Coronary stenting in small vessels: Short-term and long-term clinical outcome

Objective. To assess the clinical outcome of coronary stenting in small ves sels (< 3 mm), using high pressure balloon inflation and antithrombotic the rapy. Patients and methods. Vessel size was evaluated as < or greater than or equ al to 3 mm at the time of procedure and measured at a level of maximum diam eter. We studied 234 consecutive patients with placement of 300 stents in 2 79 lesions, comprising 84 stents implanted in 79 lesions located at small v essels (< 3 mm). The standard technique included high pressure balloon infl ation (15.8 +/- 2.2 atm) and post-stenting therapy with ticlopidine and asp irin for one month. Mean clinical follow-up was 17.6 +/- 10 months. Results. Procedural success without in-hospital major events was similar be tween small and large vessels (93.7 in vessels of < 3 mm vs 93.5% in vessel s of greater than or equal to 3 mm; p = NS). Three small vessels presented subacute stent thrombosis, whereas no thrombotic occlusion occurred in larg e vessels (3.8 vs 0%; p = 0.006). At two years, small vessels had a lower t arget lesion revascularization free survival (73.6 vs 90.3%; p < 0.001). Af ter adjustement for variables previously described as predictors of stent r eestenosis, in multivariate analysis, a small vessel of < 3 mm was an indep endent predictor of target lesion revascularization (p = 0.001). Although p atients with stenting in small vessels did not differ significantly in term s of any cause death (4.6 vs 3.8%; p = 0.7) nor acute myocardial infarction (2.9 vs 1.1%; p = 0.3), event-free survival was significantly lower after two years (69.1 vs 86.6%; p < 0.001). Conclusion. As compared to large vessels, coronary stenting in small vessel s was performed with similar rates of initial success, however they had a s ignificantly worse clinical long-term outcome in terms of subacute stent th rombosis and target lesion revascularization at follow-up.