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AS-177: Long-Term Outcome following Drug-Eluting Stent Implantation for Restenosis Lesions
Wednesday, April 22 - Friday, April 24, 2009 (E-Poster Abstract Zone) received 38-mm PES and 30 overlapping SES. Baseline clinical and angiographic characteristics were balanced. Results: At 6-month follow-up, angiographic examination was performed in all patients. There was no difference between the 2 groups in late loss area of neointimal hyperplasia (p ⫽ 0.154; mean late loss SES ⫽ 0.5550, PES ⫽ 0.214). However, there was some higher late loss at the overlapping site in the SES group (26%, 8/30 patients). Major adverse cardiac events were similar in patients treated with SES compared with those treated with 38-mm PES. Conclusion: Compared with using overlapping SES in diffuse long lesions, percutaneous coronary intervention with 38-mm PES exhibited similar late loss area and clinical outcomes. However, overlapping sites in the SES group may be a source of higher rates of intimal hyperplasia in diffuse long lesions.
AS-177 Long-Term Outcome following Drug-Eluting Stent Implantation for Restenosis Lesions. Makoto Utsunomiya. Kyoto Katsura Hospital, Kyoto, Japan. Background: Very late stent thrombosis is a concern with drug-eluting stents (DES). However, using DES in restenosis lesions at high risk for secondary restenosis is essential. The aim of this study was to evaluate outcomes for DES implantation for restenotic lesions. Methods: Between August 2004 and January 2008, we investigated 216 consecutive restenotic lesions in 189 patients treated with DES (sirolimus-eluting stent [SES] ⫽ 201 lesions; paclitaxel-eluting stent [PES] ⫽ 15 lesions). Of these, 134 lesions were in-stent restenosis lesions and 35 were DES restenosis lesions. Results: Clinical follow-up rate was 96.8%, and mean follow-up length was 27.4 months. There were 5 (2.4%) deaths, 4 patients with noncardiac death and 1 with sudden death. Thirty-two patients (15.3%) received repeat target lesion revascularization (TLR). Eight-month follow-up angiography was performed for 192 lesions (88.9%). Qualitative comparative analysis (QCA) revealed mean late loss of 0.37 mm; furthermore, 22 lesions (11.5%) demonstrated restenosis, which was defined as %diameter stenosis ⬍50%. There were no significant differences in TLR, late loss, and restenosis rates between deployed stents in cases of SES and PES usage. There were no significant differences between in-stent restenosis. Conclusion: Treatment of restenosis lesion with DES is feasible with a relatively low restenosis rate of 11.5%.
AS-178 Transradial Rotational Atherectomy with Drug-Eluting Stents for Heavily Calcified Lesions. Cheng Xing Shen, Gen Shan Ma, Yi Feng, Qiming Dai, Zhong Chen, Dan Luo, Jian Dong Ding, Cheng Chun Tang, Run Ming Wang, Huiping Wang. Zhongda Hospital, Southeast University, Nanjing, China. Background: Calcified lesions are always a treatment challenge, and periprocedural complications with a transfemoral approach are higher compared with a transradial approach. The objective of this study was to assess the immediate and 1-year outcomes of the combination of rotational atherectomy (RA) with drug-eluting stents (DES) via a transradial approach for heavily calcified lesions. Methods: Twenty-three patients with severely calcified lesions were treated with a transradial with RA followed by percutaneous coronary intervention (PCI) with DES implantation. The procedural and 1-year follow-up success rates were analyzed. Results: RA was carried out successfully in all cases with successful subsequent DES deployment. Twenty-one cases were performed by 6-Fr guiding, 2 by 7-Fr guiding. The burrs passed through the lesions successfully in all cases. Seventeen cases were treated with 1.25-mm
burr and 6 cases with 2 burrs. All patients received percutaneous transluminal coronary angioplasty after RA, and stents were deployed successfully. There was no evidence of pericardial effusion in any patient. One patient had severe coronary spasm, and 2 showed slow flow during the procedure. Eleven patents had troponin I elevation greater than threefold, but only 1 patient experienced a greater than twofold rise in creatine kinase-MB. No patient required emergency bypass graft surgery, and there was no in-hospital mortality. There was no major bleeding after the procedure. One-year follow-up showed good clinical results, and 1 in-stent restenosis was seen in follow-up angiogram in 13 patients. Conclusion: Transradial RA plus DES can increase the procedural success rate for heavily calcified lesions and can be carried out safely with good in-hospital and 1-year results.
