A randomized trial comparing stenting with balloon angioplasty in small vessels in patients with symptomatic coronary artery disease. ISAR-SMART Study Investigators. Intracoronary Stenting or Angioplasty for Restenosis Reduction in Small Arteries.
BACKGROUND
More than 30% of the lesions currently treated with interventional approaches are situated in vessels smaller in size than those representing an established indication for stenting. The objective of this randomized trial was to assess whether compared with PTCA, stenting of small coronary vessels is associated with a reduction of restenosis.


RESULTS
Patients with symptomatic coronary artery disease with lesions situated in native coronary vessels between 2 and 2.8 mm in size were randomly assigned to be treated with either stenting (n=204) or PTCA (n=200). Adjunct therapy consisted of abciximab, ticlopidine, and aspirin. Repeat angiography at 6-month follow-up was performed in 83% of the patients. The primary end point of the study was the incidence of angiographic restenosis (>/=50% diameter stenosis) at follow-up; adverse clinical events, such as death, myocardial infarction, stroke, or target vessel revascularization, were assessed as secondary end points. After 7 months, there were no significant differences in the infarct-free survival rates between the 2 study groups: 96.6% for stent patients, and 97.0% for PTCA patients (P:=0. 80). Target vessel revascularization was needed in 20.1% of the stent patients and 16.5% of the PTCA patients (P:=0.35). The primary end point of angiographic restenosis was found in 35.7% of the stent patients and 37.4% of the PTCA patients (P:=0.74). The net lumen gain observed at follow-up was identical (0.76+/-0.78 in the stent group versus 0.76+/-0.63 mm in the PTCA group, P:=0.93).


CONCLUSIONS
Stenting and PTCA are associated with equally favorable results when used for treating lesions in small coronary vessels.
Kastrati
A
A
Deutsches Herzzentrum, Lazarettstr. 36, 80636 M¿nchen, Germany. kastrati@dhm.mhn.de
Schömig
A
A
Dirschinger
J
J
Mehilli
J
J
Dotzer
F
F
von Welser
N
N
Neumann
F J
FJ
D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D001241:Aspirin / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use; D008297:Male; D015607:Stents / Q000009:adverse effects; D013988:Ticlopidine / Q000627:therapeutic use; D016896:Treatment Outcome; D014654:Vascular Patency
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D013988:Ticlopidine; D001241:Aspirin; D000077284:Abciximab