title: Influence of residual stenosis after percutaneous coronary intervention with stent implantation on development of restenosis and stent thrombosis.
abstract: The aim of this study was to assess the effects of residual stenosis after single-stent implantation on the rate of stent thrombosis, as well as restenosis within a 6-month follow-up period. Coronary angiograms of 2,157 patients with 2,523 lesions treated with a single stent were analyzed by quantitative coronary angiography before, immediately after stent implantation, and at a planned 6-month follow-up. Lesions were classified into 4 subgroups according to the degree of residual stenosis after stent implantation: group 1, gross oversizing <-15%; group 2, slight oversizing -15% to <0%; group 3, mild residual 0% to <15%; group 4, moderate residual 15% to <30%. Stent thrombosis rates were not significantly different among the 4 subgroups (group 1: 0 of 60 [0%]; group 2: 2 of 388 [0.5%]; group 3: 8 of 1,370 [0.6%]; group 4: 8 of 705 [1.1%]; p = NS for all). An adequate dosage of ticlopidine (250 mg twice daily) and aspirin (100 mg/day) led to a lower rate of stent thrombosis (6 of 2,189 cases) than inadequate dosages or missing therapy (12 of 343 cases). In 1,882 stenoses with angiographic follow-up (77.7%), gross oversizing of stents lead to a significantly higher increase of percent stenosis (p <0.001) associated with a higher restenosis rate (group 1: 34.7% vs groups 2, 3, and 4: 32.5%, 28.2%, and 29.6%, respectively). A multiple regression analysis was performed. Optimal results with regard to stent thrombosis and restenosis were achieved with mild residual stenoses between 0% and 15% after stent implantation. Oversizing of stents is no longer necessary with an adequate dosage of ticlopidine and aspirin.
authors.affiliation: Department of Cardiology, University of Leipzig Heart Center, Leipzig, Germany. sickp@medizin.unileipzig.de
authors.forename: Peter
authors.initials: P
authors.lastname: Sick
authors.forename: Tobias
authors.initials: T
authors.lastname: Hüttl
authors.forename: Josef
authors.initials: J
authors.lastname: Niebauer
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.forename: Bernward
authors.initials: B
authors.lastname: Lauer
authors.forename: Rainer
authors.initials: R
authors.lastname: Hambrecht
authors.forename: Bettina
authors.initials: B
authors.lastname: Hentschel
authors.forename: Gerhard
authors.initials: G
authors.lastname: Schuler
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects* / Q000379:methods*; D001241:Aspirin / Q000627:therapeutic use; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000145:classification / Q000000981:diagnostic imaging / Q000209:etiology*; D003328:Coronary Thrombosis / Q000145:classification / Q000000981:diagnostic imaging / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D012044:Regression Analysis; D015607:Stents; D013988:Ticlopidine / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D013988:Ticlopidine; D001241:Aspirin