Stenting in Chronic Coronary Occlusion (SICCO): a randomized, controlled trial of adding stent implantation after successful angioplasty

Feiring Heart Clinic, Norway.

OBJECTIVES: This study investigated whether stenting improves long-term results after recanalization of chronic coronary occlusions. BACKGROUND: Restenosis is common after percutaneous transluminal coronary angioplasty (PTCA) of chronic coronary occlusions. Stenting has been suggested as a means of improving results, but its use has not previously been investigated in a randomized trial. METHODS: We randomly assigned 119 patients with a satisfactory result after successful recanalization by PTCA of a chronic coronary occlusion to 1) a control (PTCA) group with no other intervention, or 2) a group in which PTCA was followed by implantation of Palmaz-Schatz stents with full anticoagulation. Coronary angiography was performed before randomization, after stenting and at 6-month follow-up. RESULTS: Inguinal bleeding was more frequent in the stent group. There were no deaths. One patient with stenting had a myocardial infarction. Subacute occlusion within 2 weeks occurred in four patients in the stent group and in three in the PTCA group. At follow-up, 57% of patients with stenting were free from angina compared with 24% of patients with PTCA only (p < 0.001). Angiographic follow-up data were available in 114 patients. Restenosis (> or = 50% diameter stenosis) developed in 32% of patients with stenting and in 74% of patients with PTCA only (p < 0.001); reocclusion occurred in 12% and 26%, respectively (p = 0.058). Minimal lumen diameter (mean +/- SD) at follow-up was 1.92 +/- 0.95 mm and 1.11 +/- 0.78 mm, respectively (p < 0.001). Target lesion revascularization within 300 days was less frequent in patients with stenting than in patients with PTCA only (22% vs. 42%, p = 0.025). CONCLUSIONS: Stent implantation improved long-term angiographic and clinical results after PTCA of chronic coronary occlusions and is thus recommended regardless of the primary PTCA result.

This article has been cited by other articles:

				A. Colombo and A. Chieffo Drug-Eluting Stent Update 2007: Part III: Technique and Unapproved/Unsettled Indications (Left Main, Bifurcations, Chronic Total Occlusions, Small Vessels and Long Lesions, Saphenous Vein Grafts, Acute Myocardial Infarctions, and Multivessel Disease) Circulation, September 18, 2007; 116(12): 1424 - 1432. [Full Text] [PDF]

				A. Prasad, C. S. Rihal, R. J. Lennon, H. J. Wiste, M. Singh, and D. R. Holmes Jr Trends in Outcomes After Percutaneous Coronary Intervention for Chronic Total Occlusions: A 25-Year Experience From the Mayo Clinic J. Am. Coll. Cardiol., April 17, 2007; 49(15): 1611 - 1618. [Abstract] [Full Text] [PDF]

				V. Dzavik, C. E. Buller, G. A. Lamas, J. M. Rankin, G.B. J. Mancini, W. J. Cantor, R. J. Carere, J. R. Ross, D. Atchison, S. Forman, et al. Randomized Trial of Percutaneous Coronary Intervention for Subacute Infarct-Related Coronary Artery Occlusion to Achieve Long-Term Patency and Improve Ventricular Function: The Total Occlusion Study of Canada (TOSCA)-2 Trial Circulation, December 5, 2006; 114(23): 2449 - 2457. [Abstract] [Full Text] [PDF]

				G. Di Giammarco, M. Pano, M. Giancane, A. Di Francesco, and M. Di Mauro Off-Pump Revascularization of Chronically Occluded Left Anterior Descending Artery Through Left Anterior Small Thoracotomy: Early and Late Angiographic and Clinical Follow-Up. Ann. Thorac. Surg., October 1, 2006; 82(4): 1446 - 1450. [Abstract] [Full Text] [PDF]

				M. J. Suttorp, G. J. Laarman, B. M. Rahel, J. C. Kelder, M. A.R. Bosschaert, F. Kiemeneij, J. M. ten Berg, E. T. Bal, B. J. Rensing, F. D. Eefting, et al. Primary Stenting of Totally Occluded Native Coronary Arteries II (PRISON II): A Randomized Comparison of Bare Metal Stent Implantation With Sirolimus-Eluting Stent Implantation for the Treatment of Total Coronary Occlusions Circulation, August 29, 2006; 114(9): 921 - 928. [Abstract] [Full Text] [PDF]

