(Circulation. 2001;104:2029.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Stent Placement to Prevent Restenosis After Angioplasty in Small Coronary Arteries
From the Department of Medicine, Montreal Heart Institute (SD, L.B., J.L., F.H.), Montreal, Quebec, Canada; Department of Cardiology, Leiden University Medical Centre (M.J.S.), Leiden, The Netherlands; Ziekenhuis Oost Limburg (M.V.), Genk, Belgium; Royal Jubilee Hospital (D.H.), Victoria, Canada; Catholic University of Louvain-UCL-Mont-Godinne Hospital (P.C.), Mont-Godinne, Belgium; Cardiovascular Centre (B.d.B.), Aalst, Belgium; Chulalongkorn University (W.U.), Bangkok, Thailand; Escorts Heart Institute and Research Centre (A.S.), New Delhi, India; and Heart Core BV (J.H.C.R.), Leiden, The Netherlands.
Correspondence to Serge Doucet, 5000 Belanger St East, Montreal, Quebec, H1T 1C8, Canada. E-mail serge.doucet{at}sympatico.ca
Background— Lesions in small-diameter vessels (<3 mm) define a group with distinct clinical and morphological characteristics. There is an inverse relationship between vessel size and angiographic restenosis rate. This study assessed whether stents reduce angiographic restenosis in small coronary arteries compared with standard balloon angioplasty.
Methods and Results— We randomly assigned 351 symptomatic patients needing dilatation of 1 native coronary vessel between 2.3 and 2.9 mm in size to angioplasty alone (n=182) or stent implantation (n=169). The primary end point was angiographic restenosis at 6 months. Secondary end points included death, myocardial infarction, bypass surgery, and target vessel revascularization in hospital and at 6 months. There were no significant differences between groups in terms of major in-hospital complications. There was a trend toward fewer in-hospital events in the stent group (3% versus 7.1% in angioplasty group, P=0.076). Crossovers to stent occurred in 37 patients (20.3%). Repeat angiography at 6-month follow-up was performed in 85.3% of patients. Angiographic restenosis occurred in 28% of the stent group and 32.9% of the angioplasty group (P=0.36). Target vessel revascularization was required in 17.8% versus 20.3% of patients (P=0.54), respectively.
Conclusions— Stenting and standard coronary angioplasty are associated with equal restenosis rate in small coronary arteries. With a lower in-hospital complication rate, stenting may be a superior strategy in small vessels.
Key Words: angioplasty • stents • restenosis
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