Compare long-term results of stenting coronary artery stenosis extended with the use of very length of the stent or a combination of drug-eluting stents and bare metal stents in patients with acute coronary syndrome without ST-segment elevation and multivessel disease

Bocharov A.V.¹, Popov L.V.²

Aim. Comparison of long-term results of stenting of extended stenoses (lesion length ≥55 mm) of clinically-dependent arteries in acute coronary syndrome without ST segment elevation in groups with implantation of super long stents with a drug coating or with a combination of a stent with a bare-metal stent.

Materials and methods. The sample consisted of 61 patients with coronary artery disease and multivessel coronary artery lesions who underwent emergency stenting of extensive stenosis of the clinically-dependent artery for acute coronary syndrome without ST segment elevation, and later — complete functional revascularization no later than 90 days from the date of the first stage. Complete functional revascularization was performed using the endovascular method using 3 generation stents with a drug coating and the biodegradable polymer “Calipso”. The minimum total length of the area to be stent was 55 mm. The main group consisted of 31 patients who underwent clinical-dependent artery revascularization using the endovascular method using 1 3rd generation super long stent with drug-coated sirolimus and biodegradable polymer “Biomime”. 30 patients, the control group, revascularization of the clinical-dependent artery was also performed with a combination of overlapped implanted stents, one of which was the 3rd generation medicinal sirolimus stent and the biodegradable polymer “Calipso”, and the bare metal stent “Sinus” another.

Results.There were no statistically significant differences between the groups in clinical, demographic and operational characteristics. Analysis of the results revealed a significant difference between the groups in terms of the frequency of repeated revascularization of the target artery and the frequency of MACCE events that were observed more often in the control group.

Conclusions. When performing extended stenting of a clinic-dependent artery in patients with acute coronary syndrome without ST-segment elevation, the use of extra-long 3-generation stents with a drug coating is effective and safe. Overlapping of the drug-eluting stent and the bare-metal stent should be avoided, as this is associated with a large number of repeated revascularization of the target vessel and large cardiovascular events. This strategy can be recommended for use in case of need to completely cover the stenotic lesion or close the dissection in the absence of drug-eluting stents.

1. Matchin YuG, Lyakishev AA, Mironova IYu et al. Drug eluting stents in treatment of patients with long and diffuse coronary artery lesions. Kardiologya. 2007;9:41-46 (In Russ).

2. Bokeria LA, Alekyan BG. Roentgen-endovascular diagnosis and treatment of heart and vascular disease in Russian Federation in 2014. Moscow: A.N. Bakulev SCCVS of RAS; 2014. (In Russ).

3. Xu B, Gao RL, Zhang RY et al. Efficacy and safety of FIREHAWK abluminal groove filled biodegradable polymer sirolimus-eluting stents for the treatment of long coronary lesions: nine-month angiographic and one-year clinical results from TARGET I trial long cohort. Chinese Med J. 2013;126(6):1026-1032. doi: 10.3760/cma.j.issn.0366-6999.20123206.

4. Kastrati A, Elezi S, Dirschinger J et al. Influence of lesion length on restenosis after coronary stent placement. Am J Cardiol. 1999;83:1617-1622.

5. Ryan TJ, Bauman WB, Kennedy JW et al. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American Heart Association / American College of Cardiology Task Force on Assesment of Diagnostic and Therapeutic Cardiovascular Procedures (committee on percutaneous transluminal coronary angioplasty). Circulation. 1993;88:2987-3007.

6. Bauters C, Hubert E, Prat A, et al. Predictors of restenosis after coronary stent implantation. J Am Coll Cardiol. 1998;31:1291-1298.

7. Hoffman R, Herrman G, Silber S et al. Randomized comparison of success and adverse event rates and cost effectiveness of one long versus two short stents for treatment of long coronary narrowings. Am J Cardiol. 2002;90:460-464.

8. Pan M, de Lezo JS, Medina A et al. Influence of stent treatment strategies in the long-term outcome of patients with long diffuse coronary lesions. Cathter Cardiovasc Interv. 2003;58:293-300.

9. Degertekin M, Arampatzis CA, Lemos PA, et al. Very long sirolimus-eluting stent implantation for de novo coronary lesions. Am J Cardiol. 2004;93:826-829.

10. Stone GW, Ellis SG, Cox DA et al. TAXUS-IV investigators. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med. 2004; 350:221-231.

11. Tsagalou E, Chieffo A, Iakovou I et al. Multiple overlapping drug-eluting stents to treat diffuse disease of the left anterior descending coronary artery. J Am Coll Cardiol. 2005;45:1570-1573.

12. Kereiakes DJ, Wang H, Popma JJ et al. Periprocedural and late consequences of overlapping Cypher sirolimus-eluting stents: pooled analysis of five clinical trials. J Am Coll Cardiol. 2006;48:21-31.

13. Wilson GJ, Polovick JE, Huibregtse BA, Poff BC. Overlapping paclitaxel eluting stents: Long-term effects in a porcine coronary artery model. Cardiovasc Res. 2007;76:361-372.

14. Gould KL, Johnson NP. Physiologic severity of diffuse coronary artery disease: Hidden hugh risk. (Editotial) Circulation. 2015;131(1):4-6. doi: 10.1161/CirculationAHA.114.013815.

15. Mancini J. Quantitative coronary arteriographic methods in the interventional catheterization laboratory: an update and perspective. J Am Coll Cardiol. 1991;17(6):23-33. doi: 10.1016/0735-1097(91)90935-3.

16. Park DW, Kim YH, Song HG et al. Comparison of everolimus- and sirolimus -eluting stents in patients with long coronary artery lesions: a randomized LONG-DES-III (Percutaneous Treatment of LONG Native Coronary Lesions With Drud-elluting Stent-III) Trial. JACC Cardiovasc Interv. 2011;4(10):1096-1103. doi: 10.1016/j.jcin.2011.05.024.

17. Ryan TJ, Bauman WB, Kennedy JW et al. Guidelines for percutaneous transluminal coronary angioplasty. A report of the American Heart Association / American College of Cardiology Task Force on Assesment of Diagnostic and Therapeutic Cardiovascular Procedures (committee on percutaneous transluminal coronary angioplasty). Circulation. 1993;88:2987-3007.

18. Aoki J, Ong A, Rodrigues GG et al. «Full metal jacket» (stented length > or = 64 mm) using drug-eluting stents for de novo coronary artery lesions. Am Heart J. 2005:150(5):994-999.

19. Balakrishnan B, Tzafriri AR, Seifert P et al. Strut position, blood flow, and drug deposition: implications for single and overlapping drug-eluting stents. Circulation. 2005;111(22):2958-2965.

20. Lee SH, Jang Y, Oh SJ et al. Overlapping vs one long stenting in long coronary lesions. Catheter Cardiovasc Interv. 2004;62(3):298-302.

21. Burzotta F, Siviglia M, Altamura L et al. Overlapping heterogenous drug-eluting stents and of overlapping drug-eluting and bare metal stents. Am J Cardiol. 2007; 99(3):364-368. doi: 10.1016/j.amjcard.2006.08.039.