Stents in total occlusion for restenosis prevention - The multicentre randomized STOP study

Aims This multicentre randomized study set out to evaluate whether coronary stenting improves the results of successful balloon angioplasty for chroni c total occlusion. Balloon angioplasty for chronic total occlusion has a hi gh restenosis rate. Several reports have suggested that coronary stenting m ay decrease the likelihood of restenosis and reocclusion. Methods and Results Patients with total coronary artery occlusions who had an optimal PTCA result were randomized either to no further treatment or ad ditional stent implantation. The AVE microstent was used and all patients w ere scheduled for a 1-, 3-, and 6-month clinical follow-up. Repeat coronary angiography to assess the rate and pattern of restenosis was performed at 6 months or earlier if clinically indicated. Ninety-six patients were enrol led in this study. The mean age was 59.3 +/- 10.3 years and 15 were females . Forty-eight patients were randomized to the stent arm, receiving 52 stent s (lengths 18-39 mm). Stent implantation was successful in all and there we re no major procedure-related complications. Sixty-nine patients (72%) were restudied after 6 months. The binary restenosis rates (50%), in the PTCA a rm were 70.9% with a minimal lumen diameter of 1.01 +/- 0.79 mm compared to 4.21% in the stent arm with a minimal lumen diameter of 1.63 +/- 1.02 mm ( P=0.033). Reocclusion occurred in 7.9% in the stent group compared to 16.1% in the PTCA group. Restenosis in the PTCA group was focal in 88% of patien ts and occurred at the point of total obstruction (within 5 mm), compared t o diffuse instent restenosis, which occurred in 54% of the patients in the stent group. Conclusion Coronary stenting can significantly decrease the rate of resteno sis and reocclusion of total occlusions. As restenosis in the stent group w as more diffuse, care should be taken to implant short stents at the site o f occlusion. (C) 2000 The European Society of Cardiology.