title: Very long sirolimus-eluting stent implantation for de novo coronary lesions.
abstract: Long-length stenting has a poor outcome when bare metal stents are used. The safety and efficacy of the sirolimus-eluting stent (SES) in long lesions has not been evaluated. Therefore, the aim of the present study was to evaluate the clinical and angiographic outcomes of SES implantation over a very long coronary artery segment. Since April 2002, all patients treated percutaneously at our institution received a SES as the device of choice as part of the Rapamycin Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) registry. During the RESEARCH registry, stents were available in lengths of 8, 18, and 33 mm. The present report includes a predefined study population consisting of patients treated with >36-mm-long stented segments. Patients had a combination of >or=2 overlapping stents at a minimum length of 41 mm (i.e., one 33-mm SES overlapping an 8-mm SES) to treat native de novo coronary lesions. The incidence of major cardiac adverse events (death, nonfatal myocardial infarction, and target lesion revascularization) was evaluated. The study group comprised 96 consecutive patients (102 lesions). Clinical follow-up was available for all patients at a mean of 320 days (range 265 to 442). In all, 20% of long-stented lesions were chronic total occlusions, and mean stented length per lesion was 61.2 +/- 21.4 mm (range 41 to 134). Angiographic follow-up at 6 months was obtained in 67 patients (71%). Binary restenosis rate was 11.9% and in-stent late loss was 0.13 +/- 0.47 mm. At long-term follow-up (mean 320 days), there were 2 deaths (2.1%), and the overall incidence of major cardiac events was 8.3%. Thus, SES implantation appears safe and effective for de novo coronary lesions requiring multiple stent placement over a very long vessel segment.
authors.affiliation: Department of Interventional Cardiology, Thoraxcentre, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Muzaffer
authors.initials: M
authors.lastname: Degertekin
authors.forename: Chourmouzios A
authors.initials: CA
authors.lastname: Arampatzis
authors.forename: Pedro A
authors.initials: PA
authors.lastname: Lemos
authors.forename: Francesco
authors.initials: F
authors.lastname: Saia
authors.forename: Angela
authors.initials: A
authors.lastname: Hoye
authors.forename: Joost
authors.initials: J
authors.lastname: Daemen
authors.forename: Kengo
authors.initials: K
authors.lastname: Tanabe
authors.forename: Chi-Hang
authors.initials: CH
authors.lastname: Lee
authors.forename: Sjoerd J
authors.initials: SJ
authors.lastname: Hofma
authors.forename: Georgios
authors.initials: G
authors.lastname: Sianos
authors.forename: Eugene
authors.initials: E
authors.lastname: McFadden
authors.forename: Willem
authors.initials: W
authors.lastname: van der Giessen
authors.forename: Pieter C
authors.initials: PC
authors.lastname: Smits
authors.forename: Pim J
authors.initials: PJ
authors.lastname: de Feyter
authors.forename: Ron T
authors.initials: RT
authors.lastname: van Domburg
authors.forename: Patrick W
authors.initials: PW
authors.lastname: Serruys
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000601:surgery*; D004343:Drug Implants; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000517:prevention & control*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D004343:Drug Implants; D007166:Immunosuppressive Agents; D020123:Sirolimus