"Full metal jacket" (stented length > or =64 mm) using drug-eluting stents for de novo coronary artery lesions.
BACKGROUND
Stented segment length was a predictive factor for restenosis in the bare metal stent era. The objective of the study was to evaluate the medium-term clinical outcome and the potential for adverse effects when very long segments (ie, > or =64 mm of stented length) are treated by drug-eluting stent (DES) implantation, an approach colloquially referred to as a "full metal jacket."


METHODS
Since April 2002, we have used DES as the default stent for all percutaneous coronary interventions. From our prospective institutional database we identified 122 consecutive patients, with de novo coronary lesions, in whom a coronary artery was treated with at least 64 mm of overlapping DES: 81 patients were treated with sirolimus-eluting stents and 41 with paclitaxel-eluting stents.


RESULTS
The mean number of stents per lesion was 3.3 +/- 1.1, and the median stented length was 79 mm (range 64-168 mm). Periprocedural Q-wave myocardial infarction (MI) occurred in 2 patients (1.6%) and subacute stent thrombosis in 1 patient (0.8%). During 1-year follow-up, 5 patients (4.1%), including 3 patients treated for acute MI with cardiogenic shock, died and 10 patients (8.2%) had nonfatal MI (creatine kinase-MB >3 times). The 1-year target vessel revascularization rate was 7.5% and the overall incidence of major adverse cardiac events was 18%. Outcomes in sirolimus-eluting stents and paclitaxel-eluting stents groups did not differ statistically.


CONCLUSIONS
The use of DES for the treatment of diffuse lesions was associated with a low rate of repeat revascularization, irrespective of stent type. No safety concerns were raised at medium-term follow-up.
Aoki
Jiro
J
Erasmus Medical Center, Thoraxcenter, Rotterdam, The Netherlands.
Ong
Andrew T L
AT
Rodriguez Granillo
Gaston A
GA
McFadden
Eugène P
EP
van Mieghem
Carlos A G
CA
Valgimigli
Marco
M
Tsuchida
Keiichi
K
Sianos
Georgios
G
Regar
Evelyn
E
de Jaegere
Peter P T
PP
van der Giessen
Willem J
WJ
de Feyter
Pim J
PJ
van Domburg
Ron T
RT
Serruys
Patrick W
PW
D003131:Combined Modality Therapy; D023921:Coronary Stenosis / Q000628:therapy*; D016503:Drug Delivery Systems; D004867:Equipment Design; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015607:Stents