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Stent placement in long (≥15 mm) coronary lesions
~bmary1998
JACC
ABSTRACI'S- P-~t~r
•
Coronary Stentin9: Difficult Lesion Subsets Tuesday, March 31. 1998, Noon--2:00 p.m. Georgia World Congress Center. West ~xhibit Hall Level Presentation Hour: Noon-l:00 p.m.
Palmaz-SchMz S1Nmtlng in Unprotected Left Main Coronary A r t e r y Stenoels: ImmedlMe end Follow-up R s s u l t l
1: Tamura, 1". Kimura, H Nosska, M. N ~ h L
~ouv~mthe ~ ~
273A
Kokura t ~
No~,
~a ~k,~,'of P~.~..z-.~.~z (IS) S ~
SuMalned Benefit of 811ntln9 in Chronk: O ~ l u l l o n e : L o n g . t m ~ FOllow-up of I h e 81CC0
St.dy
P,A, Siff~l, S, Golf, Y, Myrlmg, P, Molltld, P, Nt~rfuon, K, Endings,
~, Mar~u¢~u, For~ StCCO~x~y ~ F~r~ H~n ~ The SiCC'O ~ show~l mat ~ a~
tmprov~~ an~gnm~ o.~m~ a~r ~
~ . y
~m~m~'~
o~c h i c
coronary ~ u a l o n s (CCO) w~h a m~'l~on m me bln~nt m~teno~ mt~ tram 78% to 32%. T0 a s N ~ ~ o ~nk:/d b~m~s o~ ~ t M 9 v o m ~ ~ngk~pk.~y in
IM~ff~odlm:A tOtOl~ 1!7 (~q~l~ pl~ wilh 8 m ~ h d l y mcanalt~/~0 were ~ ~ mlt;Fl#onal~ (FA, n ,~H, ~.JJ ~ withhJ~lanti<2,S ram, ve~e! ~ m a ~ x ~ / u N m u ~ Io r i m i n g o~ eallo~ m ~ n g . M pts were h),owed for me oceummce of Majo~ Adver~ Ca~e~: End~x,nts (MACE): ~ x a ~ t a ! ~ r m ~ . tmg~ kmon ~ t ~ (TLR) or ~m~, ResU~: N ~ r ~ 2 to 3.S y. (median 2.6) of foaow,up me modallly was 1,7% in g~A VS. 5,1% in grB (Its), TLR oocuwed in 18.0% of gtA: (10 PTCA ! CABG) 8nd in 49.2% at gdl] (25 l:q'CA, 4 CABG)(p : 0.006). MACEJme
O!
,
,,
•
Me,hoe We annlyzed ~ 38 pal~nt~ (pt~) t ~ e c l m ULMC~ ImNonfrom Msrch gl Io Oe(:emb~ 9(Bl:~8 nlolml (74%), mean igo M (~ ~ IS y~lm, Tmaled I~1 were dtvk;~t~linto two gfgul~l; pool ~ g f ~ (pc) wflh o ~ o~ morn dlk hlofor for CABO, 18 I ~ and ~ , ~ can(~m~ group (GC) w~out ~ k tact~ fo~ r,~SG, 20 i ~ . Thu ux~ected h t ~ ~ k kcto~ t~x ~ of me PC grou~ were n~lat~l Io oI¢Ie ~ (_>~ ym) In 9 ~ , m m ~ v m c u ~ r .d~,~-__ In 7 plu, poor LV "fun¢lk~ (qe¢l~m fraction <40%) ~ 4 i~s, p ~ CABG in 4 ptl, ix~r mn off tn 1 pt, ~ n ¢ ~ m 1 pl. COPD ~ I pt O ~ n
of ~meng m the OC gm.p m
results
PC1Spts GC2Om
_ : 2
FoSow~ rnurm
Iml~cilp~l d e a ~ E ~ l
Sel mmm~o~s
Ipt(S.6%) 0
0 0
Ang~gmlm¢ res~-o~ 5 m (29%) 2 pes(10'%) i|
on anammCale ~
p~ma~ly~
for m l m ~ . 8Mnti~g w ~ p~loml~l I~ctmlfully m aft ptl, ~ w ~ one i f ~ deafh In PC ~ Io acut~ ¢lo~Jm of RCA dllatl~ one week la~. I p~wlm pc~r L V ~ o ~ l f m m c a ~ ¢ failure t pt w~bepm~ cam~ h ~ s.dd~m ~ m , I pt d t ~ ffem cmdlac r e . r e ~ue ~oaort~ e1~oM wo~e~r~g, 1 pt m GC dt~l from re~lenogc MI.