				M. Zimarino, A. Ausiello, G. Contegiacomo, I. Riccardi, G. Renda, C. Di Iorio, and R. De Caterina Rapid Decline of Collateral Circulation Increases Susceptibility to Myocardial Ischemia: The Trade-Off of Successful Percutaneous Recanalization of Chronic Total Occlusions J. Am. Coll. Cardiol., July 4, 2006; 48(1): 59 - 65. [Abstract] [Full Text] [PDF]

				D. M Safley, J. A House, B. D Rutherford, and S. P Marso Success rates of percutaneous coronary intervention of chronic total occlusions and long-term survival in patients with diabetes mellitus Diabetes and Vascular Disease Research, May 1, 2006; 3(1): 45 - 51. [Abstract] [PDF]

				H. Kelbaek, L. Thuesen, S. Helqvist, L. Klovgaard, E. Jorgensen, S. Aljabbari, K. Saunamaki, L. R. Krusell, G. V.H. Jensen, H. E. Botker, et al. The Stenting Coronary Arteries in Non-stress/benestent Disease (SCANDSTENT) Trial J. Am. Coll. Cardiol., January 17, 2006; 47(2): 449 - 455. [Abstract] [Full Text] [PDF]

				H. Kelbaek, L. Thuesen, S. Helqvist, L. Klovgaard, E. Jorgensen, S. Aljabbari, K. Saunamaki, L. R. Krusell, G. V.H. Jensen, H. E. Botker, et al. The Stenting Coronary Arteries in Non-stress/benestent Disease (SCANDSTENT) Trial J. Am. Coll. Cardiol., December 13, 2005; (2005) j.jacc.2005.10.045v1. [Abstract] [Full Text] [PDF]

				A. Hoye, R. T. van Domburg, K. Sonnenschein, and P. W. Serruys Percutaneous coronary intervention for chronic total occlusions: the Thoraxcenter experience 1992-2002 Eur. Heart J., December 2, 2005; 26(24): 2630 - 2636. [Abstract] [Full Text] [PDF]

				K D Dawkins, T Gershlick, M de Belder, A Chauhan, G Venn, P Schofield, D Smith, J Watkins, H H Gray, and Joint Working Group on Percutaneous Coronary Inter Percutaneous coronary intervention: recommendations for good practice and training Heart, December 1, 2005; 91(suppl_6): vi1 - vi27. [Abstract] [Full Text] [PDF]

				G. W. Stone, N. J. Reifart, I. Moussa, A. Hoye, D. A. Cox, A. Colombo, D. S. Baim, P. S. Teirstein, B. H. Strauss, M. Selmon, et al. Percutaneous Recanalization of Chronically Occluded Coronary Arteries: A Consensus Document: Part II Circulation, October 18, 2005; 112(16): 2530 - 2537. [Full Text] [PDF]

				C.-C. Fang, Y. T. F. N. Jao, Y. Chen, and S.-P. Wang Coronary Stenting or Balloon Angioplasty for Chronic Total Coronary Occlusions: The Taiwan Experience (A Single-Center Report) Angiology, September 1, 2005; 56(5): 525 - 537. [Abstract] [PDF]

				L. Ge, I. Iakovou, J. Cosgrave, A. Chieffo, M. Montorfano, I. Michev, F. Airoldi, M. Carlino, G. Melzi, G. M. Sangiorgi, et al. Immediate and mid-term outcomes of sirolimus-eluting stent implantation for chronic total occlusions Eur. Heart J., June 1, 2005; 26(11): 1056 - 1062. [Abstract] [Full Text] [PDF]

				E. Jorgensen and H. Kelbaek Drug-eluting stents for chronic total occlusions make sense, but it is too early to close the discussion Eur. Heart J., June 1, 2005; 26(11): 1049 - 1051. [Full Text] [PDF]

