The concept of protective stent placement after successful recanalization of chronic total coronary occlusions: A matched pair analysis in 100 patients

Objective: Interim results of successful balloon angioplasty for total coro nary occlusions (TCO) are disappointing due to the high rate of restenosis and reocclusion. Adjunctive stenting has been suggested to improve patency rate after recanalization of total coronary occlusions (TCO); however, this concept of protective stenting has not been substantiated in a case contro l study. Methods: To test the efficacy of protective stenting of TCO, 100 patients w ere subjected to a matched pair analysis (block design) comparing conventio nal PTCA with protective stenting (Palmaz-Schatz stents) after successful r ecanalization of TCO followed by a standard antithrombotic regimen. Matchin g parameters included age (+/- 3.5 years), sex, cardiovascular risk factor, and lesion anatomy. Coronary angiography and QCA were performed before pai r assignment, after the intervention, and at a mean follow-up of 5 +/- 1.5 months. Results: Then were no deaths or myocardial infarctions related to the inter vention in the entire study cohort; bleeding at the puncture site was obser ved in two patients in both groups. Binary reocclusion and restenosis (grea ter than or equal to 50 %) rates were observed in 8 % and 0 % in stented pa tients versus 30 % and 22 % in the group with no protective stenting, respe ctively (p < 0.01). Target lesion reintervention was necessary in 8 % after protective stenting as compared to 58 % after PTCA alone (p < 0.001). At G months follow-up, 62 % of stented patients were free of any symptoms versu s 23 % with PTCA (p < 0.01). Conclusions: Protective stenting improves the immediate and follow-up angio graphic and clinical results of PTCA in chronic total coronary occlusions. Stenting of successfully recanalized total coronary occlusions should be a routine procedure.