AS-179 Long-Term Clinical Outcomes in Diabetic Patients with Long Chronic Total Occlusion Treated with Drug-Eluting Stents. Han Jun Pei, Yong Jian Wu, Guang Yuan Song, Yue Jin Yang. FuWai Hospital, Beijing, China. Background: There are few data about the safety and efficacy of successful recanalization of long chronic total occlusion (CTO) lesions in diabetic patients. Diabetes, CTO, and long lesions are all the risk factors for unfavorable outcomes after percutaneous coronary intervention (PCI). The aim of this study was to assess clinical outcomes of long CTO treated with drug-eluting stents (DES) in patients with diabetes mellitus. Methods: From January 2006 to May 2007, 143 consecutive patients who had a sirolimus- or paclitaxel-eluting stent implanted for CTO were divided into 2 groups according to total stent length, then compared for clinical outcome. Death, myocardial infarction, repeat angioplasty, and coronary artery bypass were considered adverse events in 139 patients with available long-term follow-up (19.8 ⫾ 5.1 months). Results: There were no differences between groups in baseline clinical and main angiographic characteristics. There were 6 (8.6%) and 9 (12.3%) events in the CTO-1 group (total stent length ⬍40 mm) and the CTO-2 group (total stent length ⱖ40 mm), respectively (p ⫽ ns). In univariate analysis, %residual lesion and final minimal luminal diameter (MLD) were found to be significantly related to events at long-term follow-up. Cox regression analysis identified final MLD (odds ratio 0.097, 95% confidence interval 0.013– 0.694, p ⫽ 0.02) as the only dependant predictor at long-term follow-up. Conclusion: Patients in the 2 groups did not differ at long-term follow-up in terms of death, myocardial infarction, and target lesion revascularizations. Final MLD is a significant predictor of events during long-term follow-up.
AS-180 Serial Follow-Up of Coronary Artery Aneurysm after DrugEluting Stent Implantation at 6 Months and 2 Years. Won-Jang Kim, Young-Hak Kim, Jong-Young Lee, Duk-Woo Park, Seung-Whan Lee, Sung-Cheol Lee, Cheol Whan Lee, Myeong-Ki Hong, Seong-Wook Park, Seung-Jung Park. Asan Medical Center, Seoul, Republic of Korea. Background: There are limited data on long-term incidence and clinical outcomes of coronary artery aneurysm (CAA) after drug-eluting stent (DES) implantation. Methods: We enrolled 744 lesions treated with either sirolimuseluting stents (SES; 79%) or paclitaxel-eluting stents (PES; 21%) that underwent 6-month and 2-year angiographies. CAA was defined as
The American Journal of Cardiology姞 APRIL 22–24 2009 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster 77B
EP O S T E R A B S T R A C T S
AS-177 Long-Term Outcome following Drug-Eluting Stent Implantation for Restenosis Lesions. Makoto Utsunomiya. Kyoto Katsura Hospital, Kyoto, Japan. Background: Very late stent thrombosis is a concern with drug-eluting stents (DES). However, using DES in restenosis lesions at high risk for secondary restenosis is essential. The aim of this study was to evaluate outcomes for DES implantation for restenotic lesions. Methods: Between August 2004 and January 2008, we investigated 216 consecutive restenotic lesions in 189 patients treated with DES (sirolimus-eluting stent [SES] ⫽ 201 lesions; paclitaxel-eluting stent [PES] ⫽ 15 lesions). Of these, 134 lesions were in-stent restenosis lesions and 35 were DES restenosis lesions. Results: Clinical follow-up rate was 96.8%, and mean follow-up length was 27.4 months. There were 5 (2.4%) deaths, 4 patients with noncardiac death and 1 with sudden death. Thirty-two patients (15.3%) received repeat target lesion revascularization (TLR). Eight-month follow-up angiography was performed for 192 lesions (88.9%). Qualitative comparative analysis (QCA) revealed mean late loss of 0.37 mm; furthermore, 22 lesions (11.5%) demonstrated restenosis, which was defined as %diameter stenosis ⬍50%. There were no significant differences in TLR, late loss, and restenosis rates between deployed stents in cases of SES and PES usage. There were no significant differences between in-stent restenosis. Conclusion: Treatment of restenosis lesion with DES is feasible with a relatively low restenosis rate of 11.5%.