				S Aziz and D R Ramsdale Chronic total occlusions--a stiff challenge requiring a major breakthrough: is there light at the end of the tunnel? Heart, June 1, 2005; 91(suppl_3): iii42 - iii48. [Full Text] [PDF]

				F Piscione, G Galasso, G De Luca, G Marrazzo, G Sarno, O Viola, D Accardo, and M Chiariello Late reopening of an occluded infarct related artery improves left ventricular function and long term clinical outcome Heart, May 1, 2005; 91(5): 646 - 651. [Abstract] [Full Text] [PDF]

				Authors/Task Force Members, S. Silber, P. Albertsson, F. F. Aviles, P. G. Camici, A. Colombo, C. Hamm, E. Jorgensen, J. Marco, J.-E. Nordrehaug, et al. Guidelines for Percutaneous Coronary Interventions: The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology Eur. Heart J., April 2, 2005; 26(8): 804 - 847. [Full Text] [PDF]

				G. S. Werner, A. Krack, G. Schwarz, D. Prochnau, S. Betge, and H. R. Figulla Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents J. Am. Coll. Cardiol., December 21, 2004; 44(12): 2301 - 2306. [Abstract] [Full Text] [PDF]

				J. P. Carrozza Jr and F. W. Sellke A 69-Year-Old Woman With Left Main Coronary Artery Disease JAMA, November 24, 2004; 292(20): 2506 - 2514. [Full Text] [PDF]

				K A McCaul, M S T Hobbs, M W Knuiman, J M Rankin, and I Gilfillan Trends in two year risk of repeat revascularisation or death from cardiovascular disease after coronary artery bypass grafting or percutaneous coronary intervention in Western Australia, 1980-2001 Heart, September 1, 2004; 90(9): 1042 - 1046. [Abstract] [Full Text] [PDF]

				A. Hoye, K. Tanabe, P. A. Lemos, J. Aoki, F. Saia, C. Arampatzis, M. Degertekin, S. H. Hofma, G. Sianos, E. McFadden, et al. Significant reduction in restenosis after the use of sirolimus-eluting stents in the treatment of chronic total occlusions J. Am. Coll. Cardiol., June 2, 2004; 43(11): 1954 - 1958. [Abstract] [Full Text] [PDF]

				G. S. Werner, U. Emig, O. Mutschke, G. Schwarz, P. Bahrmann, and H. R. Figulla Regression of Collateral Function After Recanalization of Chronic Total Coronary Occlusions: A Serial Assessment by Intracoronary Pressure and Doppler Recordings Circulation, December 9, 2003; 108(23): 2877 - 2882. [Abstract] [Full Text] [PDF]

				G. S. Werner, P. Bahrmann, O. Mutschke, U. Emig, S. Betge, M. Ferrari, and H. R. Figulla Determinants of target vessel failure in chronic total coronary occlusions after stent implantation: The influence of collateral function and coronary hemodynamics J. Am. Coll. Cardiol., July 16, 2003; 42(2): 219 - 225. [Abstract] [Full Text] [PDF]

				G. N. Levine, M. J. Kern, P. B. Berger, D. L. Brown, L. W. Klein, D. J. Kereiakes, T. A. Sanborn, A. K. Jacobs, and for the American Heart Association Diagnostic and Management of Patients Undergoing Percutaneous Coronary Revascularization Ann Intern Med, July 15, 2003; 139(2): 123 - 136. [Abstract] [Full Text] [PDF]

				G. S. Werner, B. M. Richartz, S. Heinke, M. Ferrari, and H. R. Figulla Impaired acute collateral recruitment as a possible mechanism for increased cardiac adverse events in patients with diabetes mellitus Eur. Heart J., June 2, 2003; 24(12): 1134 - 1142. [Abstract] [Full Text] [PDF]

				Z. Olivari, P. Rubartelli, F. Piscione, F. Ettori, A. Fontanelli, L. Salemme, C. Giachero, C. Di Mario, G. Gabrielli, L. Spedicato, et al. Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions: data from a multicenter, prospective, observational study (TOAST-GISE) J. Am. Coll. Cardiol., May 21, 2003; 41(10): 1672 - 1678. [Abstract] [Full Text] [PDF]

