Safety and efficacy of 2.5-mm sirolimus-eluting stent implantation at lower deployment pressures in very small vessels (<2.5 mm)

Abstract

Implantation of 2.5-mm SES in vessels with reference diameters less than 2.5 mm using lower deployment pressures and predilatation and postdilatation may lead to reduced risks of restenosis and MACE without an increased risk of stent thrombosis up to 1 year.

Initial experience with angioplasty of symptomatic M2 MCA atheromatous lesions

“…The treatment of small caliber vessels with angioplasty or stenting has been associated with higher rates of subsequent adverse events due to restenosis in the coronary arteries 7. Currently stents are not sized to vessel diameters <2.0 mm, but there are reports of utilizing oversized stents in smaller coronary vessels 8. We did not feel that placement of a balloon-mounted coronary stent in this location would be safe due to the vessel diameter.…”

One‐Year Outcome of Small‐Vessel Disease Treated with Sirolimus‐Eluting Stents: A Subgroup Analysis of the e‐SELECT Registry

“…Despite the remarkably low values for late lumen loss documented in DES studies, there remains a relationship between vessel size and restenosis, with increased restenosis rates in smaller vessels; the same is true for ST. Several studies, both randomized and nonrandomized, and subanalyses of all-comer studies have supported better outcomes in small vessels with SES, and in direct and indirect comparisons to PES. 15,[38][39][40][41][42][43][44][45] Although some interventionists support balloon-only angioplasty for SmVD treatment, 46,47 SES has shown consistent benefit and lower rates of complications than alternative treatments 12,[38][39][40]42,[48][49][50][51] even when using, as was not the case in this study, 2.5 mm stents in vessels with <2.5 mm diameter, 40,44,52,53 or in patients with diabetes and very small coronary vessel (<2.1 mm) disease, 15 or even relative to thinner-strut bare metal stents (BMS) or DES. 17,54 In terms of the poten-tial for improving outcomes of PCI in SmVD, studies have shown that specific baseline clinical and angiographic characteristics are predictive of the different rates of MACE, including restenosis, seen for various lesion/patient subsets.…”

Long-term adverse outcomes associated with drug-eluting stents and bare-metal stent in patients with small coronary artery disease: a systematic review and meta-analysis

“…Thirty eight full-text articles were finally assessed for eligibility of which, 28 were further excluded for several reasons: they were case studies, meta-analyses or letters to the editor, follow-up<12 months, in some trials DES treated group was compared with BMS plus drug-eluting balloon treated group. Finally, 10 studies (3 RCTs 13,19,20 and 7 observational [10][11][12]14,[21][22][23] were selected and included in this study.…”