J. Schofer et al., Restenosis after stenting of matched occluded and non-occluded coronary arteries - Should there be a difference?, EUR HEART J, 20(16), 1999, pp. 1175-1181
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.