				J. M. Brophy, P. Belisle, and L. Joseph Evidence for Use of Coronary Stents: A Hierarchical Bayesian Meta-Analysis Ann Intern Med, May 20, 2003; 138(10): 777 - 786. [Abstract] [Full Text] [PDF]

				P. Rubartelli, E. Verna, L. Niccoli, C. Giachero, M. Zimarino, G. Bernardi, C. Vassanelli, L. Campolo, E. Martuscelli, and Gruppo Italiano di Studio sullo Stent nelle Occlus Coronary stent implantation is superior to balloon angioplasty for chronic coronary occlusions: Six-year clinical follow-up of the GISSOC trial J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1488 - 1492. [Abstract] [Full Text] [PDF]

				V. Dzavik, L.A. Sleeper, T.P. Cocke, M. Moscucci, J. Saucedo, S. Hosat, X. Jiang, J. Slater, T. LeJemtel, J.S. Hochman, et al. Early revascularization is associated with improved survival in elderly patients with acute myocardial infarction complicated by cardiogenic shock: a report from the SHOCK Trial Registry Eur. Heart J., May 1, 2003; 24(9): 828 - 837. [Abstract] [Full Text] [PDF]

				P. Urban, P. Serruys, D. Baumgart, A. Colombo, S. Silber, E. Eeckhout, A. Gershlick, K. Wegscheider, L. Verhees, R. Bonan, et al. A multicentre European registry of intraluminal coronary beta brachytherapy Eur. Heart J., April 1, 2003; 24(7): 604 - 612. [Abstract] [Full Text] [PDF]

				M. Haude, T. F.M. Konorza, U. Kalnins, A. Erglis, K. Saunamaki, H. D. Glogar, E. Grube, R. Gil, A. Serra, H. G. Richardt, et al. Heparin-Coated Stent Placement for the Treatment of Stenoses in Small Coronary Arteries of Symptomatic Patients Circulation, March 11, 2003; 107(9): 1265 - 1270. [Abstract] [Full Text] [PDF]

				A. Colombo, G. Stankovic, and J. W. Moses Selection of coronary stents J. Am. Coll. Cardiol., September 18, 2002; 40(6): 1021 - 1033. [Abstract] [Full Text] [PDF]

				H. C. Lowe, S. N. Oesterle, and L. M. Khachigian Coronary in-stent restenosis: Current status and future strategies J. Am. Coll. Cardiol., January 16, 2002; 39(2): 183 - 193. [Abstract] [Full Text] [PDF]

				D. L. Bhatt, M. E. Bertrand, P. B. Berger, P. L. L'Allier, I. Moussa, J. W. Moses, G. Dangas, M. Taniuchi, J. M. Lasala, D. R. Holmes, et al. Meta-analysis of randomized and registry comparisons of ticlopidine with clopidogrel after stenting J. Am. Coll. Cardiol., January 2, 2002; 39(1): 9 - 14. [Abstract] [Full Text] [PDF]

				R. Moer, Y. Myreng, P. Molstad, P. Albertsson, P.a. Gunnes, B. Lindvall, R. Wiseth, K. Ytre-Arne, J. Kjekshus, and S. Golf Stenting in small coronary arteries (SISCA) trial: A randomized comparison between balloon angioplasty and the heparin-coated beStent J. Am. Coll. Cardiol., November 15, 2001; 38(6): 1598 - 1603. [Abstract] [Full Text] [PDF]

				J.E.F Zwart-van Rijkom and B.A van Hout Cost-efficacy in interventional cardiology; results from the EPISTENT study Eur. Heart J., August 2, 2001; 22(16): 1476 - 1484. [Abstract] [PDF]

				C.V Patil, E Nikolsky, M Boulos, E Grenadier, and R Beyar Multivessel coronary artery disease: current revascularization strategies Eur. Heart J., July 2, 2001; 22(14): 1183 - 1197. [PDF]

