Comparison of Clinical Outcomes Between Very Long Stents and Overlapping Stents for the Treatment of Diffuse Coronary Disease in Real Clinical Practice

Abstract

Background: The stent length as well as the stent overlap for the percutaneous treatment of diffuse coronary disease have been considered predictors of adverse events. However, there are no comparative data on the use of very long stents or overlapping stents in this scenario.

Objective: To compare the clinical results of very long stents (≥40 mm) or overlapping stents in real clinical practice.

Methods: We included 643 lesions in 628 consecutive patients treated with a single very long stent (≥40 mm) (251 lesions) or ≥2 overlapped stents (392 lesions). We analyzed the procedural characteristics and the presentation of the combined endpoint [cardiovascular death, non-fatal myocardial infarction, need for target lesion revascularization or stent thrombosis] after a follow-up of 20 months.

Results: Total stent length was 54 ± 18 mm and minimum diameter was 2.9 ± 1.2 mm. At the end of follow-up, the rate of adverse events was 8.3% (cardiac death: 4.9%, myocardial infarction: 1.7%, target lesion revascularization: 3.1%, stent thrombosis: 0.7%). There were no significant differences between both groups in the presentation of the combined endpoint. Procedures with overlapping stents had more contrast volume (309 ± 115 vs 273 ± 127 ml; p = 0.002), longer duration (47 ± 22 vs 39 ± 18 min; p < 0.0001), higher fluoroscopy time (20 ± 13 vs 16 ± 9 min; p < 0.0001) and higher number of stents to treat the index lesion (2.2 ± 0.5 vs 1; p < 0.0001).

Conclusions: New designs of very long stents allow not only treating increasingly complex lesions, but also simplifying the procedure and decreasing the number of stents with very favorable results similar to those obtained with stent overlap.

Keywords: Diffuse coronary disease; Overlapping stents; Very long stents.