Impact of Acute Gain on Clinical Outcomes of Patients Treated With Sirolimus-Eluting Stent - A Sub-Analysis Study From the STLLR Trial -

Abstract

Background: Geographical miss (GM), representing suboptimal drug-eluting stent deployment, is associated with an increased risk of target lesion revascularization (TLR) and myocardial infarction. The impact of suboptimal stenting techniques on clinical outcomes in diabetics remains unknown. Methods and Results:Stent deployment Techniques on cLinicaL outcomes of patients treated with the cypheR TM stent (STLLR) is the first multicenter, large trial to prospectively evaluate outcomes associated with sirolimus-eluting stent (SES) deployment techniques. Axial GM and longitudinal GM (LGM), defined as a balloon injured segment or a diseased segment not covered by a SES, were assessed by an independent core laboratory. One-year outcomes between diabetics and non-diabetics and their relationship with GM were assessed. This substudy included 1,336 patients, 28.8% with diabetes. In non-LGM patients, TLR was similarly low in both diabetics and non-diabetics (2.0% vs. 2.0%, P=NS). However, TLR increased 4.1 times in diabetics (8.0%) and 1.9 times in non-diabetics (3.8%) in the presence of LGM (P=0.03). Axial GM had no impact on outcomes. By univariate analysis, stent length, acute gain, and LGM were the predictors of TLR in the total cohort. However, by multivariate analysis, acute gain was the only predictor of TLR (P=0.03), independently of LGM or diabetes.Conclusions: Acute gain is the exclusive predictor of TLR after SES implantation. Particularly in diabetics, the negative impact of LGM on TLR seems to be amplified. Diligent SES deployment for larger acute gain is critical to improve clinical outcomes. (Circ J 2011; 75: 2113 - 2119

Longitudinal Geographic Miss (LGM) in Robotic Assisted Versus Manual Percutaneous Coronary Interventions

“…Longitudinal geographic miss (LGM) is the failure to fully cover a diseased coronary segment during percutaneous coronary intervention (PCI) procedures. The Stent deployment Techniques on clinical outcomes of patients treated with the cypher stent trial (STLLR) prospectively evaluated the impact of stent deployment technique in manual PCI (M‐PCI) on outcomes, and established a direct correlation between the occurrence of LGM and the resulting negative impact on long‐term clinical outcomes when compared with patients without LGM . Patients with LGM at 12 months post PCI in the STLLR trial had significantly higher incidences of target vessel revascularization (TVR) (6.1% vs 2.6%; P < 0.05) and myocardial infarction (MI) (2.4% vs 0.8%; P = 0.04) than patients without LGM.…”

Effect of Stent Inflation Pressure and Post-Dilatation on the Outcome of Coronary Artery Intervention. A Report of More than 90 000 Stent Implantations

“…The procedure involves advancement of yet another catheter and accurate placement of the NC balloon within the borders of the stent is not always achieved and this may result in edge dissection, geographic miss [21], or even coronary perforation [22]. These complications typically lead to additional stenting or target lesion revascularization at a later stage.…”

Expert Opinion: Optimising Stent Deployment in Contemporary Practice: The Role of Intracoronary Imaging and Non-compliant Balloons

“…While it has been clearly demonstrated that high-pressure postdilatation with the NC balloon helps optimise stent expansion and achieve a large lumen, disadvantages to the approach may also exist. Aggressive post-dilatation might result in more intimal hyperplasia compared with a less aggressive approach, 19 or lead to edge dissections, geographic miss 20 or even coronary perforation. 21 These complications may require additional stenting and influence TLR adversely.…”