title: Stent placement to prevent restenosis after angioplasty in small coronary arteries.
abstract: BACKGROUND
  Lesions in small-diameter vessels (<3 mm) define a group with distinct clinical and morphological characteristics. There is an inverse relationship between vessel size and angiographic restenosis rate. This study assessed whether stents reduce angiographic restenosis in small coronary arteries compared with standard balloon angioplasty.
  
  
  RESULTS
  We randomly assigned 351 symptomatic patients needing dilatation of 1 native coronary vessel between 2.3 and 2.9 mm in size to angioplasty alone (n=182) or stent implantation (n=169). The primary end point was angiographic restenosis at 6 months. Secondary end points included death, myocardial infarction, bypass surgery, and target vessel revascularization in hospital and at 6 months. There were no significant differences between groups in terms of major in-hospital complications. There was a trend toward fewer in-hospital events in the stent group (3% versus 7.1% in angioplasty group, P=0.076). Crossovers to stent occurred in 37 patients (20.3%). Repeat angiography at 6-month follow-up was performed in 85.3% of patients. Angiographic restenosis occurred in 28% of the stent group and 32.9% of the angioplasty group (P=0.36). Target vessel revascularization was required in 17.8% versus 20.3% of patients (P=0.54), respectively.
  
  
  CONCLUSIONS
  Stenting and standard coronary angioplasty are associated with equal restenosis rate in small coronary arteries. With a lower in-hospital complication rate, stenting may be a superior strategy in small vessels.
authors.affiliation: Department of Medicine, Montreal Heart Institute, Montreal, Quebec, Canada. serge.doucet@sympatico.ca
authors.forename: S
authors.initials: S
authors.lastname: Doucet
authors.forename: M J
authors.initials: MJ
authors.lastname: Schalij
authors.forename: M C
authors.initials: MC
authors.lastname: Vrolix
authors.forename: D
authors.initials: D
authors.lastname: Hilton
authors.forename: P
authors.initials: P
authors.lastname: Chenu
authors.forename: B
authors.initials: B
authors.lastname: de Bruyne
authors.forename: W
authors.initials: W
authors.lastname: Udayachalerm
authors.forename: A
authors.initials: A
authors.lastname: Seth
authors.forename: L
authors.initials: L
authors.lastname: Bilodeau
authors.forename: J H
authors.initials: JH
authors.lastname: Reiber
authors.forename: F
authors.initials: F
authors.lastname: Harel
authors.forename: J
authors.initials: J
authors.lastname: Lespérance
mesh_terms: D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000601:surgery*; D003331:Coronary Vessels / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents / Q000009:adverse effects; D016896:Treatment Outcome; D014654:Vascular Patency