CLINICAL STUDIES
Angiographic and clinical outcome following coronary stenting of small vessels
A comparison with coronary stenting of large vessels
Tatsuro Akiyama, MD*,
Issam Moussa, MD ,
Bernhard Reimers, MD*,
Massimo Ferraro, RT*,
Yoshio Kobayashi, MD*,
Simonetta Blengino, MD*,
Lucia Di Francesco, PhD*,
Leo Finci, MD*,
Carlo Di Mario, MD, PhD, FACC* and
Antonio Colombo, MD, FACC*
* Centro Cuore Columbus, Milan, Italy
Lenox Hill Hospital, New York, New York, USA
Manuscript received December 10, 1997;
revised manuscript received July 1, 1998,
accepted July 29, 1998.
Address for correspondence: Dr. Antonio Colombo, Centro Cuore Columbus, Via M. Buonarotti 48, 20145 Milan, Italy
Objectives. Stent implantation reduces restenosis in vessels  3 mm compared with balloon angioplasty, but few data are available for stents implanted in vessels <3 mm. The aim of this study was to evaluate immediate and follow-up patient outcomes after stent implantation in vessels <3 mm compared to stent implantation in vessels 3 mm.
Methods. Between March 1993 and May 1996, a total of 1,298 consecutive patients (1,673 lesions) underwent coronary stenting. The study population was divided into two groups based on angiographic vessel diameter. In case of multivessel stenting, patients were randomly assigned only one lesion. Group I included 696 patients (696 lesions) in whom stents were implanted in vessels 3 mm, and group II included 602 patients (602 lesions) in whom stents were implanted in vessels <3 mm.
Results. There was no difference in procedural success (95.4% in group I and 95.9% in group II), or subsequent subacute stent thrombosis (1.5% in group I and 1.4% in group II, p = NS). The postprocedure residual diameter stenosis was 3.31 ± 12.4% in group I and –2.45 ± 16.2% in group II. Angiographic follow-up was performed in 75% of patients, restenosis occurred in 19.9% of patients in group I and 32.6% in group II (p <0.0001). Absolute lumen gain was significantly higher in group I compared to group II, but absolute late lumen loss was similar in the two groups (1.05 ± 0.91 mm in group I vs. 1.11 ± 0.85 mm in group II, p = NS). Subsequently, the loss index was more favorable in group I (0.45 vs. 0.56; p = 0.0006). Independent predictors of freedom from restenosis by multivariate logistic regression in the total population were: larger baseline reference diameter (odds ratio 2.032 p = 0.006), larger postprocedure minimal stent cross-sectional area (odds ratio 1.190, p = 0.0001) and shorter lesions (odds ratio 1.037, p = 0.01). At long-term clinical follow-up, patients with small vessels had a lower rate of event-free survival (63% vs. 71.3%, p = 0.007).
Conclusions. Coronary stenting can be performed in small vessels with a high success rate and low incidence of stent thrombosis. However, the long-term angiographic and clinical outcome of patients undergoing stent implantation in small vessels is less favorable than that of patients with large vessels.
|
Abbreviations and Acronyms
| | ACT | = activated clotting time | | CABG | = coronary artery bypass graft surgery | | CI | = confidence interval | | CSA | = cross-sectional area | | ECG | = electrocardiogram | | IVUS | = intravascular ultrasound | | MI | = myocardial infarction | | MLD | = minimum lumen diameter | | PTCA | = percutaneous transluminal coronary angioplasty | | TIMI | = thrombolysis in myocardial infarction |
|
This article has been cited by other articles:
|
|
|
|
 
M. J. Zaman, A. M. Crook, C. Junghans, N. K. Fitzpatrick, G. Feder, A. D. Timmis, and H. Hemingway
Ethnic differences in long-term improvement of angina following revascularization or medical management: a comparison between south Asians and white Europeans
J. Public Health Med.,
March 1, 2009;
31(1):
168 - 174.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. I. Levy, J. Mocco, R. M. Samuelson, R. D. Ecker, B. S. Jahromi, and L. N. Hopkins
Optimal treatment of carotid artery disease.
J. Am. Coll. Cardiol.,
March 11, 2008;
51(10):
979 - 985.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. O. Jensen, P. Thayssen, L. Thuesen, H. S. Hansen, J. F. Lassen, H. Kelbaek, A. Junker, K. N. Hansen, H. E. Boetker, L. R. Krusell, et al.
