[An experience of the use of stents with drug coating in patients with long and diffuse coronary artery lesions]

Abstract

Treatment of long and diffuse lesions of coronary arteries remains one of most complicated sections of endovascular treatment. From 2003 to 2005 treatment with the use of stents with drug coating was conducted in 198 patients with long and diffuse coronary artery lesions. This made up 26% of total number of patients subjected to percutaneous coronary intervention during this time. Mean age of patients was 58 +/- 11 years, 164 (83%) of them were men, 37 (19%) had chronic occlusions of coronary arteries, in 91 (46%) side branches went out from the damaged segment. Patients were divided in two groups: 1st (n=136) comprised patients with lesion length from 22 to 33 mm, 2nd consisted of patients in whom lesion length exceeded 33 mm. Control group comprised 54 patients with lesion length less than 23 mm subjected to endovascular treatment with the use of stents with drug coating during same period of time. Average length of stented segment was 27.3 +/- 3.6 mm in the first group, 44.5 +/- 9.8 mm in the second group and 14 +/- 3.6 in the control group. Immediate success of the procedure was somewhat lower in group II compared with group I (87 and 91%, respectively). Hemopericardium and cardiac tamponade requiring urgent surgery developed in 2 group II patients (3.2%) during first 2 hours after attempt of recanalization of long chronic occlusions of the anterior descending artery. One patient (1.6%) had small-focal myocardial infarction after procedure, in another patient (1.6%) subacute occlusion developed after stenting of venous graft to the right coronary artery which we failed to eliminate. In the first group in 2 patients (1.4%) small-focal myocardial infarction developed. There were no complications in the control group. In 8 months after procedure angiographic restenosis developed in 6 patients (5%) in the 1st group, in 4 (8%) in the second and in 1 (2%) in the control group, however differences were not significant. Rates of repeat revascularizations of the target stenosis were 3, 5 and 0%, respectively. Of 10 cases of restenosis in patients with long stenoses in 5 cases restenosis was located inside stent and was focal (length less than 10 mm), in 3 cases it was located proximal or distal to stent, and in 2 patients manifested as complete occlusion of the stented segment. Treatment of long and diffuse lesions with the use of stents with drug coating appears safe and effective. Overall rate of development of perioperative complications is higher in treatment of stenoses longer than 33 mm compared with stenoses with length 23-33 cm (6.4 vs. 1.4%). Probability of restenosis and repeat revascularization of target stenosis after 8 months is not high.