title: Use of multiple overlapping sirolimus-eluting stents for treatment of long coronary artery lesions: results from a single-center registry in 318 consecutive patients.
abstract: Drug-eluting stents (DES) are superior to bare metal stents in the prevention of restenosis and target lesion revascularization (TLR). This has led to a more aggressive use of DES in everyday interventional cardiology practice.
  
  
  METHODS
  All consecutive patients who underwent coronary artery stenting with greater than 34 mm of overlapping, sirolimus-eluting stent (SES) were reviewed from a prospectively created database. A prespecified group of patients with greater than 60 mm of SES was also followed.
  
  
  RESULTS
  318 patients were followed up at a minimum of 6 months and a mean of 9 months. The mean target lesion stented length was over 55 mm. Use of IVUS was 19.8%. Forty patients (12.6%) suffered a peri-procedural CK-MB rise. The MACE rate at 9 months was 17% with 12.6% being periprocedural myocardial infarction (MI). Clinically driven TLR was 4.4% and cardiac death was 1.3%. There were 4 cases defined as late stent thrombosis. The independent predictors of periprocedural MI were the presence of a major side branch and longer target lesion stented length, with stable angina being a negative predictor. The independent predictors of in-stent restenosis were unstable angina and target lesion number per patient. There was a trend to increased MACE in the subgroup with longer than 60 mm of SES length.
  
  
  CONCLUSIONS
  The use of multiple, overlapping SES is safe and effective with an acceptably low follow up MACE rate. A significant peri-procedural CK-MB rise appears to be a risk of long segment stenting. Whether this translates to long-term sequelae needs further investigation.
authors.affiliation: Institute of Cardiology, University of Milan, Centro Cardiologico Monzino, IRCCS, Milan, Italy.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Ruchin
authors.forename: Daniela
authors.initials: D
authors.lastname: Trabattoni
authors.forename: Franco
authors.initials: F
authors.lastname: Fabbiocchi
authors.forename: Piero
authors.initials: P
authors.lastname: Montorsi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Lualdi
authors.forename: Paolo
authors.initials: P
authors.lastname: Ravagnani
authors.forename: Luca
authors.initials: L
authors.lastname: Grancini
authors.forename: Stefano
authors.initials: S
authors.lastname: Galli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Teruzzi
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Calligaris
authors.forename: Stefano
authors.initials: S
authors.lastname: De Martini
authors.forename: Antonio L
authors.initials: AL
authors.lastname: Bartorelli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000628:therapy*; D023903:Coronary Restenosis / Q000517:prevention & control*; D054855:Drug-Eluting Stents / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012042:Registries / Q000706:statistics & numerical data; D012307:Risk Factors; D020123:Sirolimus / Q000008:administration & dosage*
chemical_list: D007166:Immunosuppressive Agents; D020123:Sirolimus