Safety and efficacy of 48 mm Xience Xpedition everolimus‐eluting stent for the treatment of long coronary lesions

Abstract

Introduction Long drug‐eluting stents may limit the issue of overlapping multiple stents when treating long coronary lesions. Aim The aim of the study was to assess the safety and efficacy of the 48 mm Xience Xpedition everolimus‐eluting stent (48mm‐EES) for the treatment of long coronary lesions, in an all‐comer population. Methods Patients receiving at least one 48mm‐EES were prospectively included from March 2014 to December 2018. The primary endpoint was target lesion failure (TLF), defined as a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization (TLR) at 1 year. The main secondary endpoint was the patient‐oriented composite endpoint (POCE) defined as a composite of death, stroke, myocardial infarction, and reintervention. Results A total of 268 patients with 276 long coronary lesions, including 94 chronic total occlusions (CTO), were successfully treated using at least one 48mm‐EES. The total stent length per lesion was 66 ± 22 mm. A single 48mm‐EES was suitable to successfully treat the target lesion in 48% of cases (60% for non‐CTO lesions). One‐year follow‐up rate was 96.3%. TLF occurred in 13 patients (5.3%), mainly driven by TLR (4.1%). Two cardiac death occurred (0.7%). POCE occurred in 30 patients (11.6%) mainly driven by repeat revascularization (9.7%). Definite stent thrombosis was observed in two patients (0.7%). No difference was observed in one‐year outcomes between single 48mm‐EES and multiple stents implantation as well as between CTO and non‐CTO lesions. Conclusion The 48mm‐EES is safe and effective to treat long coronary lesions, including CTOs, and provides attractive cost‐effectiveness by limiting multiple stenting.

Second generation drug eluting stent: The longer, the better?

“…All these trials, however, indicated that the implantation of a single stent v multiple stents of equivalent length means induces longer fluoroscopy and procedure time, with more contrast volume and, if the stent cost is the same irrespective of length, greater cost. Gautier et al also observed shorter procedure time and reduced contrast volume in single 48 mm EES patients in this study 3 …”

“…It is with this backdrop that we read with keen interest the study by Gautier et al in this issue of Catheterization and Cardiovascular Interventions, in which the authors provide results of a consecutive series of 268 patients and 276 lesions receiving a 48 mm long everolimus eluting stent (EES) either alone or in combination with other stents. 3 The excellent 1-year outcome (4.1% clinically driven target lesion revascularization (TLR) and 0.8% stent thrombosis with a nearly complete −96.1%follow-up) is even more remarkable if you consider the high prevalence (34%) after chronic total occlusions (CTO) and of small stents (46.1% smaller than 3.0 mm). Deliverability was also excellent with uneventful aborted attempts occurring in 5.3% of cases, a percentage possibly going to drop even more with the claimed better new iterations of this stent design (Skypoint ® , Abbott Vascular).…”

“…5 This study also addressed a challenging lesion subset: CTOs. 3 After crossing CTOs a complete rapid coverage of all the occluded segments reduces the risk of dissections propagating downstream or expanding laterally, with the possible development of late pseudoaneurysms. Especially after retrograde recanalization when the extracorporeal loop provides excellent support, advancing a longer stent is always feasible.…”

“…This study also addressed a challenging lesion subset: CTOs 3 . After crossing CTOs a complete rapid coverage of all the occluded segments reduces the risk of dissections propagating downstream or expanding laterally, with the possible development of late pseudoaneurysms.…”

“…Unfortunately, lesions longer than 40 mm may include more than 20% of the complex currently treated PCI lesions. It is with this backdrop that we read with keen interest the study by Gautier et al in this issue of Catheterization and Cardiovascular Interventions, in which the authors provide results of a consecutive series of 268 patients and 276 lesions receiving a 48 mm long everolimus eluting stent (EES) either alone or in combination with other stents 3 . The excellent 1‐year outcome (4.1% clinically driven target lesion revascularization (TLR) and 0.8% stent thrombosis with a nearly complete −96.1%‐ follow‐up) is even more remarkable if you consider the high prevalence (34%) after chronic total occlusions (CTO) and of small stents (46.1% smaller than 3.0 mm).…”