Sirolimus-Eluting Stent in the Prevention of Restenosis in Small Coronary Arteries

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Published Jun 22, 2010
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Vol. 88 No. 7 (2010): Issue Jul 2010

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Dhaker Lahidheb
Wafa Fehri
Nadhem Hajlaoui
Imen Saaidi
Abdedayem Haggui
Thouraya FILALI
Othman Salah
Nadia Barakett
Hedi Mhenni
Habib Haouala

Abstract

Background: Angioplasty of coronary arteries with a small diameter (commonly defined as diameter inferior than 2.75 mm) is associated with a high rate of restenosis and revascularization. Since the use of Drug Eluting Stents (DES) and considering their good results on simple lesions compared to other techniques (balloon dilation and bare metal stents), many studies have also demonstrated the superiority of DES in reducing restenosis and revascularization of complex lesions in particular lesions on coronary arteries with small diameter.
Aim : Assessement of this revascularization procedure.
Methods: Our study is a prospective one carried on between june 2002 and august 2006, involving a cohort of 299 patients. Patients are divided into 2 groups: group I: 175 patients with 220 lesions on coronary arteries with small diameter treated by 233 sirolimus DES (Cypher) and group II: 124 patients treated by 136 angioplasty of coronary arteries with diameter superior than 2.75 mm using 179 DES.
Results: During hospitalisation, there was no significant difference in MACE between the 2 groups. Nevertheless, 2 patients among the first group had no angioplasty because of unsuccessful progression of the balloon through the lesion and the absence of atherectomy in our center. All patients having acute thrombosis during hospitalization and presenting with ST elevated acute coronary syndrom had successful urgent revascularization with TIMI 3 flow.
The mid-term follow-up (12 months) concerned 157/174 patients in group I and 113/123 patients in group II. We observed a higher mortality and non fatal myocardial infarction in group I without statistically significant difference.
Conclusion: despite the complexity of the lesions on coronary arteries with small diameter and despite the association with several risk factors in particular diabetes, the use of DES reduces the MACE specially secondary revascularisations thus improving early and midterm prognosis.

Keywords:

Coronary artery disease, coronary stent, coronary angioplasty, drug eluting stent

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References

  1. B.Chevalier et col , De l'usage des endoprothéses coronaires. Archives des maladies du coeur et des vaisseaux, 2003; 96 :
  2. Foley DP, Melkert R, Serruys PW. Influence of coronary vessel size on renarrowing process and late angiographic outcome after successfuil balloon angioplasty. Circulation 1994 ; 90 :1239-51
  3. Kimball PB, Cohen EA, Adelman AG et al. Influence of stenotic lesion morphology on immediate and long-term (6 months) angiographic outcome: comparative analysis of directional coronary atherectomy versus standard balloon angioplasty. J Am Coll Cardiol 1996 ; 27 : 543-51.
  4. Crosby IK, Wellons HAJ, Taylor GJ, et al. Critical analysis of the preoperative and operative predictors of aortocoronary bypass patency. Ann Surg 1981; 193:743-51.
  5. O'Connor NJ, Morton JR, Birkmeyer JD, et al. Effect of coronary artery diameter in patients undergoing coronary bypass surgery. Circulation 1996; 93:652-5.
  6. Foley DP, Melkert R, Serruys PW, et al. Influence of vessel size on renarrowing process and late angiographic outcome after successful balloon angioplasty. Circulation 1994; 90:1239-51.
  7. Schunkert H, Harrel L, Palacios IF. Implications of small reference vessel diameter in patients undergoing percutaneous coronary revascularization. J Am Coll Cardiol 1999; 34:40-8.
  8. Hirshfeld JW, Schwartz JS, Jugo R, et al. Restenosis after coronary angioplasty: a multivariate statistical model to relate lesion and procedure variables to restenosis. J Am Coll Cardiol 1991;18:647-56.
  9. Elezi S, Kastrati A, Neumann FJ, et al. Vessel size and longterm outcome after coronary stent placement. Circulation 1998; 98:1875-80.
  10. Akiyama T, Moussa I, Reimers B, et al. Angiographic and clinical outcome following coronary stenting of small vessels: a comparison with coronary stenting in large vessels. J Am Coll Cardiol 1998; 32:1610-8.
  11. Holmes DR, Kereiakes DJ. The approach to small vessels in the era of drug-eluting stents. Rev Cardiovasc Med 2005; 6(suppl 1):S31-7.
  12. Guagliumi G, Sousa JE, Voudris V, et al. Optimal implantation technique for sirolimus eluting stents in small vessels with de novo coronary artery lesions: a comparison between the SIRIUS and SVELTE trials. Am J Cardiol 2004; 94(suppl 6A):65E.
  13. Ardissino D, Cavallini C, Bramucci E, et al. Sirolimus-eluting versus uncoated stents for prevention of restenosis in small arteries: a randomized trial. JAMA 2004; 292:2727-34.
  14. Guyon P, Urban P, Schofer J, et al. The impact of sirolimuseluting stent implantation in small vessel angioplasty: a report from the e-CYPHER registry. J Am Coll Cardiol 2005; 45:64A.
  15. Lemos PA, Arampatzis CA, Saia F, et al. Treatment of very small vessels with 2.25-mm diameter sirolimus-eluting stents (from the RESEARCH Registry). Am J Cardiol 2004; 93:633-6.
  16. Sabaté M, Jiménez QP, Dominick J, et al. Randomized Comparison of Sirolimus-Eluting Stent Versus Standard Stent for Percutaneous Coronary Revascularization in Diabetic Patients: The Diabetes and Sirolimus-Eluting Stent (DIABETES) Trial. Circulation 2005; 112:2175-2183.