CLINICAL STUDIES
Stent implantation versus balloon angioplasty in chronic coronary occlusions: results from the GISSOC trial
Paolo Rubartelli, MDa,
Luigi Niccoli, MD*,
Edoardo Verna, MD ,
Corinna Giachero, MDa,
Marco Zimarino, MD ,
Alessandro Fontanelli, MD ,
Corrado Vassanelli, MD||,
Luigi Campolo, MD¶,
Eugenio Martuscelli, MD#,
Giorgio Tommasini, MD** for the Gruppo Italiano di Studio sullo Stent nelle Occlusioni Coronariche (GISSOC)
a Ospedale San Martino, Genoa, Italy
* Spedali Civili, Brescia, Italy
Ospedale di Circolo, Varese, Italy
Ospedale Calai, Gualdo Tadino, Italy
Ospedale Santa Maria della Misericordia, Udine, Italy
|| Ospedale Policlinico, Verona, Italy
¶ Ospedale Niguarda, Milan, Italy
# Policlinico Umberto 1, Rome, Italy
** Ospedale Maggiore, Treviglio, Italy
Manuscript received September 12, 1997;
revised manuscript received March 3, 1998,
accepted March 16, 1998.
Address for correspondence: Dr. Paolo Rubartelli, II Divisione di Cardiologia, Ospedale San Martino, 16132 Genoa, Italy
prubartelli{at}smartino.ge.it
Objectives. In this multicenter, randomized trial we evaluated whether stent implantation after successful recanalization of a chronic coronary occlusion reduced the incidence of restenosis.
Background. Percutaneous transluminal coronary angioplasty (PTCA) in chronic total occlusions is associated with a higher rate of angiographic restenosis and reocclusion than PTCA in subtotal stenoses. Preliminary reports have suggested a decreased restenosis rate after stent implantation in coronary total occlusions.
Methods. We randomly assigned 110 patients with recanalized total occlusion to Palmaz-Schatz stent implantation, followed by 1 month of anticoagulant therapy versus no other treatment. The primary end point was the minimal lumen diameter (MLD) of the treated segment at follow-up, as determined by quantitative angiography at a core laboratory.
Results. Repeat coronary angiography was performed 9 months after the procedure in 88% of patients. The MLD (mean ± SD) at follow-up was 1.74 ± 0.88 mm in patients assigned to stent implantation and 0.85 ± .75 mm in patients assigned to PTCA (p < 0.001). Stent implantation was associated with a lower incidence of restenosis (defined as diameter stenosis  50% at follow-up) (32% vs. 68%, p < 0.001) and reocclusion (8% vs. 34%, p = 0.003) than balloon PTCA. Likewise, stent-treated patients had less recurrent ischemia (14% vs. 46%, p = 0.002) and target lesion revascularization (5.3% vs. 22%, p = 0.038), but experienced a longer hospital stay.
Conclusions. Palmaz-Schatz stent implantation after successful balloon PTCA of chronic total occlusions improves the midterm angiographic and clinical outcome and could be the preferred treatment option in selected patients with occluded vessels.
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Abbreviations and Acronyms
| | BENESTENT | = Belgium and Netherland Stent study | | DS | = diameter stenosis | | GISSOC | = Gruppo Italiano di Studio sullo Stent nelle Occlusioni Coronariche | | MLD | = minimal lumen diameter | | PTCA | = percutaneous transluminal coronary angioplasty | | RD | = reference diameter | | SICCO | = Stenting in Chronic Coronary Occlusions | | STRESS | = Stent Restenosis Study | | TIMI | = Thrombolysis in Myocardial Infarction |
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