CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY
Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents
Gerald S. Werner, MD, FACC*,
Andreas Krack, MD,
Gero Schwarz, MD,
Dirk Prochnau, MD,
Stefan Betge, MD and
Hans R. Figulla, MD
Clinic for Internal Medicine I, Friedrich-Schiller University Jena, Jena, Germany
Manuscript received July 26, 2004;
accepted September 7, 2004.
* Reprint requests and correspondence: Dr. Gerald S. Werner, Klinik für Innere Medizin I, Friedrich-Schiller-Universität, Erlanger Allee 101, D-07740 Jena, Germany
(Email: gerald.werner{at}med.uni-jena.de).
OBJECTIVES: The aim of this research was to assess the efficacy of paclitaxel-eluting stents in chronic total coronary occlusions (CTO).
BACKGROUND: Percutaneous coronary interventions for CTOs are characterized by a high target vessel failure rate.
METHODS: In 48 consecutive patients, paclitaxel-eluting stents (Taxus, Boston Scientific Corp., Natick, Massachusetts) were implanted after successful recanalization of a CTO (duration >2 weeks). Patients underwent an angiography after 6 months and were followed clinically for 12 months. They were compared with 48 lesion- and risk-matched patients with CTOs treated with bare metal stents (BMS). Primary clinical end point was the one-year incidence of major adverse cardiac events (MACE) (death, myocardial infarction, repeat revascularization); secondary end points were the rate of restenosis and re-occlusion.
RESULTS: In-hospital MACE was 4.2% with Taxus, and 2.1% with BMS (p = NS). The one-year MACE rate was 12.5% in the Taxus group, and 47.9% in the BMS group (p < 0.001), which was due to a reduced need for repeat revascularization. The angiographic restenosis rate was 8.3% with Taxus versus 51.1% with BMS (p < 0.001). There was only one late re-occlusion with Taxus (2.1%) as compared with 23.4% with BMS (p < 0.005). The late loss was reduced in the Taxus group by 84% as compared with BMS. All nonocclusive restenoses in the Taxus group were focal and successfully treated by implanting an additional Taxus stent.
CONCLUSIONS: The treatment of CTOs with a paclitaxel-eluting stent drastically reduces MACE and restenosis, and almost eliminates re-occlusion, which is typically frequent with BMS in CTOs. Chronic total coronary occlusion should be a preferred indication for drug-eluting stents.
|
Abbreviations and Acronyms
| | BMS = bare metal stent | | CTO = chronic total coronary occlusion | | LV = left ventricle/ventricular | | MACE = major adverse cardiac event | | MI = myocardial infarction | | MLD = minimum luminal diameter | | PCI = percutaneous coronary intervention | | TLR = target lesion revascularization | | TVF = target vessel failure |
|
This article has been cited by other articles:
|
|
|
|
 
K. Tsujita, A. Maehara, G. S. Mintz, T. Kubo, H. Doi, A. J. Lansky, G. W. Stone, J. W. Moses, M. B. Leon, and M. Ochiai
Intravascular Ultrasound Comparison of the Retrograde Versus Antegrade Approach to Percutaneous Intervention for Chronic Total Coronary Occlusions
J. Am. Coll. Cardiol. Intv.,
September 1, 2009;
2(9):
846 - 854.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Valenti, A. Migliorini, U. Signorini, R. Vergara, G. Parodi, N. Carrabba, G. Cerisano, and D. Antoniucci
Impact of complete revascularization with percutaneous coronary intervention on survival in patients with at least one chronic total occlusion
Eur. Heart J.,
October 1, 2008;
29(19):
2336 - 2342.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. S.H. Cheng, J. B. Selvanayagam, M. Jerosch-Herold, W. J. van Gaal, T. D. Karamitsos, S. Neubauer, and A. P. Banning
Percutaneous treatment of chronic total coronary occlusions improves regional hyperemic myocardial blood flow and contractility insights from quantitative cardiovascular magnetic resonance imaging.
J. Am. Coll. Cardiol. Intv.,
February 1, 2008;
1(1):
44 - 53.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Colombo and A. Chieffo
Drug-Eluting Stent Update 2007: Part III: Technique and Unapproved/Unsettled Indications (Left Main, Bifurcations, Chronic Total Occlusions, Small Vessels and Long Lesions, Saphenous Vein Grafts, Acute Myocardial Infarctions, and Multivessel Disease)
Circulation,
September 18, 2007;
116(12):
1424 - 1432.
