Comparison of thrombosis and restenosis risk from stent length of sirolimus-eluting stents versus bare metal stents

被引:64
作者
Mauri, L
O'Malley, AJ
Popma, JJ
Moses, JW
Leon, MB
Holmes, DR
Teirstein, PS
Cutlip, DE
Donahoe, D
Kuntz, RE
机构
[1] Brigham & Womens Hosp, Boston, MA 02115 USA
[2] Harvard Univ, Sch Med, Dept Hlth Care Policy, Boston, MA 02115 USA
[3] Lenox Hill Heart & Vasc Inst, New York, NY USA
[4] Mayo Clin, Rochester, MN USA
[5] Scripps Clin, La Jolla, CA USA
[6] Beth Israel Deaconess Hosp, Boston, MA USA
[7] Cordis Corp, Warren, NJ USA
关键词
D O I
10.1016/j.amjcard.2005.01.039
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Selection of coronary stent length varies from covering only the zone of maximum obstruction to stenting from normal- to normal-appearing vessels. With bare metal stenting, for any given lesion there is a high restenotic risk associated with longer stent length. With drug-eluting stents, the relation between stent length and restenosis has not been evaluated. In the angiographic follow-up cohort of the SIRIUS trial that compared the sirolimus-eluting Bx Velocity stent with the standard Bx Velocity stent (n = 699), we constructed a multiple regression model to predict 8-month percent diameter stenosis using the main effects of lesion length and excess stent length beyond the lesion length and adjusting for known predictors of restenosis. Stent length exceeded lesion length in 94% of lesions overall. Mean difference in length was 8.3 +/- 8.3 mm (mean lesion length 14.6 +/- 5.9 mm, mean stent length 22.9 +/- 9.6 mm). Stented lesion length and excess stent length were associated with absolute increases in percent diameter stenosis per 10 mm of 9.1% (p < 0.0001) and 3.6% (p = 0.053) in the bare metal arm and 3.5% (p = 0.047) and 2.1% (p = 0.040) in the sirolimus-eluting stent arm. Although the effects of lesion length and excess stent length on restenosis were markedly decreased with sirolimus-eluting stents (vs bare metal stents), a small restenotic penalty is still paid for excessive stent length. Longer stent-to-lesion length strategies should be used only when a shorter stent is likely to result in incomplete lesion coverage and edge dissection, a strong determinant of stent thrombosis. (c) 2005 by Excerpta Medica Inc.
引用
收藏
页码:1140 / 1145
页数:6
相关论文
共 12 条
[1]   Clinical restenosis after coronary stenting: Perspectives from multicenter clinical trials [J].
Cutlip, DE ;
Chauhan, MS ;
Baim, DS ;
Ho, KKL ;
Popma, JJ ;
Carrozza, JP ;
Cohen, DJ ;
Kuntz, RE .
JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY, 2002, 40 (12) :2082-2089
[2]  
Cutlip DE, 2001, CIRCULATION, V103, P1967
[3]   CORONARY MORPHOLOGICAL AND CLINICAL DETERMINANTS OF PROCEDURAL OUTCOME WITH ANGIOPLASTY FOR MULTIVESSEL CORONARY-DISEASE - IMPLICATIONS FOR PATIENT SELECTION [J].
ELLIS, SG ;
VANDORMAEL, MG ;
COWLEY, MJ ;
DISCIASCIO, G ;
DELIGONUL, U ;
TOPOL, EJ ;
BULLE, TM .
CIRCULATION, 1990, 82 (04) :1193-1202
[4]   Analysis of 1-year clinical outcomes in the SIRIUS trial - A randomized trial of a sirolimus-eluting stent versus a standard stent in patients at high risk for coronary restenosis [J].
Holmes, DR ;
Leon, MB ;
Moses, JW ;
Popma, JJ ;
Cutlip, D ;
Fitzgerald, PJ ;
Brown, C ;
Fischell, T ;
Wong, SC ;
Midei, M ;
Snead, D ;
Kuntz, RE .
CIRCULATION, 2004, 109 (05) :634-640
[5]   Influence of lesion length on restenosis after coronary stent placement [J].
Kastrati, A ;
Elezi, S ;
Dirschinger, J ;
Hadamitzky, M ;
Neumann, FJ ;
Schömig, A .
AMERICAN JOURNAL OF CARDIOLOGY, 1999, 83 (12) :1617-1622
[6]   Effects of Stent length and lesion length on coronary restenosis [J].
Mauri, L ;
O'Malley, AJS ;
Cutlip, DE ;
Ho, KKL ;
Popma, JJ ;
Chauhan, MS ;
Baim, DS ;
Cohen, DJ ;
Kuntz, RE .
AMERICAN JOURNAL OF CARDIOLOGY, 2004, 93 (11) :1340-1346
[7]   A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. [J].
Morice, M ;
Serruys, PW ;
Sousa, JE ;
Fajadet, J ;
Hayashi, EB ;
Perin, M ;
Colombo, A ;
Schuler, G ;
Barragan, P ;
Guagliumi, G ;
Molnar, F ;
Falotico, R .
NEW ENGLAND JOURNAL OF MEDICINE, 2002, 346 (23) :1773-1780
[8]   Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery [J].
Moses, JW ;
Leon, MB ;
Popma, JJ ;
Fitzgerald, PJ ;
Holmes, DR ;
O'Shaughnessy, C ;
Caputo, RP ;
Kereiakes, DJ ;
Williams, DO ;
Teirstein, PS ;
Jaeger, JL ;
Kuntz, RE .
NEW ENGLAND JOURNAL OF MEDICINE, 2003, 349 (14) :1315-1323
[10]   A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease [J].
Stone, GW ;
Ellis, SG ;
Cox, DA ;
Hermiller, J ;
O'Shaughnessy, C ;
Mann, JT ;
Turco, M ;
Caputo, R ;
Bergin, P ;
Greenberg, J ;
Popma, JJ ;
Russell, ME .
NEW ENGLAND JOURNAL OF MEDICINE, 2004, 350 (03) :221-231