Six-month Clinical and Angiographic Outcomes of Small-vessel Stenting using 2.25 mm Paclitaxel-Eluting Stent

초록

Background: It has been reported that the rate of positive outcomes for stenting is less robust for smaller coronary vessels. Drug-eluting stents (DES) are highly effective in reducingthe rate of in-stent restenosis. We investigated whether the 6-month clinical and angiographic outcomes of patients (pts) who underwent percutaneous coronary intervention (PCI) with 2.25 mm Paclitaxel-Eluting Stent (PES, TaxusTM) is safe and durable. Methods: All pts who underwent PCI with 2.25 mm PES were enrolled. All pts received aspirin, clopidogrel and/or cilostazol as the antiplatelet regimen. The unfractionated heparin (UFH; 50 IU/Kg) was given during the PCI and glycoprotein IIb/IIIa inhibitors were used on physician’s discretion. Six-month angiographic and clinical outcomes of 2.25 mm PES were evaluated. Results: A total 56 pts (male 23, 64.3±10.9 years, Diabetes mellitus 17/56, 30.3 %) were treated with total 135 DESs (120 PES and 15 Sirolimus-eluting stents, SES; CypherTM). Among them, 78 PESs with 2.25 mm diameter (78/135, 57.8 %) were implanted to cover left anterior descending artery 32.1 %, diagonal branch 7.7 %, left circumflex artery 20.5 %, obtuse marginal branch 10.3 %, right coronary artery 20.3 %, other branch 9.1 %. The ostial and proximal lesions were 1.3 %, and 21.7 %, respectively. The mean length of 2.25 mm PES was 23.7±19.6 mm. Angiographic and procedural success was achieved in 98.2 % of patients. There were one in-hospital deaths (2 %). At 6 month, there were 1 cardiac death (2.0 %), 4 repeat PCI (target lesion revascularization; TLR 7.8 %) and 6 major adverse cardiac events (TLR-MACE, 10.7 %). Sixmonth angiography showed the binary restenosis in 10 pts (17.8 %, type Ic, Ib, 10.7 %, 7.1 %, respectively). The mean late loss was 0.68 ± 0.61 mm. Conclusions: Small PES (2.25 mm diameter) specifically designed for smallvessel disease application appears to be safe and durable up to 6 months and could be considered as a standard care for small vessel PCI.