CARDIOVASCULAR JOURNAL OF AFRICA • Vol 21, No 6, November/December 2010
AFRICA
311
Cardiovascular Topics
Outcomes of stenting with overlapping drug-eluting
stents versus overlapping drug-eluting and bare-metal
stents for the treatment of diffuse coronary lesions
SE KASSAIAN, M SALARIFAR, M RAISSI DEHKORDI, M ALIDOOSTI, E NEMATIPOUR, HR POORHOSSEINI,
AM HAJIZEINALI, D KAZEMISALEH, A SHARAFI, M MAHMOODIAN, N PAYDARI, AV FARAHANI
Summary
Introduction:
We investigated the outcomes of stenting with
overlapping drug-eluting stents (DES) versus overlapping
stenting with a combination of drug-eluting and bare metal
stents (BMS) in very long coronary lesions (
≥
25 mm).
Methods and Results:
Fifty-two patients treated with either
overlapping DES-DES (
n
=
22) or DES-BMS (
n
=
30) were
selected from a registry of 588 patients with very long coro-
nary lesions. Patients with acute myocardial infarction (MI)
within the preceding 48 hours were excluded. The DES-DES
combination was more frequently used for longer lesions
compared with the DES-BMS group (47.95
±
9.25 vs 39.98
±
9.15 mm,
p
=
0.003). Left anterior descending artery
lesions were also more frequently treated with the DES-DES
combination (95.5 vs 66.7%,
p
=
0.02). In four patients in the
DES-BMS group, overlapping stents were used for the cover-
age of dissections. Peri-procedural non-Q-wave MI occurred
in one patient in the DES-BMS group. On follow up, only one
case of non-fatal MI occurred in a patient with overlapping
DES-DES.
Conclusion:
Overlapping a BMS in the proximal part of a
long DES instead of exclusive deployment of two or more
overlapped DES seems to be a safe and feasible therapeutic
strategy in our practice.
Keywords:
angioplasty, stents, restenosis, overlapping stents,
drug-eluting stents
Submitted 11/2/09, accepted 10/3/10
Cardiovasc J Afr
2010;
21
: 311–315
DOI: CVJ-21.006
Percutaneous intervention in long coronary lesions was previous-
ly associated with poorer short- and long-term results than that in
discrete lesions.
1
Owing to their associated low angiographic and
procedural success rates and their higher dissection and threat-
ened or acute vessel closure rates, these lesions were considered
a contraindication to balloon angioplasty.
2
Nevertheless, promis-
ing results were obtained when using drug-eluting stents (DES),
making these lesions inviting targets for percutaneous coronary
intervention (PCI).
3-5
In the bare-metal stent (BMS) era, there were conflicting data
regarding the efficacy of overlapping stents for the treatment of
long lesions.
1,6-8
However, in the contemporary DES era, multiple
stent implantations in long lesions have been widely used.
4,5,9
Nevertheless, concerns remain about potential local toxicity with
delayed endothelial coverage that could contribute to an excess
in very late stent thrombosis, most likely at adjacent DES strut
overlaps,
10
and also greater in-stent late lumen loss and angio-
graphic restenosis.
11
In our practice, combinations of drug-eluting and bare-metal
stents have sometimes been used for covering very long lesions.
One of the reasons was the unavailability of appropriate sizes of
DES for overlapping coverage of these types of lesions, especial-
ly during the first two years of DES usage. Another reason was
the high cost of DES in our country, which many people could
not afford. However, the use of an additional stent was occasion-
ally unplanned in cases such as dissections. To our knowledge,
few clinical studies have to date systematically investigated the
outcomes of a combination of overlapping DES and BMS.
In this study at our centre, we report on cases of multiple
overlapping stenting in two groups of patients with implantation
of DES and a combination of DES and BMS in coronary lesions
of
≥
25 mm in length.
Methods
DES were first used at our centre in March 2003 in selected,
planned procedures. Then, on the basis of contemporary stud-
ies, their use increased so that by March 2004, DES were used
as often as BMS. Since then, the use of DES at our institute has
steadily increased, accounting for about 60% of the procedures
in the last year.
Between April 2003 and March 2005, a total of 588 consecu-
tive patients with lesions
≥
25 mm underwent PCI at the catheter
laboratory of our hospital, which performs 2 000 PCI proce-
dures per year using six expert operators. After the exclusion
Department of Interventional Cardiology, Tehran Heart
Center, Tehran University of Medical Sciences, Tehran, Iran
SE KASSAIAN, MD,
M SALARIFAR, MD
M RAISSI DEHKORDI, MD
M ALIDOOSTI, MD
E NEMATIPOUR, MD
HR POORHOSSEINI, MD
AM HAJIZEINALI, MD
D KAZEMISALEH, MD
A SHARAFI, MD
M MAHMOODIAN, MD
N PAYDARI, MD
AV FARAHANI, MD
