Intrahospital and long term clinic outcomes of treatment with drug eluting stent, in small vessel with "Off Label" coronary angioplasty indication

Objective

To evaluate drug eluting stent (DES) effectiveness and safety in small vessel (2,25 mm – 2,75 mm) in coronary angioplasty with “off label” indication.

Material and methods

117 consecutive patients (pts) were analysed restrospectively (07-07-03 to 28-2-07) average age 66 (40-88), male 87 (74.4%) with a mean folow up of 21 month.

Demographics

• Hipertension: 47 (40.27%)
• Diabetic: 28 (23.9%)
• Dislypemia: 36 (30.8%)
• Smokers 40 (34.2%)
• Previous MI: 31 (26.5%)
• Previous ACTP: 22 (18.8%)
• Previous cardiac surgery: 5 (4.3%)

Clinical indication

• Stable angina: 8 (6.8%)
• Unastable angina: 109 (93.2%)

Anatomy indication

• Ostial lesions: 8 (6.8%)
• Total oclusion: 17 (14.5%)
• Bifurcation lesions: 6 (5.1%)
• Restenosis of bare metal stents: 16 (13.7%)
• Restenosis of drug eluting stents: 14 (12%)

Vessel treated: 137 vessels

• Left main: 1 (0.9%)
• LAD: 84 (71.8%)
• Circunflex: 24 (20.5%)
• Rigth coronary: 18 (15.4%)
• Diagonal: 7 (6%)
• Marginal: 3 (2.6%)

Lesion type: 148 lesions

• Type A: 1 (0.6%)
• Type B1: 4 (2.7%)
• Type B2: 35 (23.6%)
• Type C: 108 (72.9%)
  
  
• VESSELS DIAMETER: 2.25 mm A 2.75 mm
• LESIONS LENGTH 10-49 mm (mean 25 mm)

Number of vessels treated

• One vessel: 96 ptes (82.1%)
• Two vessels: 20 ptes (17%)
• Three vessels: 1 pte (0.9%)

Stent Type: 160 stents

Technique implantation

• Balon predilatation in 114 patients (97.4%).
• Direct stent in 3 patients (2.5%)
• Stents length: 12 A 33 mm (mean 27,6 mm)

Results

No intrahospital complications.
Follow-up: cardiac death 0, extra-cardiac death 3 (2.6%) myocardial infarction (MI) 1 (0.8%), target lesion revascularization (TRL) 18 (15.6%), major events (MI, death, TRL. 19%), later thrombosis 1 (0.8%) Survival free of MI and death 96.6%, survival free of MI and cardiac death 99.2%, survival free of major events 81%, angina 3 ptes (2.6%), asymptomatic without events 78.3%.

Late trombosis in one patient who stopped clopidogrel.
Target vessel revascularization in 18 patients (13 (11.1%) with angioplasty and 5 (4,3%) with surgery).

Conclusions

In our experience, DES implantation in small coronary vessels, in patients with “off label” indication resulted safe, but with a relative high rate of major cardiac events at the expense of an increased incidence of TLR. This would seem to confirm the tendency that although DES with "on label" indication reduces the restenosis risk significantly, the illness of small vessels in patients with high restenosis risk is a major cause of DES failure.