WIKTOR STENT FOR TREATMENT OF CHRONIC TOTAL CORONARY-ARTERY OCCLUSIONS - SHORT-TERM AND LONG-TERM CLINICAL AND ANGIOGRAPHIC RESULTS FROM A LARGE MULTICENTER EXPERIENCE

Objectives. This study reports the first multicenter experience with t he Wiktor coil stent for treatment of chronic total coronary artery oc clusions (CTOs).Background. Percutaneous transluminal coronary angiopl asty (PTCA) of CTO is associated with very high restenosis and reocclu sion rates. Coronary stenting has been proposed as a means of improvin g outcome. However, the Wiktor device for CTOs has never been tested i n a large patient sample. Methods. From January 1993 to December 1996, 89 patients with 91 CTOs underwent Wiktor stent implantation after su ccessful PTCA. The post-stenting regimen consisted of warfarin (Coumad in) plus aspirin in the initial 49 patients (55%) and aspirin plus tic lopidine in 40 patients (45%). Results. Stenting was successful in 87 patients (98%), At 1 month, 6% of patients had subacute stent thrombos is, 3% had a major bleeding event, and 1% had access-site complication s. Subacute stent thrombosis showed univariate association with warfar in therapy (p = 0.009). Angiographic follow-up was obtained in 76 (93% ) of 82 eligible patients. The restenosis rate was 32%, including 4% r eocclusions. By multiple logistic regression analysis, restenosis was independently associated with multiple stents (adjusted odds ratio [OR ] 27.67, 95% confidence interval [CI] 4.25 to 79.95, p = 0.0008) and i ncreasing values of occlusion length (adjusted OR 1.23, 95% CI 1.09 to 1.39, p = 0.001). Freedom from death, myocardial infarction or stente d vessel revascularization was 87% and 72% at 1 and 3 years, respectiv ely. Conclusions. Short-and long term clinical and angiographic outcom es are favorable in patients undergoing Wiktor stent implantation in C TO. Further technical improvement is needed to reduce the restenosis r ate in patients with long lesions and multiple stents. (C) 1998 by the American College of Cardiology.