title: Early and late outcome of stenting in a consecutive series of patients with coronary lesions in vessels less than 2.8 mm in diameter.
abstract: In an attempt to determine the early and late outcomes of small vessel stenting, we retrospectively evaluated our database on 51 consecutive patients (41 males, mean age, 57.1 +/- 10.1 years) who underwent stenting of at least one significant lesion in a coronary artery with a reference vessel diameter (RVD) <2.8 mm between March 1999 and March 2001. Sixty balloon expandable tubular stents were implanted in 57 lesions (29 Type B2/C, mean RVD: 2.54 +/- 0.16 mm) without intravascular ultrasound guidance under a heparin-aspirin-ticlopidine regimen. The mean diameter stenosis (DS) decreased from 75.8 +/- 13.6% to 4.2 +/- 1.9% (P<0.0001) with stenting at a mean deployment pressure of 13.6 +/- 1.7 atm and a final balloon to RVD ratio (FB/RVD) of 1.08 +/- 0.03. All stents were deployed successfully. Acute stent thrombosis occurred in 3 patients (6%), one died, and 2 developed non-Q-wave myocardial infarction (procedural success 94%). Clinical follow-up, available in 48 patients, revealed a 29% target lesion revascularization rate, a 2% myocardial infarction rate, and a 71% event-free survival at a mean of 11.6 months. Angiographic follow-up, available in 40 patients, showed a DS of 48.8 +/- 31.3% and a binary restenosis rate of 50% at a mean of 7.7 months. The FB/RVD ratio was significantly lower in the group with restenosis than in the group without (1.06 +/- 0.02 vs 1.1 +/- 0.05, P = 0.04). Subgroup analysis yielded a significantly greater rate of restenosis in diabetics with complex (Type B2/C) lesion morphology compared to nondiabetics with simple (Type A/B1) lesions (75% vs 21%, P < 0.05). In conclusion, stenting in vessels <2.8 mm was found to be associated with a high rate of acute stent thrombosis and in-stent restenosis. Further analysis detected a subgroup of patients without diabetes or complex lesions who could be stented with an acceptable in-stent restenosis rate.
authors.affiliation: Department of Cardiology, Gazi University School of Medicine, Ankara, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Ozdemir
authors.forename: Timur
authors.initials: T
authors.lastname: Timurkaynak
authors.forename: Murat
authors.initials: M
authors.lastname: Tulmaç
authors.forename: Mustafa
authors.initials: M
authors.lastname: Cemri
authors.forename: Bülent
authors.initials: B
authors.lastname: Boyaci
authors.forename: Ridvan
authors.initials: R
authors.lastname: Yalçin
authors.forename: Atiye
authors.initials: A
authors.lastname: Cengel
authors.forename: Ovsev
authors.initials: O
authors.lastname: Dörtlemez
authors.forename: Halis
authors.initials: H
authors.lastname: Dörtlemez
mesh_terms: D000208:Acute Disease; D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000503:physiopathology / Q000601:surgery*; D023903:Coronary Restenosis / Q000453:epidemiology*; D003328:Coronary Thrombosis / Q000453:epidemiology*; D003331:Coronary Vessels / Q000473:pathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015607:Stents; D016896:Treatment Outcome