Outcomes of overlapping bare-metal stents with sirolimus-eluting stents for long lesions in small coronary vessels.
OBJECTIVE
Compare outcomes of hybrid bare-metal stent (BMS)/sirolimus-eluting stent (SES) to BMS alone for the treatment of stenoses in small coronary arteries.


BACKGROUND
One approach to potentially reduce the risk of restenosis in long lesions with smaller distal reference diameters is to use a small (2.0-2.5 mm) "BMS cap" (BMC) distally, telescoped in tandem with a SES(s) proximally, matched to a proximal segment where the diameter is > or = 2.5 mm (creating a BMC/SES hybrid stent). Results from previous reports using "hybrid" drug-eluting stents and BMS are mixed.


METHODS
We performed a retrospective analysis of BMC/SES cases in small vessels at our institution and compared the outcomes with a control group (BMS) consisting of patients treated with at least one 2.0-2.5 mm BMS.


RESULTS
During the years 2003-2006, 41 BMC/SES and 62 BMS cases were identified and follow up was available in 33 and 49 patients, respectively. Baseline demographics, procedure indications and pertinent discharge medications for the two groups were similar. Despite the use of more stents and longer total stent length in the BMC/SES group compared to the BMS group (2.9 +/- 0.79 vs. 1.4 +/- 0.69 and 64 +/- 21 mm vs. 26 +/- 18 mm; p < 0.0001 for both comparisons), there was a significant decrease in the composite of restenosis, myocardial infarction and cardiac death (9% vs. 29%; p = 0.033).


CONCLUSIONS
The use of a "BMS cap" distally, telescoped in tandem with SES more proximally, may be a reasonable approach in treating long lesions in coronary arteries with distal reference diameters < or = 2.5 mm.
Kronsteiner
Emily
E
Midwestern University, Glendale, Arizona, USA.
Lee
Richard W
RW
Sweeney
John P
JP
Metallo
Jennifer R
JR
Stoehr
James D
JD
Fortuin
F David
FD
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D003324:Coronary Artery Disease / Q000628:therapy*; D003331:Coronary Vessels; D054855:Drug-Eluting Stents; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D008297:Male; D008670:Metals; D008875:Middle Aged; D012189:Retrospective Studies; D020123:Sirolimus / Q000008:administration & dosage*; D016896:Treatment Outcome
D007166:Immunosuppressive Agents; D008670:Metals; D020123:Sirolimus