Ream PTCA 2 pts (12%) 2 pts110%)
~
MI
CABG
3pts(1B%) lpl(5.9%) lp:(5.9'%) I m (5.0%) I I~ (5.0%) 0 Tan~! ~
m~cu~a~,on 3 p~ (18%) 2 ~ (10%)
v
~ : ~ in utC~>~'toO I.MCA co~d be a chellengmg aJtemalive to CABG in selected patk~ts, dese~ng fudher careful cfincal evalualmn.
.o.t " l k h f * . . . . . . ~ . ~ . . . . ~ .
O,
Pr(~
~2"-~ 0
4
6
12 16 20 2~4 :m ~
354044
4~
Sun~al T ~ M~hs Con~.usio~: Stent iml~an~aben in chronic comnar/occlusions resufled ;n a supenor long-term clinical outcome as compared to angloplasty alone.
~
Intemal Mammary Artery Graft Angioplasty
A Single Center Experience M. Tebeca, M. Masfoof, R. Mehmn, G. Plude, E. I~nnow, S. Slack, 1". Bucher, J. Popma. A. Pichard, J. Lindsay. Jr.. W ~ Hosp/ta/ Center. ~ f o n , DC, USA Inc~asing use of internal mammary artery grafts (IMA) in the surgical revascularization of coronary arten/diseasehas made the need for percutaneous angloplasty ef IMA steno~es mere common. We analyzed 139 pts who undenNentangioplasty of 145 IMA graft stenoses at our instRul~n between 1/94 and 5/97. Of these 120 were left, oo were r~Jht and 3 were free fight IMA grafts. Stenoses were located at the anasfomotic site in 72.5%, 5% were ostial and 22.5.°.oin the body of the IMA. 40% of angioplaslies were performed within an year of surgical procedure, regardless of the site of IMA stenosis. New c~eviceswere used in 30 pts: 2 laser, 1 athemctomy and 27 stents. 6 pts had stenls for restenotic lesions. Angiographic success (postprocedural stenosis < 50%) was obtained in 85% of cases. In-hospital and late (6 months to 3 year's)complications are shocm below. In-hospital c~ompl¢.ations (%)
Late complP..ations (%)
MI
Repeat PTCA
Emergent CABG
Deaths
MI
Repeat PTCA
CABG
Deaths
2
2
0.6
2
9.6
158
0,6
2
Conclusion: Angioplasty of IMA grafts is sate. Its effectiveness is comparable to that in native corona W arteries.
Stent Placement in L o n g ( > 1 5 ram) Coronary Leskms
S. ElezL A. KasfralJ.A. Wehmger, H. Walter, N. Nibler, H. Scts~nlon, M. H a d a n ~ , J. Dfrsc~nger, A. S c ~ . 1. Medizin~che Klintk & Herzzentmm, TU M~nct~, Germany Pabenls (p~s) with long lesions (L) t~ave a worse angmgraph¢ and ¢lincal
outcome after PTCA compared to pts wffh short lemons (Sh). We compared 371 L pl~ (>_15 mm long) with 1420 Sh pts after successful stent placeme~ S~-monm ang~,;Oap~c ~dow.up was peffom~d m 300 L pls (80.1%) and m 1121 Sh pts (79.4%; p = 0.71). R ~ - c , ~ s wa~ defined by a %-diameter stenosm >50%. L pts o~d not d~fferfrom 8h I~S wiffl respect to vsssel dist r 2 ~ u ~ bafloon size, bafloon prelmum and referance dklmeter before at¢l after intervsnlion. Altar four weeks them were no signiftcam differences beN,-eenthe two groups ~ n g the maj~" adverse caro~acevents (MACE) and subacute stent closure. At one year ,;.a rote of MACE wes ~ by L pts (28.3% vs. 21.8%, p : 0.01), but them was no significant clifferance in me ~ occurrence of MI or cardmc death (4.6% vs. 33%, p = 0.4). Ang~ograph¢ resu~ are presented in the table. Long ~ Balloon]ve,~ sffo Acute garn (ram) tats loss (rra'n| %-Dmmeter s;eno.~s Reslenosis rote
106 ± 011 2.14 ± 0.57 1.26 ± 084 444 ± 259 33.7%
Short ~ 1.06 ~ 012 2.10 ± 0.58 1 04 ± 0.74 375 ± 232 252%
p.vakJe f~ ns ~0.001 q0001 0004
Conclusions: Stent p|acemem in lesions >15 mm long can be ~ch~eved with good acute angiographic and clinical resul:s. Long-term angmgmphic and clinical outcome however, is impaired by a greater late loss and higher restenosis and clinical event rate.
•
Clinical Outcome o f Patients Undergoing Coronary Slentlng f o r Extended Lesions :>30 ram?
