Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents.
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.
Werner
Gerald S
GS
Clinic for Internal Medicine I, Friedrich-Schiller University Jena, Jena, Germany.
Krack
Andreas
A
Schwarz
Gero
G
Prochnau
Dirk
D
Betge
Stefan
S
Figulla
Hans R
HR
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
D017239:Paclitaxel