				A. H Gershlick CORONARY DISEASE: Role of stenting in coronary revascularisation Heart, July 1, 2001; 86(1): 104 - 112. [Full Text] [PDF]

				D. E. Cutlip, D. S. Baim, K. K. L. Ho, J. J. Popma, A. J. Lansky, D. J. Cohen, J. P. Carrozza Jr, M. S. Chauhan, O. Rodriguez, and R. E. Kuntz Stent Thrombosis in the Modern Era : A Pooled Analysis of Multicenter Coronary Stent Clinical Trials Circulation, April 17, 2001; 103(15): 1967 - 1971. [Abstract] [Full Text] [PDF]

				G. S. Werner, B. M. Richartz, O. Gastmann, M. Ferrari, and H. R. Figulla Immediate Changes of Collateral Function After Successful Recanalization of Chronic Total Coronary Occlusions Circulation, December 12, 2000; 102(24): 2959 - 2965. [Abstract] [Full Text] [PDF]

				J.N. Hamburger and P.W. Serruys The battle of Vladimir Eur. Heart J., December 1, 2000; 21(23): 1911 - 1913. [PDF]

				C Lotan, Y Rozenman, A Hendler, Y Turgeman, O Ayzenberg, R Beyar, R Krakover, T Rosenfeld, and M.S Gotsman Stents in Total Occlusion for restenosis Prevention. The multicentre randomized STOP study Eur. Heart J., December 1, 2000; 21(23): 1960 - 1966. [Abstract] [PDF]

				P.J. De Feyter and D. Foley Coronary stent implantation: a panacea for the interventional cardiologist? Eur. Heart J., November 1, 2000; 21(21): 1719 - 1726. [PDF]

				R. Hoffmann and G.S. Mintz Coronary in-stent restenosis--predictors, treatment and prevention Eur. Heart J., November 1, 2000; 21(21): 1739 - 1749. [PDF]

				P.W Serruys, J.N Hamburger, J Fajadet, M Haude, H Klues, R Seabra-Gomes, T Corcos, C Hamm, L Pizzuli, B Meier, et al. Total occlusion trial with angioplasty by using laser guidewire. The TOTAL trial Eur. Heart J., November 1, 2000; 21(21): 1797 - 1805. [Abstract] [PDF]

				J. Al Suwaidi, P. B. Berger, and D. R. Holmes Jr Coronary Artery Stents JAMA, October 11, 2000; 284(14): 1828 - 1836. [Abstract] [Full Text] [PDF]

				W. J. Cantor, E. D. Peterson, J. J. Popma, J. P. Zidar, M. H. Sketch Jr., J. E. Tcheng, and E. M. Ohman Provisional stenting strategies: systematic overview and implications for clinical decision-making J. Am. Coll. Cardiol., October 1, 2000; 36(4): 1142 - 1151. [Abstract] [Full Text] [PDF]

				H. W. ROBERTS and S. W. REDDING CORONARY ARTERY STENTS: REVIEW AND PATIENT-MANAGEMENT RECOMMENDATIONS J Am Dent Assoc, June 1, 2000; 131(6): 797 - 801. [Abstract] [Full Text] [PDF]

				L. Gruberg, R. Mehran, G. Dangas, M. K. Hong, G. S. Mintz, R. Kornowski, A. J. Lansky, K. M. Kent, A. D. Pichard, L. F. Satler, et al. Effect of plaque debulking and stenting on short- and long-term outcomes after revascularization of chronic total occlusions J. Am. Coll. Cardiol., January 1, 2000; 35(1): 151 - 156. [Abstract] [Full Text] [PDF]

				J. M. Rankin, J. J. Spinelli, R. G. Carere, D. R. Ricci, I. M. Penn, J. D. Hilton, M. A. Henderson, R. I. Hayden, and C. E. Buller Improved Clinical Outcome after Widespread Use of Coronary-Artery Stenting in Canada N. Engl. J. Med., December 23, 1999; 341(26): 1957 - 1965. [Abstract] [Full Text] [PDF]

				A. K. Jacobs Coronary Stents -- Have They Fulfilled Their Promise? N. Engl. J. Med., December 23, 1999; 341(26): 2005 - 2006. [Full Text]