T. Joseph, J. Fajadet, B. Cassagneau, C. Jordan. J.C. Laberde, J.P. Laurent, R. Cortina, J. Marco. Unite de C.ar~oJogie Intezventionne;le, Clinique Pasteur. Toulouse, France Background: Balloon angioplasty of extended co;ona~ lesions (ECL) _>30
JACC
ABSTRACI'S- P-~t~r
•
Coronary Stentin9: Difficult Lesion Subsets Tuesday, March 31. 1998, Noon--2:00 p.m. Georgia World Congress Center. West ~xhibit Hall Level Presentation Hour: Noon-l:00 p.m.
Palmaz-SchMz S1Nmtlng in Unprotected Left Main Coronary A r t e r y Stenoels: ImmedlMe end Follow-up R s s u l t l
1: Tamura, 1". Kimura, H Nosska, M. N ~ h L
~ouv~mthe ~ ~
273A
Kokura t ~
No~,
~a ~k,~,'of P~.~..z-.~.~z (IS) S ~
SuMalned Benefit of 811ntln9 in Chronk: O ~ l u l l o n e : L o n g . t m ~ FOllow-up of I h e 81CC0
St.dy
P,A, Siff~l, S, Golf, Y, Myrlmg, P, Molltld, P, Nt~rfuon, K, Endings,
~, Mar~u¢~u, For~ StCCO~x~y ~ F~r~ H~n ~ The SiCC'O ~ show~l mat ~ a~
tmprov~~ an~gnm~ o.~m~ a~r ~
~ . y
~m~m~'~
o~c h i c
coronary ~ u a l o n s (CCO) w~h a m~'l~on m me bln~nt m~teno~ mt~ tram 78% to 32%. T0 a s N ~ ~ o ~nk:/d b~m~s o~ ~ t M 9 v o m ~ ~ngk~pk.~y in
IM~ff~odlm:A tOtOl~ 1!7 (~q~l~ pl~ wilh 8 m ~ h d l y mcanalt~/~0 were ~ ~ mlt;Fl#onal~ (FA, n ,~H, ~.JJ ~ withhJ~lanti<2,S ram, ve~e! ~ m a ~ x ~ / u N m u ~ Io r i m i n g o~ eallo~ m ~ n g . M pts were h),owed for me oceummce of Majo~ Adver~ Ca~e~: End~x,nts (MACE): ~ x a ~ t a ! ~ r m ~ . tmg~ kmon ~ t ~ (TLR) or ~m~, ResU~: N ~ r ~ 2 to 3.S y. (median 2.6) of foaow,up me modallly was 1,7% in g~A VS. 5,1% in grB (Its), TLR oocuwed in 18.0% of gtA: (10 PTCA ! CABG) 8nd in 49.2% at gdl] (25 l:q'CA, 4 CABG)(p : 0.006). MACEJme
O!
,
,,
•
Me,hoe We annlyzed ~ 38 pal~nt~ (pt~) t ~ e c l m ULMC~ ImNonfrom Msrch gl Io Oe(:emb~ 9(Bl:~8 nlolml (74%), mean igo M (~ ~ IS y~lm, Tmaled I~1 were dtvk;~t~linto two gfgul~l; pool ~ g f ~ (pc) wflh o ~ o~ morn dlk hlofor for CABO, 18 I ~ and ~ , ~ can(~m~ group (GC) w~out ~ k tact~ fo~ r,~SG, 20 i ~ . Thu ux~ected h t ~ ~ k kcto~ t~x ~ of me PC grou~ were n~lat~l Io oI¢Ie ~ (_>~ ym) In 9 ~ , m m ~ v m c u ~ r .d~,~-__ In 7 plu, poor LV "fun¢lk~ (qe¢l~m fraction <40%) ~ 4 i~s, p ~ CABG in 4 ptl, ix~r mn off tn 1 pt, ~ n ¢ ~ m 1 pl. COPD ~ I pt O ~ n
of ~meng m the OC gm.p m
results
PC1Spts GC2Om
_ : 2
FoSow~ rnurm
Iml~cilp~l d e a ~ E ~ l
Sel mmm~o~s
Ipt(S.6%) 0
0 0
Ang~gmlm¢ res~-o~ 5 m (29%) 2 pes(10'%) i|
on anammCale ~
p~ma~ly~
for m l m ~ . 8Mnti~g w ~ p~loml~l I~ctmlfully m aft ptl, ~ w ~ one i f ~ deafh In PC ~ Io acut~ ¢lo~Jm of RCA dllatl~ one week la~. I p~wlm pc~r L V ~ o ~ l f m m c a ~ ¢ failure t pt w~bepm~ cam~ h ~ s.dd~m ~ m , I pt d t ~ ffem cmdlac r e . r e ~ue ~oaort~ e1~oM wo~e~r~g, 1 pt m GC dt~l from re~lenogc MI.
Ream PTCA 2 pts (12%) 2 pts110%)
~
MI
CABG
3pts(1B%) lpl(5.9%) lp:(5.9'%) I m (5.0%) I I~ (5.0%) 0 Tan~! ~
m~cu~a~,on 3 p~ (18%) 2 ~ (10%)
v
~ : ~ in utC~>~'toO I.MCA co~d be a chellengmg aJtemalive to CABG in selected patk~ts, dese~ng fudher careful cfincal evalualmn.
