CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 6, November/December 2010
AFRICA
313
eluting and bare-metal stents (Table 4). In two cases, four stents;
and in one case, three stents were used; in one patient, two stents
were used for the coverage of lesions. In all cases, the first
implanted stent was a DES. In the case with three stents, the
second stent was also a DES. All the other stents were BMS. In
our total population, the mean length and diameter of DES vs
BMS was 27.96
±
6.53 vs 16.53
±
7.59 mm (
p
<
0.0001) and
2.58
±
0.32 vs 3.01
±
0.43 mm (
p
=
0.025), respectively. In the
DES-BMS group, the mean length and diameter of DES vs BMS
was 31.21
±
3.67 vs 16.53
±
7.59 mm (
p
<
0.001) and 2.84
±
0.35
vs 3.01
±
0.43 mm (
p
=
0.071), respectively.
Late outcomes
The mean follow-up duration was 13.5
±
4.6 months. Of the 52
patients, 50 were followed up with clinic visits: all 22 patients
treated with overlapping DES and 28 of the 30 patients treated
with a combination of DES and BMS. At 30 days’ and six
months’ follow up, MACE did not occur in any patient.
MI did however occur in a patient treated with two overlap-
ping Cypher stents (3
×
33 and 3
×
18 mm). He was an ex-smok-
er and the diseased location was distal LAD. He continued to
receive clopidogrel for seven months. After 13 months, he was
admitted due to post MI angina. Re-angiography showed mini-
mal CAD and development of coronary aneurysm in the coro-
nary segment that had received overlapping stents. The patient
underwent implantation of an intra-cardiac defibrillator (ICD)
due to ventricular fibrillation and ejection fraction of 15%.
With univariate analysis, the composite endpoint of TVR, MI
and cardiac death (MACE) was not related to any variable listed
in Table 4.
Discussion
In the present report, we describe the clinical outcomes of a
small, consecutive series of patients treated with overlapping
DES or overlapping DES and BMS. The data presented here
demonstrate that overlapping stents may be used for the treat-
ment of long coronary lesions, with both a high acute success
rate and a good mid-term clinical outcome.
TABLE 1. SELECTED BASELINE CLINICAL CHARACTERISTICS IN
PATIENTS TREATEDWITH OVERLAPPING DRUG-ELUTING STENTS
VERSUS COMBINED BARE-METALAND DRUG-ELUTING STENTS
DES-DES
(
n
=
22)
n
(%)
DES-BMS
(
n
=
30)
n
(%)
p
-value
Female gender
4 (18.2)
8 (26.7)
0.53
Positive family history
7 (31.8)
15 (50)
0.19
Age (years)
56.13
±
10.75
54.80
±
14.63
0.71
Smoking
14 (63.6)
14 (46.7)
0.22
Diabetes mellitus
2 (9.1)
9 (30)
0.09
Hyperlipidaemia
13 (59.1)
19 (63.3)
0.76
Hypertension
5 (22.7)
11 (36.7)
0.28
MI history
8 (36.4)
12 (40)
0.79
Prior PCI
1 (4.5)
0
0.42
Prior CABG
0
3 (10)
0.25
*Mean
±
SD. MI: myocardial infarction; PCI: percutaneous coronary interven-
tion; CABG: coronary artery bypass grafting.
TABLE 2. LESION CHARACTERISTICS IN PATIENTS TREATED
WITH OVERLAPPING DRUG-ELUTING STENTS VERSUS
COMBINED BARE-METALAND DRUG-ELUTING STENTS
DES-DES
(
n
=
22)
n
(%)
DES-BMS
(
n
=
30)
n
(%)
p
-value
Type B2/C lesions
24 (100)
30 (100)
–
Multi-vessel disease
7 (31.8)
12 (40)
0.56
Pre-procedural stenosis* (%)
90.95
±
9.08 92.07
±
6.50 0.61
Lesion length*
47.95
±
9.25 39.98
±
9.15 0.003
Ostial lesion
1 (4.5)
0
0.42
Lest anterior descending artery
21 (95.5)
20 (66.7)
0.02
Right coronary artery
1 (4.5)
8 (26.7)
0.06
Left circumflex artery
0
2 (6.7)
0.50
Calcified
2 (9.1)
4 (13.3)
>
0.999
Eccentric
3 (13.6)
7 (23.3)
0.49
Angulated segments
1 (4.5)
6 (20)
0.22
Thrombus
0
1 (3.3)
>
0.999
Total occlusion
5 (22.7)
3 (10)
0.26
*Mean
±
SD.
TABLE 3. PROCEDURAL CHARACTERISTICS IN PATIENTS
TREATEDWITH OVERLAPPING DRUG-ELUTING STENTS VERSUS
COMBINED BARE-METALAND DRUG-ELUTING STENTS
DES-DES (
n
=
22)
(Cypher-Cypher: 17)
(Taxus-Taxus: 5)
n
(%)
DES-BMS (
n
=
30)
(Cypher-BMS: 25)
(Taxus-BMS: 5)
n
(%)
p
-value
Stent length (mm)*
#
50.91
±
8.35
55.79
±
16.37
0.17
Mean stent length per
lesion* (mm)
25.68
±
4.34
23.81
±
3.96
0.11
Mean stent diameter per
lesion* (mm)
2.86
±
0.25
2.94
±
0.35
0.34
Mean stent inflation pres-
sure per lesion* (atm)
16.29
±
2.26
14.52
±
2.22
0.01
Number of stents per lesion
2
22 (100)
23 (76.7)
3
0
4 (13.3)
4
0
3 (10)
*Mean
±
SD,
#
the reported stented length is based on the cumulative length of
the adjacent stents.
TABLE 4. IN-HOSPITALAND LATE CLINICAL OUTCOMES IN
PATIENTS TREATEDWITH OVERLAPPING DRUG-ELUTING STENTS
VERSUS COMBINED BARE-METALAND DRUG-ELUTING STENTS
DES-DES
(
n
=
22)
n
(%)
DES-BMS
(
n
=
30)
n
(%)
p
-value
In-hospital outcomes
Peri-procedural non-Q-wave MI
0
1 (3.3)
>
0.999
Angiographic success
21 (95.5)
29 (96.7)
>
0.999
Procedural success
21 (95.5)
28 (93.3)
>
0.999
Dissection
0
4 (13.3)
0.13
Abrupt closure
0
0
–
Long-term outcomes
n
=
22
(100%)
n
=
28
(93.3%)
Mean follow-up duration (months)
13.9
±
4.2 13.3
±
4.8 0.65
MACE
1 (4.5)
0
0.44
Cardiac death
0
0
-
Non-fatal MI
1 (4.5)
0
0.44
TVR
0
0
-
TLR
0
0
-
CABG
0
0
-
*Mean
±
SD. MI: myocardial infarction; MACE: major adverse cardiac events;
TVR: target vessel revascularisation; TLR: target lesion revascularisation;
CABG: coronary artery bypass grafting.
