Long-term angiographic results of stenting in chronic total occlusions: Influence of stent design and vessel size

Background Although coronary stenting has decreased the high restenosis rat e associated with percutaneous transluminal coronary angioplasty of chronic total occlusions (CTOs), the results are still less satisfactory than thos e found in nonoccluded lesions, at least as reported with the Palmaz-Schatz stent. The present work compares the restenosis rate of other stent design s with that of the Palmaz-Schatz stent. Methods We studied the long-term angiographic outcome of 120 CTOs successfu lly recanalized with balloon-expandable stents and without concomitant debu lking techniques. Angiographic follow-up and full quantitative coronary ang iography analysis was prospectively performed in all patients. Three differ ent stent designs were compared: Palmaz-Schatz (n = 47), coil (n = 24), and multicellular (n = 49). Particular attention was paid to their performance in vessels of 3 mm or less and greater than 3 mm in diameter. Restenosis w as defined as a 50% or greater diameter stenosis at follow-up. Results Multicellular stents were implanted more frequently in the left ant erior descending artery and in patients with multivessel disease. No other significant differences in clinical or angiographic baseline characteristic s, including vessel size, were noted between groups. At follow-up, multicel lular stents presented a lower restenosis rate (22% vs 36% and 58% in the P almaz-Schatz and coil stent groups, respectively; P = .01) and larger minim al luminal diameters (1.92 +/- 0.85 mm vs 1.73 +/- 0.98 and 1.38 +/- 0.83 m m in the Palmaz-Schatz and coil stent groups, respectively; P = 0.0). The s uperiority of the multicellular stent design resulted from a lower restenos is rate in vessels of 3.0 mm or less in diameter (20% vs 47% and 79% in the Palmaz-Schatz and coil stent groups, respectively; P = .006). Conclusions These results suggest that the restenosis rate after stent reca nalization of CTOs is influenced by both stent design and vessel size and m ay indicate a superiority of multicellular over Palmaz-Schatz and coil sten t designs for this purpose.