				J. Escaned, J. Goicolea, F. Alfonso, M. J. Perez-Vizcayno, R. Hernandez, A. Fernandez-Ortiz, C. Banuelos, and C. Macaya Propensity and mechanisms of restenosis in different coronary stent designs: Complementary value of the analysis of the luminal gain-loss relationship J. Am. Coll. Cardiol., November 1, 1999; 34(5): 1490 - 1497. [Abstract] [Full Text] [PDF]

				J. Schofer, T. Rau, M. Schluter, and D.G. Mathey Restenosis after stenting of matched occluded and non-occluded coronary arteries. Should there be a difference? Eur. Heart J., August 2, 1999; 20(16): 1175 - 1181. [Abstract] [PDF]

				C. E. Buller, V. Dzavik, R. G. Carere, G. B. J. Mancini, G. Barbeau, C. Lazzam, T. J. Anderson, M. L. Knudtson, J.-F. Marquis, T. Suzuki, et al. Primary Stenting Versus Balloon Angioplasty in Occluded Coronary Arteries : The Total Occlusion Study of Canada (TOSCA) Circulation, July 20, 1999; 100(3): 236 - 242. [Abstract] [Full Text] [PDF]

				D. R. Holmes Jr., J. Hirshfeld Jr., D. Faxon, R. Vlietstra, A. Jacobs, S. B. King III, T. M. Bashore, N. D. Bridges, C. B. Higgins, L. F. Hiratzka, et al. ACC expert consensus document on coronary artery stents: Document of the American College of Cardiology J. Am. Coll. Cardiol., November 1, 1998; 32(5): 1471 - 1482. [Full Text] [PDF]

				S. Goldberg and J. Aji Plaque Excision Combined With Stent Placement : Can a Poor "Finisher" Become a Good "Starter"? Circulation, October 20, 1998; 98(16): 1591 - 1593. [Full Text] [PDF]

				P. Rubartelli, L. Niccoli, E. Verna, C. Giachero, M. Zimarino, A. Fontanelli, C. Vassanelli, L. Campolo, E. Martuscelli, G. Tommasini, et al. Stent implantation versus balloon angioplasty in chronic coronary occlusions: results from the GISSOC trial J. Am. Coll. Cardiol., July 1, 1998; 32(1): 90 - 96. [Abstract] [Full Text] [PDF]

				M. E. Pfusterer, P. Buser, S. Osswald, P. Weiss, J. Bremerich, and F. Burkart Time dependence of left ventricular recovery after delayed recanalization of an occluded infarct-related coronary artery: findings of a pilot study J. Am. Coll. Cardiol., July 1, 1998; 32(1): 97 - 102. [Abstract] [Full Text] [PDF]

				D. R. Yu, R. Miller, and P. F. Bray Through Thick and Thin N. Engl. J. Med., June 4, 1998; 338(23): 1684 - 1687. [Full Text] [PDF]

				K K HAASE, A BAUMBACH, and K R KARSCH Stents are used too often Heart, June 1, 1998; 79(6): 541 - 542. [Full Text]

				C. R. Narins, D. R. Holmes Jr, and E. J. Topol A Call for Provisional Stenting : The Balloon Is Back! Circulation, April 7, 1998; 97(13): 1298 - 1305. [Full Text] [PDF]

				J Hancock, M R Thomas, S Holmberg, R J Wainwright, and D E Jewitt Randomised trial of elective stenting after successful percutaneous transluminal coronary angioplasty of occluded coronary arteries Heart, January 1, 1998; 79(1): 18 - 23. [Abstract] [Full Text] [PDF]

				I. Moussa, B. Reimers, J. Moses, C. Di Mario, L. Di Francesco, M. Ferraro, and A. Colombo Long-term Angiographic and Clinical Outcome of Patients Undergoing Multivessel Coronary Stenting Circulation, December 2, 1997; 96(11): 3873 - 3879. [Abstract] [Full Text]

				Stents Better in Chronic Occlusions Journal Watch Cardiology, January 27, 1997; 1997(127): 5 - 5. [Full Text]