Significant reduction in restenosis after the use of sirolimus-eluting stents in the treatment of chronic total occlusions.
OBJECTIVE
The aim of this study was to assess sirolimus-eluting stent (SES) implantation for the treatment of chronic total coronary occlusions (CTO).


BACKGROUND
Long-term results after percutaneous coronary intervention (PCI) in the treatment of CTOs is hindered by a significant rate of restenosis and reocclusion. In the treatment of relatively simple nonocclusive lesions, SESs have shown dramatically reduced restenosis rates compared with bare metal stents (BMS), but whether these results are more widely applicable is unknown.


METHODS
From April 2002, all patients at our institution were treated with SES as the device of choice during PCI. During the first six months, 563 patients were treated solely with SES, with treatment of a de novo CTO in 56 (9.9%). This CTO cohort was compared with a similar group of patients (n = 28) treated in the preceding six-month period with BMS.


RESULTS
At one year, the cumulative survival-free of major adverse cardiac events was 96.4% in the SES group versus 82.8% in the BMS group, p < 0.05. At six-month follow-up, 33 (59%) patients in the SES group underwent angiography with a binary restenosis rate (>50% diameter stenosis) of 9.1% and in-stent late loss of 0.13 +/- 0.46 mm. One patient (3.0%) at follow-up was found to have reoccluded the target vessel.


CONCLUSIONS
The use of SESs in the treatment of chronic total coronary occlusions is associated with a reduction in the rate of major adverse cardiac events and restenosis compared with BMS.
Hoye
Angela
A
Department of Interventional Cardiology, Erasmus MC, Rotterdam, the Netherlands.
Tanabe
Kengo
K
Lemos
Pedro A
PA
Aoki
Jiro
J
Saia
Francesco
F
Arampatzis
Chourmouzios
C
Degertekin
Muzaffer
M
Hofma
Sjoerd H
SH
Sianos
Georgios
G
McFadden
Eugene
E
van der Giessen
Willem J
WJ
Smits
Pieter C
PC
de Feyter
Pim J
PJ
van Domburg
Ron T
RT
Serruys
Patrick W
PW
D015906:Angioplasty, Balloon, Coronary; D002908:Chronic Disease; D015331:Cohort Studies; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D020123:Sirolimus / Q000008:administration & dosage*; D015607:Stents; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D020123:Sirolimus