title: Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents.
abstract: OBJECTIVE
  The aim of this research was to assess the efficacy of paclitaxel-eluting stents in chronic total coronary occlusions (CTO).
  
  
  BACKGROUND
  Percutaneous coronary interventions for CTOs are characterized by a high target vessel failure rate.
  
  
  METHODS
  In 48 consecutive patients, paclitaxel-eluting stents (Taxus, Boston Scientific Corp., Natick, Massachusetts) were implanted after successful recanalization of a CTO (duration >2 weeks). Patients underwent an angiography after 6 months and were followed clinically for 12 months. They were compared with 48 lesion- and risk-matched patients with CTOs treated with bare metal stents (BMS). Primary clinical end point was the one-year incidence of major adverse cardiac events (MACE) (death, myocardial infarction, repeat revascularization); secondary end points were the rate of restenosis and re-occlusion.
  
  
  RESULTS
  In-hospital MACE was 4.2% with Taxus, and 2.1% with BMS (p = NS). The one-year MACE rate was 12.5% in the Taxus group, and 47.9% in the BMS group (p < 0.001), which was due to a reduced need for repeat revascularization. The angiographic restenosis rate was 8.3% with Taxus versus 51.1% with BMS (p < 0.001). There was only one late re-occlusion with Taxus (2.1%) as compared with 23.4% with BMS (p < 0.005). The late loss was reduced in the Taxus group by 84% as compared with BMS. All nonocclusive restenoses in the Taxus group were focal and successfully treated by implanting an additional Taxus stent.
  
  
  CONCLUSIONS
  The treatment of CTOs with a paclitaxel-eluting stent drastically reduces MACE and restenosis, and almost eliminates re-occlusion, which is typically frequent with BMS in CTOs. Chronic total coronary occlusion should be a preferred indication for drug-eluting stents.
authors.affiliation: Clinic for Internal Medicine I, Friedrich-Schiller University Jena, Jena, Germany.
authors.forename: Gerald S
authors.initials: GS
authors.lastname: Werner
authors.forename: Andreas
authors.initials: A
authors.lastname: Krack
authors.forename: Gero
authors.initials: G
authors.lastname: Schwarz
authors.forename: Dirk
authors.initials: D
authors.lastname: Prochnau
authors.forename: Stefan
authors.initials: S
authors.lastname: Betge
authors.forename: Hans R
authors.initials: HR
authors.lastname: Figulla
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D002908:Chronic Disease; D015331:Cohort Studies; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000517:prevention & control* / Q000628:therapy*; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000401:mortality / Q000517:prevention & control* / Q000628:therapy; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000628:therapy; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017239:Paclitaxel / Q000008:administration & dosage*; D055502:Secondary Prevention; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome
chemical_list: D017239:Paclitaxel