AS-178 Transradial Rotational Atherectomy with Drug-Eluting Stents for Heavily Calcified Lesions. Cheng Xing Shen, Gen Shan Ma, Yi Feng, Qiming Dai, Zhong Chen, Dan Luo, Jian Dong Ding, Cheng Chun Tang, Run Ming Wang, Huiping Wang. Zhongda Hospital, Southeast University, Nanjing, China. Background: Calcified lesions are always a treatment challenge, and periprocedural complications with a transfemoral approach are higher compared with a transradial approach. The objective of this study was to assess the immediate and 1-year outcomes of the combination of rotational atherectomy (RA) with drug-eluting stents (DES) via a transradial approach for heavily calcified lesions. Methods: Twenty-three patients with severely calcified lesions were treated with a transradial with RA followed by percutaneous coronary intervention (PCI) with DES implantation. The procedural and 1-year follow-up success rates were analyzed. Results: RA was carried out successfully in all cases with successful subsequent DES deployment. Twenty-one cases were performed by 6-Fr guiding, 2 by 7-Fr guiding. The burrs passed through the lesions successfully in all cases. Seventeen cases were treated with 1.25-mm
burr and 6 cases with 2 burrs. All patients received percutaneous transluminal coronary angioplasty after RA, and stents were deployed successfully. There was no evidence of pericardial effusion in any patient. One patient had severe coronary spasm, and 2 showed slow flow during the procedure. Eleven patents had troponin I elevation greater than threefold, but only 1 patient experienced a greater than twofold rise in creatine kinase-MB. No patient required emergency bypass graft surgery, and there was no in-hospital mortality. There was no major bleeding after the procedure. One-year follow-up showed good clinical results, and 1 in-stent restenosis was seen in follow-up angiogram in 13 patients. Conclusion: Transradial RA plus DES can increase the procedural success rate for heavily calcified lesions and can be carried out safely with good in-hospital and 1-year results.
AS-179 Long-Term Clinical Outcomes in Diabetic Patients with Long Chronic Total Occlusion Treated with Drug-Eluting Stents. Han Jun Pei, Yong Jian Wu, Guang Yuan Song, Yue Jin Yang. FuWai Hospital, Beijing, China. Background: There are few data about the safety and efficacy of successful recanalization of long chronic total occlusion (CTO) lesions in diabetic patients. Diabetes, CTO, and long lesions are all the risk factors for unfavorable outcomes after percutaneous coronary intervention (PCI). The aim of this study was to assess clinical outcomes of long CTO treated with drug-eluting stents (DES) in patients with diabetes mellitus. Methods: From January 2006 to May 2007, 143 consecutive patients who had a sirolimus- or paclitaxel-eluting stent implanted for CTO were divided into 2 groups according to total stent length, then compared for clinical outcome. Death, myocardial infarction, repeat angioplasty, and coronary artery bypass were considered adverse events in 139 patients with available long-term follow-up (19.8 ⫾ 5.1 months). Results: There were no differences between groups in baseline clinical and main angiographic characteristics. There were 6 (8.6%) and 9 (12.3%) events in the CTO-1 group (total stent length ⬍40 mm) and the CTO-2 group (total stent length ⱖ40 mm), respectively (p ⫽ ns). In univariate analysis, %residual lesion and final minimal luminal diameter (MLD) were found to be significantly related to events at long-term follow-up. Cox regression analysis identified final MLD (odds ratio 0.097, 95% confidence interval 0.013– 0.694, p ⫽ 0.02) as the only dependant predictor at long-term follow-up. Conclusion: Patients in the 2 groups did not differ at long-term follow-up in terms of death, myocardial infarction, and target lesion revascularizations. Final MLD is a significant predictor of events during long-term follow-up.
AS-180 Serial Follow-Up of Coronary Artery Aneurysm after DrugEluting Stent Implantation at 6 Months and 2 Years. Won-Jang Kim, Young-Hak Kim, Jong-Young Lee, Duk-Woo Park, Seung-Whan Lee, Sung-Cheol Lee, Cheol Whan Lee, Myeong-Ki Hong, Seong-Wook Park, Seung-Jung Park. Asan Medical Center, Seoul, Republic of Korea. Background: There are limited data on long-term incidence and clinical outcomes of coronary artery aneurysm (CAA) after drug-eluting stent (DES) implantation. Methods: We enrolled 744 lesions treated with either sirolimuseluting stents (SES; 79%) or paclitaxel-eluting stents (PES; 21%) that underwent 6-month and 2-year angiographies. CAA was defined as
The American Journal of Cardiology姞 APRIL 22–24 2009 ANGIOPLASTY SUMMIT ABSTRACTS/E-Poster 77B
EP O S T E R A B S T R A C T S