Restenosis after stenting of matched occluded and non-occluded coronary arteries - Should there be a difference?

Aims It is not known whether the higher restenosis rates reported after bal loon angioplasty of occluded as opposed to non-occluded coronary arteries a re still found after placement of coronary stents in lesions matched for fa ctors known to affect late angiographic outcome Methods and Results In a retrospective analysis of 1276 patients who had un dergone coronary stent placement and in whom B-month angiographic follow-up was available, we identified 144 patients with a total coronary occlusion which matched a non-occluded coronary lesion in another 144 patients. Match ing lesion pairs were of the same type (de novo or restenotic), were suppli ed with the same type of stent, had reference vessel diameters identical wi thin 0.3 mm and stented vessel segment lengths identical within 8 mm, and w ere located in corresponding target vessels. After stenting, statistically identical minimal lumen diameters had been achieved in both groups (occlude d: 2.74 +/- 0.35 mm, non-occluded: 2.77 +/- 0.32mm, P=0.45). At follow-up, minimal lumen diameters were not different (occluded: 1.65 +/- 0.77 mm, non -occluded: 1.76 +/- 0.76 mm, P=0.24), reflecting an identical late lumen lo ss for occlusions (1.09 +/- 0.76mm) and non-occluded lesions (1.01 +/- 0.70 mm, P=0.38). Because of the significantly larger acute gain, the loss index was significantly lower for occluded vessels (0.40 +/- 0.27 vs 0.51 +/- 0. 35, P=0.003). Corresponding restenosis rates were 33% (occluded) and 28% (n on-occluded; P=0.44). For stented vessel segment lengths >18 mm, restenosis rates were markedly higher (occluded: 42%, non-occluded: 36%) than for ste nted vessel segment lengths less than or equal to 18 mm (occluded: 25%, non -occluded: 22%). Conclusions In occluded and non-occluded coronary lesions matched for facto rs known to affect the angiographic outcome, no difference between the resp ective restenosis rates was observed within 6 months of coronary stenting. Thus, either type of coronary lesion appears to exhibit the same propensity for neointimal hyperplasia.