Influence of a Pressure Gradient Distal to Implanted Bare-Metal Stent on In-Stent Restenosis After Percutaneous Coronary Intervention
Circulation,
December 11, 2007;
116(24):
2802 - 2808.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. Ardissino, C. Cavallini, E. Bramucci, C. Indolfi, A. Marzocchi, A. Manari, G. Angeloni, G. Carosio, E. Bonizzoni, S. Colusso, et al.
Sirolimus-Eluting vs Uncoated Stents for Prevention of Restenosis in Small Coronary Arteries: A Randomized Trial
JAMA,
December 8, 2004;
292(22):
2727 - 2734.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Sonoda, Y. Morino, J. Ako, M. Terashima, A. H. M. Hassan, H. N. Bonneau, M. B. Leon, J. W. Moses, P. G. Yock, Y. Honda, et al.
Impact of final stent dimensions on long-term results following sirolimus-eluting stent implantation: Serial intravascular ultrasound analysis from the sirius trial
J. Am. Coll. Cardiol.,
June 2, 2004;
43(11):
1959 - 1963.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Moreno, C. Fernandez, F. Alfonso, R. Hernandez, M. J. Perez-Vizcayno, J. Escaned, M. Sabate, C. Banuelos, D. J. Angiolillo, L. Azcona, et al.
Coronary stenting versus balloon angioplasty in small vessels: A meta-analysis from 11 randomized studies
J. Am. Coll. Cardiol.,
June 2, 2004;
43(11):
1964 - 1972.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Matsuura, J. Kobayashi, O. Tagusari, K. Bando, K. Niwaya, H. Nakajima, T. Yagihara, and S. Kitamura
Rationale for off-pump coronary revascularization to small branches--angiographic study of 1,283 anastomoses in 408 patients
Ann. Thorac. Surg.,
May 1, 2004;
77(5):
1530 - 1534.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
Y.-H. Chen, L.-Y. Chau, M.-W. Lin, L.-C. Chen, M.-H. Yo, J.-W. Chen, and S.-J. Lin
Heme oxygenase-1 gene promotor microsatellite polymorphism is associated with angiographic restenosis after coronary stenting
Eur. Heart J.,
January 1, 2004;
25(1):
39 - 47.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. W. Moses, M. B. Leon, J. J. Popma, P. J. Fitzgerald, D. R. Holmes, C. O'Shaughnessy, R. P. Caputo, D. J. Kereiakes, D. O. Williams, P. S. Teirstein, et al.
Sirolimus-Eluting Stents versus Standard Stents in Patients with Stenosis in a Native Coronary Artery
N. Engl. J. Med.,
October 2, 2003;
349(14):
1315 - 1323.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. Mehilli, A. Kastrati, H. Bollwein, A. Dibra, H. Schuhlen, J. Dirschinger, and A. Schomig
Gender and restenosis after coronary artery stenting
Eur. Heart J.,
August 2, 2003;
24(16):
1523 - 1530.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
K. Kwon, D. Choi, S.-H. Choi, Bon Kwon Koo, Y. Jang, W.-H. Shim, and S.-Y. Cho
Coronary Stenting After Rotational Atherectomy in Diffuse Lesions of the Small Coronary Artery: Comparison with Balloon Angioplasty Before Stenting
Angiology,
July 1, 2003;
54(4):
423 - 431.
[Abstract]
[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]
|
|
|
|
|
|
|
C. Briguori, C. Sarais, P. Pagnotta, F. Liistro, M. Montorfano, A. Chieffo, F. Sgura, N. Corvaja, R. Albiero, G. Stankovic, et al.
In-stent restenosis in small coronary arteries: Impact of strut thickness
J. Am. Coll. Cardiol.,
August 7, 2002;
40(3):
403 - 409.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. E. Ajani, R. Waksman, D.-H. Cha, L. Gruberg, L. F. Satler, A. D. Pichard, and K. M. Kent
The impact of lesion length and reference vessel diameter on angiographic restenosis and target vessel revascularization in treating in-stent restenosis with radiation
J. Am. Coll. Cardiol.,
April 17, 2002;
39(8):
1290 - 1296.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Haude and R. Erbel
How big is small?
Eur. Heart J.,
February 1, 2002;
23(3):
198 - 199.
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Briguori, J. Tobis, T. Nishida, M. Vaghetti, R. Albiero, C. Di Mario, and A. Colombo
Discrepancy between angiography and intravascular ultrasound when analysing small coronary arteries
Eur. Heart J.,
February 1, 2002;
23(3):
247 - 254.
