Stent placement to prevent restenosis after angioplasty in small coronary arteries

Background-Lesions in small-diameter vessels (<3 mm) define a group with di stinct clinical and morphological characteristics. There is an inverse rela tionship between vessel size and angiographic restenosis rate. This study a ssessed whether stents reduce angiographic restenosis in small coronary art eries compared with standard balloon angioplasty. Methods and Results-We randomly assigned 351 symptomatic patients needing d ilatation of I native coronary vessel between 2.3 and 2.9 mm in size to ang ioplasty alone (n=182) or stent implantation (n=169). The primary end point was angiographic restenosis at 6 months. Secondary end points included dea th, myocardial infarction, bypass surgery, and target vessel revascularizat ion in hospital and at 6 months. There were no significant differences betw een groups in terms of major in-hospital complications. There was a trend t oward fewer in-hospital events in the stent group (3% versus 7.1% in angiop lasty group, P=0.076). Crossovers to stent occurred in 37 patients (20.3%). Repeat angiography at 6-month follow-up was performed in 85.3% of patients . Angiographic restenosis occurred in 28% of the stent group and 32.9% of t he angioplasty group (P=0.36). Target vessel revascularization was required in 17.8% versus 20.3% of patients (P=0.54), respectively. Conclusions-Stenting and standard coronary angioplasty are associated with equal restenosis rate in small coronary arteries. With a lower in-hospital complication rate, stenting may be a superior strategy in small vessels.