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. Prasad, C. S. Rihal, R. J. Lennon, H. J. Wiste, M. Singh, and D. R. Holmes Jr
Trends in Outcomes After Percutaneous Coronary Intervention for Chronic Total Occlusions: A 25-Year Experience From the Mayo Clinic
J. Am. Coll. Cardiol.,
April 17, 2007;
49(15):
1611 - 1618.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Di Giammarco, M. Pano, M. Giancane, A. Di Francesco, and M. Di Mauro
Off-Pump Revascularization of Chronically Occluded Left Anterior Descending Artery Through Left Anterior Small Thoracotomy: Early and Late Angiographic and Clinical Follow-Up.
Ann. Thorac. Surg.,
October 1, 2006;
82(4):
1446 - 1450.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. J. Suttorp, G. J. Laarman, B. M. Rahel, J. C. Kelder, M. A.R. Bosschaert, F. Kiemeneij, J. M. ten Berg, E. T. Bal, B. J. Rensing, F. D. Eefting, et al.
Primary Stenting of Totally Occluded Native Coronary Arteries II (PRISON II): A Randomized Comparison of Bare Metal Stent Implantation With Sirolimus-Eluting Stent Implantation for the Treatment of Total Coronary Occlusions
Circulation,
August 29, 2006;
114(9):
921 - 928.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. T.L. Ong and P. W. Serruys
Complete Revascularization: Coronary Artery Bypass Graft Surgery Versus Percutaneous Coronary Intervention
Circulation,
July 18, 2006;
114(3):
249 - 255.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. Zimarino, A. Ausiello, G. Contegiacomo, I. Riccardi, G. Renda, C. Di Iorio, and R. De Caterina
Rapid Decline of Collateral Circulation Increases Susceptibility to Myocardial Ischemia: The Trade-Off of Successful Percutaneous Recanalization of Chronic Total Occlusions
J. Am. Coll. Cardiol.,
July 4, 2006;
48(1):
59 - 65.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
D. M Safley, J. A House, B. D Rutherford, and S. P Marso
Success rates of percutaneous coronary intervention of chronic total occlusions and long-term survival in patients with diabetes mellitus
Diabetes and Vascular Disease Research,
May 1, 2006;
3(1):
45 - 51.
[Abstract]
[PDF]
|
|
|
|
|
|
|
A. Hoye, R. T. van Domburg, K. Sonnenschein, and P. W. Serruys
Percutaneous coronary intervention for chronic total occlusions: the Thoraxcenter experience 1992-2002
Eur. Heart J.,
December 2, 2005;
26(24):
2630 - 2636.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. W. Stone, N. J. Reifart, I. Moussa, A. Hoye, D. A. Cox, A. Colombo, D. S. Baim, P. S. Teirstein, B. H. Strauss, M. Selmon, et al.
Percutaneous Recanalization of Chronically Occluded Coronary Arteries: A Consensus Document: Part II
Circulation,
October 18, 2005;
112(16):
2530 - 2537.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. Ge, I. Iakovou, J. Cosgrave, A. Chieffo, M. Montorfano, I. Michev, F. Airoldi, M. Carlino, G. Melzi, G. M. Sangiorgi, et al.
Immediate and mid-term outcomes of sirolimus-eluting stent implantation for chronic total occlusions
Eur. Heart J.,
June 1, 2005;
26(11):
1056 - 1062.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Jorgensen and H. Kelbaek
Drug-eluting stents for chronic total occlusions make sense, but it is too early to close the discussion
Eur. Heart J.,
June 1, 2005;
26(11):
1049 - 1051.
[Full Text]
[PDF]
|
|
|
|
|
|
|
W. W. O'Neill, S. R. Dixon, and C. L. Grines
The year in interventional cardiology
J. Am. Coll. Cardiol.,
April 5, 2005;
45(7):
1117 - 1134.
[Full Text]
[PDF]
|
|
|
|
|
|
|
Authors/Task Force Members, S. Silber, P. Albertsson, F. F. Aviles, P. G. Camici, A. Colombo, C. Hamm, E. Jorgensen, J. Marco, J.-E. Nordrehaug, et al.
Guidelines for Percutaneous Coronary Interventions: The Task Force for Percutaneous Coronary Interventions of the European Society of Cardiology
Eur. Heart J.,
April 2, 2005;
26(8):
804 - 847.
[Full Text]
[PDF]
|
|
|
|
