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J Am Coll Cardiol, 2004; 43:1954-1958, doi:10.1016/j.jacc.2004.01.045 © 2004 by the American College of Cardiology Foundation |
* Department of Interventional Cardiology, Erasmus MC, Rotterdam, the Netherlands
Manuscript received October 29, 2003; revised manuscript received January 15, 2004, accepted January 19, 2004.
* Reprint requests and correspondence: Dr. Patrick W. Serruys, Department of Interventional Cardiology, Thoraxcentre Bd 404, Dr Molewaterplein 40, NL-3015 GD Rotterdam, the Netherlands.
p.w.j.c.serruys{at}erasmusmc.nl
OBJECTIVES: The aim of this study was to assess sirolimus-eluting stent (SES) implantation for the treatment of chronic total coronary occlusions (CTO).
BACKGROUND: Long-term results after percutaneous coronary intervention (PCI) in the treatment of CTOs is hindered by a significant rate of restenosis and reocclusion. In the treatment of relatively simple nonocclusive lesions, SESs have shown dramatically reduced restenosis rates compared with bare metal stents (BMS), but whether these results are more widely applicable is unknown.
METHODS: From April 2002, all patients at our institution were treated with SES as the device of choice during PCI. During the first six months, 563 patients were treated solely with SES, with treatment of a de novo CTO in 56 (9.9%). This CTO cohort was compared with a similar group of patients (n = 28) treated in the preceding six-month period with BMS.
RESULTS: At one year, the cumulative survival-free of major adverse cardiac events was 96.4% in the SES group versus 82.8% in the BMS group, p < 0.05. At six-month follow-up, 33 (59%) patients in the SES group underwent angiography with a binary restenosis rate (>50% diameter stenosis) of 9.1% and in-stent late loss of 0.13 ± 0.46 mm. One patient (3.0%) at follow-up was found to have reoccluded the target vessel.
CONCLUSIONS: The use of SESs in the treatment of chronic total coronary occlusions is associated with a reduction in the rate of major adverse cardiac events and restenosis compared with BMS.
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