Comparison of Clinical Outcomes Between Very Long Stents and Overlapping Stents for the Treatment of Diffuse Coronary Disease in Real Clinical Practice

• Published in: Cardiovascular revascularization medicine Vol. 20; no. 8; pp. 681 - 686
• Main Authors: Jurado-Román, Alfonso, Abellán-Huerta, José, Requena, Juan Antonio, Sánchez-Pérez, Ignacio, López-Lluva, María T., Maseda-Uriza, Ramón, Piqueras-Flores, Jesús, Pérez-Díaz, Pedro, Frías-García, Raquel, Lozano-Ruíz-Poveda, Fernando
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-08-2019
• Subjects: Aged; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; Coronary Thrombosis - etiology; Diffuse coronary disease; Female; Humans; Male; Middle Aged; Myocardial Infarction - etiology; Overlapping stents; Percutaneous Coronary Intervention - adverse effects; Percutaneous Coronary Intervention - instrumentation; Percutaneous Coronary Intervention - mortality; Prosthesis Design; Registries; Retreatment; Retrospective Studies; Risk Factors; Stents; Time Factors; Treatment Outcome; Very long stents; Very long stents; ST; OS; MACE; Overlapping stents; Diffuse coronary disease; TLR; dCAD; VLS; AMI
• ISSN: 1553-8389; 1878-0938
• DOI: 10.1016/j.carrev.2018.09.009

The stent length as well as the stent overlap for the percutaneous treatment of diffuse coronary disease have been considered predictors of adverse events. However, there are no comparative data on the use of very long stents or overlapping stents in this scenario.
To compare the clinical results of very long stents (≥40 mm) or overlapping stents in real clinical practice.
We included 643 lesions in 628 consecutive patients treated with a single very long stent (≥40 mm) (251 lesions) or ≥2 overlapped stents (392 lesions). We analyzed the procedural characteristics and the presentation of the combined endpoint [cardiovascular death, non-fatal myocardial infarction, need for target lesion revascularization or stent thrombosis] after a follow-up of 20 months.
Total stent length was 54 ± 18 mm and minimum diameter was 2.9 ± 1.2 mm. At the end of follow-up, the rate of adverse events was 8.3% (cardiac death: 4.9%, myocardial infarction: 1.7%, target lesion revascularization: 3.1%, stent thrombosis: 0.7%). There were no significant differences between both groups in the presentation of the combined endpoint. Procedures with overlapping stents had more contrast volume (309 ± 115 vs 273 ± 127 ml; p = 0.002), longer duration (47 ± 22 vs 39 ± 18 min; p < 0.0001), higher fluoroscopy time (20 ± 13 vs 16 ± 9 min; p < 0.0001) and higher number of stents to treat the index lesion (2.2 ± 0.5 vs 1; p < 0.0001).
New designs of very long stents allow not only treating increasingly complex lesions, but also simplifying the procedure and decreasing the number of stents with very favorable results similar to those obtained with stent overlap.
•There are no comparative data on the use of very long stents or overlapping stents in this diffuse coronary disease.•We compared the implantation of a single very long stent (≥40 mm) versus overlapped stents in this scenario.•Very long stent implantation was associated with less contrast volume, duration of procedure and fluoroscopy time.•After 20 months there were no significant differences between both groups in the presentation of clinical adverse events.•New designs of very long stents simplify the procedures with possible reduction of procedural costs.