[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]
|
|
|
|
|
|
|
A. Kastrati, H. Schuhlen, and A. Schomig
Stenting for small coronary vessels: a contestable winner
J. Am. Coll. Cardiol.,
November 15, 2001;
38(6):
1604 - 1607.
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Doucet, M. J. Schalij, M. C.M. Vrolix, D. Hilton, P. Chenu, B. de Bruyne, W. Udayachalerm, A. Seth, L. Bilodeau, J. H.C. Reiber, et al.
Stent Placement to Prevent Restenosis After Angioplasty in Small Coronary Arteries
Circulation,
October 23, 2001;
104(17):
2029 - 2033.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Koning, H. Eltchaninoff, P. Commeau, K. Khalife, M. Gilard, J. Lipiecki, P. Coste, M. Bedossa, T. Lefevre, P. Brunel, et al.
Stent Placement Compared With Balloon Angioplasty for Small Coronary Arteries: In-Hospital and 6-Month Clinical and Angiographic Results
Circulation,
October 2, 2001;
104(14):
1604 - 1608.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. Mudra, C. di Mario, P. de Jaegere, H. R. Figulla, C. Macaya, R. Zahn, B. Wennerblom, W. Rutsch, V. Voudris, E. Regar, et al.
Randomized Comparison of Coronary Stent Implantation Under Ultrasound or Angiographic Guidance to Reduce Stent Restenosis (OPTICUS Study)
Circulation,
September 18, 2001;
104(12):
1343 - 1349.
[Abstract]
[Full Text]
[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]
|
|
|
|
|
|
|
M.Y Salame, S Verheye, I.R Crocker, N.A.F Chronos, K.A Robinson, and S.B King III
Intracoronary radiation therapy
Eur. Heart J.,
April 2, 2001;
22(8):
629 - 647.
[PDF]
|
|
|
|
|
|
|
A. Kastrati, A. Schomig, J. Dirschinger, J. Mehilli, F. Dotzer, N. von Welser, and F.-J. Neumann
A Randomized Trial Comparing Stenting With Balloon Angioplasty in Small Vessels in Patients With Symptomatic Coronary Artery Disease
Circulation,
November 21, 2000;
102(21):
2593 - 2598.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Roguin and R. Beyar
Small vessel stenting is safe, but still waiting for a well-proven antirestenotic effect
Eur. Heart J.,
November 1, 2000;
21(21):
1732 - 1734.
[PDF]
|
|
|
|
|
|
|
S.-W Park, C.W Lee, M.-K Hong, J.-J Kim, G.-Y Cho, D.-Y Nah, and S.-J Park
Randomized comparison of coronary stenting with optimal balloon angioplasty for treatment of lesions in small coronary arteries
Eur. Heart J.,
November 1, 2000;
21(21):
1785 - 1789.
[Abstract]
[PDF]
|
|
|
|
|
|
|
C Di Mario, F Marsico, M Adamian, E Karvouni, R Albiero, and A Colombo
New recipes for in-stent restenosis: cut, grate, roast, or sandwich the neointima?
Heart,
November 1, 2000;
84(5):
471 - 475.
[Full Text]
|
|
|
|
|
|
|
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]
|
|
|
|
|
|
|
S. E. Kimmel, A. R. Localio, C. Brensinger, C. Miles, J. Hirshfeld, H. L. Haber, and B. L. Strom
Effects of Coronary Stents on Cardiovascular Outcomes in Broad-Based Clinical Practice
Arch Intern Med,
September 25, 2000;
160(17):
2593 - 2599.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C M Gross, J Kramer, O Weingartner, F Uhlich, R Dietz, and J Waigand
Clinical and angiographic outcome in patients with in-stent restenosis and repeat target lesion revascularisation in small coronary arteries
Heart,
September 1, 2000;
84(3):
307 - 313.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. H. Baron, A. H. Gershlick, K. Hogrefe, J. Armstrong, C. M. Holt, R. K. Aggarwal, M. Azrin, M. Ezekowitz, and D. P. de Bono
In vitro evaluation of c7E3-Fab (ReoProTM) eluting polymer-coated coronary stents
Cardiovasc Res,
June 1, 2000;
46(3):
585 - 594.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. E. Chambers, S. T Riebel, and M. Kozak
Interventional Cardiology: Advances in Percutaneous Techniques for the Treatment of Cardiac Disease
Seminars in Cardiothoracic and Vascular Anesthesia,
July 1, 1999;
3(2):
109 - 125.
[Abstract]
[PDF]
|
|
|
|
