Vessel Size and Long-Term Outcome After Coronary Stent Placement

Abstract

Background —The role of coronary stenting in the treatment of patients with small vessels is not well defined. The purpose of this study was to investigate the influence of vessel size on long-term clinical and angiographic outcome after coronary stent placement. Methods and Results —The study comprised 2602 patients with successful stent implantation for symptomatic coronary artery disease. Patients were subdivided into 3 equally sized groups (tertiles) according to vessel size, with respective ranges of <2.8, 2.8 to 3.2, and >3.2 mm. Event-free survival at 1 year was 69.5% in the group with smaller vessels, 77.5% in the second group, and 81% in the group with larger vessels ( P <0.001). Late lumen loss was similar between the 3 groups (1.12±0.73, 1.12±0.79, and 1.09±0.88 mm, respectively). Angiographic restenosis rate was significantly higher in the small-vessel group (38.6%, 28.4%, and 20.4% in groups 1, 2, and 3, respectively; P <0.001). The analysis identified subgroups with different risk for restenosis even among patients with small vessels. Within this group, the restenosis rate may be as low as 29.6% in patients without additional risk factors and as high as 53.5% in patients with diabetes and complex lesions. Conclusions —Patients with small vessels present a higher risk for an adverse outcome after coronary stent placement because of a higher incidence of restenosis. However, the unusually high risk for restenosis is confined to those patients with small vessels who have concomitant risk factors such as diabetes and complex lesions.

Predictive Factors for Restenosis after Drug-Eluting Stent Implantation

“…12)13) Several reports have evaluated the impact of baseline and procedural characteristics on the risk of subsequent restenosis after bare metal stent implantation, and a number of highrisk parameters such as diabetes, lesion length and vessel size have been consistently identified in most studies (Table 1). [14][15][16] Intravascular ultrasound variables, including the in-stent area, the extent of the preexisting plaque, stenting of total occlusions and a history of diabetes mellitus, as well as implantation of a long stent, have all been shown to predict in-stent restenosis. 17) In addition, the thickness of the stent strut has also been found to play an important role in the development of restenosis, with thin-strut stents reported to cause less neointima proliferation.…”

Wingspan Stents for the Treatment of Symptomatic Atherosclerotic Stenosis in Small Intracranial Vessels: Safety and Efficacy Evaluation

“…3 Vessel diameter is negatively correlated with ISR and other adverse outcomes. 4 By using the self-expanding Wingspan stent system (Boston Scientific, Freemont, California) to treat intracranial artery stenosis, the surgical success rate and safety of the procedure are further improved because of increased compliance. Bose et al 5 studied patients with intracranial stenosis in arteries 2.5 to 4.5 mm in diameter and who were treated with a Wingspan stent; however, to date, only a few studies have been conducted on the use of Wingspan stents in the treatment of small intracranial artery stenosis, and the sample size was small.…”

Volume do stent à ultra-sonografia intracoronária como preditor de reestenose angiográfica: estudo em pacientes com alto risco de reestenose

“…Entretanto, Elezi et al 32 também encontraram resultados semelhantes em série com mais de 2000 pacientes, na qual os pacientes com vasos de calibre < 2,8 mm apresentaram maior taxa de reestenose pelo critério binário, quando comparados àqueles com calibre superior a 3,2 mm (38,6 versus 20,4%). Nessa investigação, a maior taxa de reestenose esteve diretamente relacionada à evolução clínica, uma vez que naqueles pacientes com vasos menores, a sobrevida livre de eventos cardiovasculares graves em um ano foi de 69,5%, versus 77,5% e 81%, respectivamente para vasos com calibres intermediários e calibres maiores.…”