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(Circulation. 2000;102:2593.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
A Randomized Trial Comparing Stenting With Balloon Angioplasty in Small Vessels in Patients With Symptomatic Coronary Artery Disease
Correspondence to Dr Adnan Kastrati, Deutsches Herzzentrum, Lazarettstr. 36, 80636 München, Germany. E-mail kastrati{at}dhm.mhn.de
Background—More than 30% of the lesions currently treated with interventional approaches are situated in vessels smaller in size than those representing an established indication for stenting. The objective of this randomized trial was to assess whether compared with PTCA, stenting of small coronary vessels is associated with a reduction of restenosis.
Methods and
Results—Patients with symptomatic
coronary artery disease with lesions situated in native
coronary vessels between 2 and 2.8 mm in size were
randomly assigned to be treated with either stenting (n=204) or PTCA
(n=200). Adjunct therapy consisted of abciximab, ticlopidine, and
aspirin. Repeat angiography at 6-month follow-up was performed in 83%
of the patients. The primary end point of the study was the incidence
of angiographic restenosis (
50% diameter stenosis)
at follow-up; adverse clinical events, such as death, myocardial
infarction, stroke, or target vessel
revascularization, were assessed as secondary end
points. After 7 months, there were no significant differences in the
infarct-free survival rates between the 2 study groups: 96.6% for
stent patients, and 97.0% for PTCA patients (P=0.80).
Target vessel revascularization was needed in
20.1% of the stent patients and 16.5% of the PTCA patients
(P=0.35). The primary end point of angiographic
restenosis was found in 35.7% of the stent patients and 37.4%
of the PTCA patients (P=0.74). The net lumen gain
observed at follow-up was identical (0.76±0.78 in the stent group
versus 0.76±0.63 mm in the PTCA group,
P=0.93).
Conclusions—Stenting and PTCA are associated with equally favorable results when used for treating lesions in small coronary vessels.
Key Words: stents • angioplasty • restenosis
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|
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|
|
|
|
|
|
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|
|
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|
|
|
|
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|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
|
|
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|
|
|
|
 |
|
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|
|