.o.t " l k h f * . . . . . . ~ . ~ . . . . ~ .
O,
Pr(~
~2"-~ 0
4
6
12 16 20 2~4 :m ~
354044
4~
Sun~al T ~ M~hs Con~.usio~: Stent iml~an~aben in chronic comnar/occlusions resufled ;n a supenor long-term clinical outcome as compared to angloplasty alone.
~
Intemal Mammary Artery Graft Angioplasty
A Single Center Experience M. Tebeca, M. Masfoof, R. Mehmn, G. Plude, E. I~nnow, S. Slack, 1". Bucher, J. Popma. A. Pichard, J. Lindsay. Jr.. W ~ Hosp/ta/ Center. ~ f o n , DC, USA Inc~asing use of internal mammary artery grafts (IMA) in the surgical revascularization of coronary arten/diseasehas made the need for percutaneous angloplasty ef IMA steno~es mere common. We analyzed 139 pts who undenNentangioplasty of 145 IMA graft stenoses at our instRul~n between 1/94 and 5/97. Of these 120 were left, oo were r~Jht and 3 were free fight IMA grafts. Stenoses were located at the anasfomotic site in 72.5%, 5% were ostial and 22.5.°.oin the body of the IMA. 40% of angioplaslies were performed within an year of surgical procedure, regardless of the site of IMA stenosis. New c~eviceswere used in 30 pts: 2 laser, 1 athemctomy and 27 stents. 6 pts had stenls for restenotic lesions. Angiographic success (postprocedural stenosis < 50%) was obtained in 85% of cases. In-hospital and late (6 months to 3 year's)complications are shocm below. In-hospital c~ompl¢.ations (%)
Late complP..ations (%)
MI
Repeat PTCA
Emergent CABG
Deaths
MI
Repeat PTCA
CABG
Deaths
2
2
0.6
2
9.6
158
0,6
2
Conclusion: Angioplasty of IMA grafts is sate. Its effectiveness is comparable to that in native corona W arteries.
Stent Placement in L o n g ( > 1 5 ram) Coronary Leskms
S. ElezL A. KasfralJ.A. Wehmger, H. Walter, N. Nibler, H. Scts~nlon, M. H a d a n ~ , J. Dfrsc~nger, A. S c ~ . 1. Medizin~che Klintk & Herzzentmm, TU M~nct~, Germany Pabenls (p~s) with long lesions (L) t~ave a worse angmgraph¢ and ¢lincal
outcome after PTCA compared to pts wffh short lemons (Sh). We compared 371 L pl~ (>_15 mm long) with 1420 Sh pts after successful stent placeme~ S~-monm ang~,;Oap~c ~dow.up was peffom~d m 300 L pls (80.1%) and m 1121 Sh pts (79.4%; p = 0.71). R ~ - c , ~ s wa~ defined by a %-diameter stenosm >50%. L pts o~d not d~fferfrom 8h I~S wiffl respect to vsssel dist r 2 ~ u ~ bafloon size, bafloon prelmum and referance dklmeter before at¢l after intervsnlion. Altar four weeks them were no signiftcam differences beN,-eenthe two groups ~ n g the maj~" adverse caro~acevents (MACE) and subacute stent closure. At one year ,;.a rote of MACE wes ~ by L pts (28.3% vs. 21.8%, p : 0.01), but them was no significant clifferance in me ~ occurrence of MI or cardmc death (4.6% vs. 33%, p = 0.4). Ang~ograph¢ resu~ are presented in the table. Long ~ Balloon]ve,~ sffo Acute garn (ram) tats loss (rra'n| %-Dmmeter s;eno.~s Reslenosis rote
106 ± 011 2.14 ± 0.57 1.26 ± 084 444 ± 259 33.7%
Short ~ 1.06 ~ 012 2.10 ± 0.58 1 04 ± 0.74 375 ± 232 252%
p.vakJe f~ ns ~0.001 q0001 0004
Conclusions: Stent p|acemem in lesions >15 mm long can be ~ch~eved with good acute angiographic and clinical resul:s. Long-term angmgmphic and clinical outcome however, is impaired by a greater late loss and higher restenosis and clinical event rate.
•
Clinical Outcome o f Patients Undergoing Coronary Slentlng f o r Extended Lesions :>30 ram?
T. Joseph, J. Fajadet, B. Cassagneau, C. Jordan. J.C. Laberde, J.P. Laurent, R. Cortina, J. Marco. Unite de C.ar~oJogie Intezventionne;le, Clinique Pasteur. Toulouse, France Background: Balloon angioplasty of extended co;ona~ lesions (ECL) _>30