therapeutics
Myocardial Infarction
Stable Angina
Unstable Angina
Cardiology
Thrombosis
Metals
Databases

Keywords

  • Coronary artery
  • Drug eluting stents
  • Overlapping
  • Sirolimus

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{938c501579054259b9c49814fc2c35c1,
title = "Use of multiple overlapping sirolimus-eluting stents for treatment of long coronary artery lesions: Results from a single-center registry in 318 consecutive patients",
abstract = "Drug-eluting stents (DES) are superior to bare metal stents in the prevention of restenosis and target lesion revascularization (TLR). This has led to a more aggressive use of DES in everyday interventional cardiology practice. Methods: All consecutive patients who underwent coronary artery stenting with greater than 34 mm of overlapping, sirolimus-eluting stent (SES) were reviewed from a prospectively created database. A prespecified group of patients with greater than 60 mm of SES was also followed. Results: 318 patients were followed up at a minimum of 6 months and a mean of 9 months. The mean target lesion stented length was over 55 mm. Use of IVUS was 19.8{\%}. Forty patients (12.6{\%}) suffered a peri-procedural CK-MB rise. The MACE rate at 9 months was 17{\%} with 12.6{\%} being periprocedural myocardial infarction (MI). Clinically driven TLR was 4.4{\%} and cardiac death was 1.3{\%}. There were 4 cases defined as late stent thrombosis. The independent predictors of periprocedural MI were the presence of a major side branch and longer target lesion stented length, with stable angina being a negative predictor. The independent predictors of in-stent restenosis were unstable angina and target lesion number per patient. There was a trend to increased MACE in the subgroup with longer than 60 mm of SES length. Conclusion: The use of multiple, overlapping SES is safe and effective with an acceptably low follow up MACE rate. A significant peri-procedural CK-MB rise appears to be a risk of long segment stenting. Whether this translates to long-term sequelae needs further investigation.",
keywords = "Coronary artery, Drug eluting stents, Overlapping, Sirolimus",
author = "Ruchin, {Peter E.} and Daniela Trabattoni and Franco Fabbiocchi and Piero Montorsi and Alessandro Lualdi and Paolo Ravagnani and Luca Grancini and Stefano Galli and Giovanni Teruzzi and Giuseppe Calligaris and {De Martini}, Stefano and Bartorelli, {Antonio L.}",
year = "2009",
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language = "English",
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journal = "International Journal of Cardiology",
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T1 - Use of multiple overlapping sirolimus-eluting stents for treatment of long coronary artery lesions

T2 - Results from a single-center registry in 318 consecutive patients

AU - Ruchin, Peter E.

AU - Trabattoni, Daniela

AU - Fabbiocchi, Franco

AU - Montorsi, Piero

AU - Lualdi, Alessandro

AU - Ravagnani, Paolo

AU - Grancini, Luca

AU - Galli, Stefano

AU - Teruzzi, Giovanni

AU - Calligaris, Giuseppe

AU - De Martini, Stefano

AU - Bartorelli, Antonio L.

PY - 2009/5/15

Y1 - 2009/5/15

N2 - Drug-eluting stents (DES) are superior to bare metal stents in the prevention of restenosis and target lesion revascularization (TLR). This has led to a more aggressive use of DES in everyday interventional cardiology practice. Methods: All consecutive patients who underwent coronary artery stenting with greater than 34 mm of overlapping, sirolimus-eluting stent (SES) were reviewed from a prospectively created database. A prespecified group of patients with greater than 60 mm of SES was also followed. Results: 318 patients were followed up at a minimum of 6 months and a mean of 9 months. The mean target lesion stented length was over 55 mm. Use of IVUS was 19.8%. Forty patients (12.6%) suffered a peri-procedural CK-MB rise. The MACE rate at 9 months was 17% with 12.6% being periprocedural myocardial infarction (MI). Clinically driven TLR was 4.4% and cardiac death was 1.3%. There were 4 cases defined as late stent thrombosis. The independent predictors of periprocedural MI were the presence of a major side branch and longer target lesion stented length, with stable angina being a negative predictor. The independent predictors of in-stent restenosis were unstable angina and target lesion number per patient. There was a trend to increased MACE in the subgroup with longer than 60 mm of SES length. Conclusion: The use of multiple, overlapping SES is safe and effective with an acceptably low follow up MACE rate. A significant peri-procedural CK-MB rise appears to be a risk of long segment stenting. Whether this translates to long-term sequelae needs further investigation.

AB - Drug-eluting stents (DES) are superior to bare metal stents in the prevention of restenosis and target lesion revascularization (TLR). This has led to a more aggressive use of DES in everyday interventional cardiology practice. Methods: All consecutive patients who underwent coronary artery stenting with greater than 34 mm of overlapping, sirolimus-eluting stent (SES) were reviewed from a prospectively created database. A prespecified group of patients with greater than 60 mm of SES was also followed. Results: 318 patients were followed up at a minimum of 6 months and a mean of 9 months. The mean target lesion stented length was over 55 mm. Use of IVUS was 19.8%. Forty patients (12.6%) suffered a peri-procedural CK-MB rise. The MACE rate at 9 months was 17% with 12.6% being periprocedural myocardial infarction (MI). Clinically driven TLR was 4.4% and cardiac death was 1.3%. There were 4 cases defined as late stent thrombosis. The independent predictors of periprocedural MI were the presence of a major side branch and longer target lesion stented length, with stable angina being a negative predictor. The independent predictors of in-stent restenosis were unstable angina and target lesion number per patient. There was a trend to increased MACE in the subgroup with longer than 60 mm of SES length. Conclusion: The use of multiple, overlapping SES is safe and effective with an acceptably low follow up MACE rate. A significant peri-procedural CK-MB rise appears to be a risk of long segment stenting. Whether this translates to long-term sequelae needs further investigation.

KW - Coronary artery

KW - Drug eluting stents

KW - Overlapping

KW - Sirolimus

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