CLINICAL STUDIES
A randomized trial of elective stenting after balloon recanalization of chronic total occlusions
Martin Höher, MD*,
Jochen Wöhrle, MD*,
Olaf C. Grebe*,
Matthias Kochs, MD*,
Hans-H. Osterhues, MD*,
Vinzenz Hombach, MD* and
Arnd B. Buchwald, MD
* Department of Cardiology, University of Ulm, Ulm, Germany
Department of Cardiology, University of Göttingen, Göttingen, Germany
Manuscript received December 17, 1998;
revised manuscript received March 25, 1999,
accepted May 10, 1999.
Reprint requests and correspondence: Dr. Martin Höher, Department of Cardiology, University of Ulm, Robert-Koch-Straße 8, 89081 Ulm, Germany
martin.hoeher{at}medizin.uni-ulm.de
OBJECTIVES
The aim of this study was to assess the role of Wiktor stent implantation after recanalization of chronic total coronary occlusions with regard to the clinical and angiographic outcome after six months.
BACKGROUND
Beside the common use of stents in clinical practice, the number of stent indications proven by randomized trials is still limited.
METHODS
Eighty-five patients with a thrombolysis in myocardial infarction grade 0 chronic coronary occlusion were examined. After standard balloon angioplasty, the patients were randomly assigned to stent implantation, or percutaneous transluminal coronary angioplasty (PTCA) alone (no further intervention). Quantitative coronary angiography was performed at baseline and after six months.
RESULTS
The minimal lumen diameter did not differ immediately after recanalization (stent group 1.61 ± 0.30 mm vs. PTCA group 1.65 ± 0.36 mm), and increased after stent implantation to 2.51 ± 0.41 mm. After six months, the stent group still had a significantly greater lumen (1.57 ± 0.59 vs. 1.06 ± 0.90 mm; p < 0.01) and a significantly lower restenosis and reocclusion rate (32% and 3%) compared with the PTCA group (64% and 24%); restenosis analysis according to treatment was 72% (PTCA) versus 29% (stent, p < 0.01). Late loss was equal in both groups. At follow-up, the stent patients had a better angina class (p < 0.01), and fewer cardiac events (p < 0.03). A meta-analysis including this trial and three other controlled trials with the Palmaz-Schatz stent showed concordant results.
CONCLUSIONS
Stent implantation after reopening of a chronic total occlusion provides a better angiographic result, corresponding to a better clinical outcome with fewer recurrence of symptoms and reinterventions after six months.
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Abbreviations and Acronyms
| | BENESTENT | = Belgium Netherlands Stent Trial | | CCS | = Canadian Cardiovascular Society | | GISSOC | = Gruppo Italiano di Studio sullo Stent nelle Occlusioni Coronariche | | LAD | = left anterior descending artery | | MLD | = minimal luminal diameter | | PTCA | = percutaneous transluminal coronary angioplasty | | RCA | = right coronary artery | | RD | = reference diameter | | SICCO | = Stenting in chronic coronary occlusion | | SPACTO | = Stent versus PTCA after recanalization of chronic total occlusions | | STRESS | = Stent Restenosis Study | | TIMI | = thrombolysis in myocardial infarction |
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