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CLINICAL STUDIES

Stented segment length as an independent predictor of restenosis

^a Centro Cuore Columbus, Via Buonarroti 48, 20145 Milan, Italy

Manuscript received April 20, 1998; revised manuscript received March 19, 1999, accepted June 3, 1999.

Reprint requests and correspondence: Dr. Antonio Colombo, Centro Cuore Columbus, Via Buonarroti 48, 20145 Milan, Italy
columbus{at}micronet.it

OBJECTIVES

We sought to evaluate the relation between stented segment length and restenosis.

BACKGROUND

Multiple or long coronary stents are now being implanted in long lesions or in tandem lesions. A longer stented segment might result in a higher probability of restenosis. However, there is little information available on the relation between stented segment length and restenosis.

METHODS

Between April 1995 and December 1996, 725 patients with 1,090 lesions underwent stenting. Lesions were divided into three groups according to the length of the stented segment: 1) group I (n = 565): stented segment length 20 mm; 2) group II (n = 278): stented segment length >20 but 35 mm; and 3) group III (n = 247): stented segment length >35 mm.

RESULTS

There was no significant difference in the incidence of subacute stent thrombosis among the three groups (0.4% in group I, 0.4% in group II, 1.2% in group III; p = NS). The minimal lumen diameter (MLD) after stenting was greater in group I than in group III (3.04 ± 0.60 mm in group I, 3.01 ± 0.54 mm in group II, 2.91 ± 0.58 mm in group III; p < 0.05). At follow up, a smaller MLD was observed in group III as compared with group I and group II (2.04 ± 0.93 mm in group I, 1.92 ± 1.00 mm in group II, 1.47 ± 0.97 mm in group III; p < 0.01). The restenosis rates were 23.9% in group I, 34.6% in group II and 47.2% in group III (p < 0.01). Using multivariate analysis, the longer stented segment, the angiographic reference vessel diameter and the percent diameter stenosis after stenting were independent predictors of restenosis.

CONCLUSIONS

The present study shows that a longer stented segment is an independent predictor of restenosis without an influence on the risk of subacute thrombosis.

Abbreviations and Acronyms   ACC/AHA = American College of Cardiology/American Heart Association   IVUS = intravascular ultrasound   MLD = minimal lumen diameter   PTCA = percutaneous transluminal coronary angioplasty   TIMI = Thrombolysis in Myocardial Infarction

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