Influence of residual stenosis after percutaneous coronary intervention with stent implantation on development of restenosis and stent thrombosis

Am J Cardiol. 2003 Jan 15;91(2):148-53. doi: 10.1016/s0002-9149(02)03100-4.

Abstract

The aim of this study was to assess the effects of residual stenosis after single-stent implantation on the rate of stent thrombosis, as well as restenosis within a 6-month follow-up period. Coronary angiograms of 2,157 patients with 2,523 lesions treated with a single stent were analyzed by quantitative coronary angiography before, immediately after stent implantation, and at a planned 6-month follow-up. Lesions were classified into 4 subgroups according to the degree of residual stenosis after stent implantation: group 1, gross oversizing <-15%; group 2, slight oversizing -15% to <0%; group 3, mild residual 0% to <15%; group 4, moderate residual 15% to <30%. Stent thrombosis rates were not significantly different among the 4 subgroups (group 1: 0 of 60 [0%]; group 2: 2 of 388 [0.5%]; group 3: 8 of 1,370 [0.6%]; group 4: 8 of 705 [1.1%]; p = NS for all). An adequate dosage of ticlopidine (250 mg twice daily) and aspirin (100 mg/day) led to a lower rate of stent thrombosis (6 of 2,189 cases) than inadequate dosages or missing therapy (12 of 343 cases). In 1,882 stenoses with angiographic follow-up (77.7%), gross oversizing of stents lead to a significantly higher increase of percent stenosis (p <0.001) associated with a higher restenosis rate (group 1: 34.7% vs groups 2, 3, and 4: 32.5%, 28.2%, and 29.6%, respectively). A multiple regression analysis was performed. Optimal results with regard to stent thrombosis and restenosis were achieved with mild residual stenoses between 0% and 15% after stent implantation. Oversizing of stents is no longer necessary with an adequate dosage of ticlopidine and aspirin.

MeSH terms

  • Aged
  • Angioplasty, Balloon, Coronary / adverse effects*
  • Angioplasty, Balloon, Coronary / methods*
  • Aspirin / therapeutic use
  • Coronary Angiography
  • Coronary Restenosis / classification
  • Coronary Restenosis / diagnostic imaging
  • Coronary Restenosis / etiology*
  • Coronary Thrombosis / classification
  • Coronary Thrombosis / diagnostic imaging
  • Coronary Thrombosis / etiology*
  • Coronary Thrombosis / prevention & control
  • Female
  • Humans
  • Male
  • Middle Aged
  • Platelet Aggregation Inhibitors / therapeutic use
  • Regression Analysis
  • Stents*
  • Ticlopidine / therapeutic use

Substances

  • Platelet Aggregation Inhibitors
  • Ticlopidine
  • Aspirin