STENTING IN CHRONIC CORONARY-OCCLUSION (SICCO) - A RANDOMIZED, CONTROLLED TRIAL OF ADDING STENT IMPLANTATION AFTER SUCCESSFUL ANGIOPLASTY

Objectives. This study investigated whether stenting improves long-ter m results after recanalization of chronic coronary occlusions. Backgro und. Restenosis is common after percutaneous transluminal coronary ang ioplasty (PTCA) of chronic coronary occlusions. Stenting has been sugg ested as a means of improving results, but its use has not previously been investigated in a randomized trial. Methods. We randomly assigned 119 patients with a satisfactory result after successful recanalizati on by PTCA of a chronic coronary occlusion to 1) a control (PTCA) grou p with no other intervention, or 2) a group in which PTCA was followed by implantation of Palmaz-Schatz stents with full anticoagulation. Co ronary angiography was performed before randomization, after stenting and at 6-month follow-up. Results. Inguinal bleeding was more frequent in the stent group. There were no deaths. One patient with stenting h ad a myocardial infarction. Subacute occlusion within 2 weeks occurred in four patients in the stent group and in three in the PTCA group, A t follow-up, 57% of patients with stenting were free from angina compa red with 24% of patients with PTCA only (p < 0.001), Angiographic foll ow-up data were available in 114 patients, Restenosis (greater than or equal to 50% diameter stenosis) developed in 32% of patients with ste nting and in 74% of patients with PTCA only (p < 0.001); reocclusion o ccurred in 12% and 26%, respectively (p = 0.058), Minimal lumen diamet er (mean +/- SD) at follow-up was 1.92 +/- 0.95 mm and 1.11 +/- 0.78 m m, respectively (p < 0,001). Target lesion revascularization within 30 0 days was less frequent in patients with stenting than in patients wi th PTCA only (22% vs, 42%, p = 0.025), Conclusions., Si ent implantati on improved long-term angiographic and clinical results after PTCA of chronic coronary occlusions and is thus recommended regardless of the primary PTCA result.