"Full Metal Jacket" (Stented Length ≥ 64 mm) Using Drug-Eluting Stents for De Novo Coronary Artery Lesions

Jiro Aoki, MD; Andrew T.L. Ong, MBBS, FRACP; Gaston A. Rodriguez Granillo, MD; Eugène P. McFadden, MD, FRCPI; Carlos A.G. van Mieghem, MD; Marco Valgimigli, MD; Keiichi Tsuchida, MD; Georgios Sianos, MD, PhD; Evelyn Regar, MD, PhD; Peter P.T. de Jaegere, MD, PhD; Willem J. van der Giessen, MD, PhD; Pim J. de Feyter, MD, PhD; Ron T. van Domburg, PhD; Patrick W. Serruys, MD, PhD

Disclosures

Am Heart J. 2005;150(5):994-999. 

In This Article

Abstract and Introduction

Background: Stented segment length was a predictive factor for restenosis in the bare metal stent era. The objective of the study was to evaluate the medium-term clinical outcome and the potential for adverse effects when very long segments (ie, ≥64 mm of stented length) are treated by drug-eluting stent (DES) implantation, an approach colloquially referred to as a "full metal jacket."
Methods: Since April 2002, we have used DES as the default stent for all percutaneous coronary interventions. From our prospective institutional database we identified 122 consecutive patients, with de novo coronary lesions, in whom a coronary artery was treated with at least 64 mm of overlapping DES: 81 patients were treated with sirolimus-eluting stents and 41 with paclitaxel-eluting stents.
Results: The mean number of stents per lesion was 3.3 ± 1.1, and the median stented length was 79 mm (range 64-168 mm). Periprocedural Q-wave myocardial infarction (MI) occurred in 2 patients (1.6%) and subacute stent thrombosis in 1 patient (0.8%). During 1-year follow-up, 5 patients (4.1%), including 3 patients treated for acute MI with cardiogenic shock, died and 10 patients (8.2%) had nonfatal MI (creatine kinase–MB >3 times). The 1-year target vessel revascularization rate was 7.5% and the overall incidence of major adverse cardiac events was 18%. Outcomes in sirolimus-eluting stents and paclitaxel-eluting stents groups did not differ statistically.
Conclusions: The use of DES for the treatment of diffuse lesions was associated with a low rate of repeat revascularization, irrespective of stent type. No safety concerns were raised at medium-term follow-up.

In the bare metal stent era, the length of a stented segment was an independent predictor of in-stent restenosis.[1,2,3] Recent randomized trials, in low-risk patient/lesion cohorts, showed that drug-eluting stents (DES) reduce the need for repeat intervention compared with bare metal stents.[4,5,6,7] Drug-eluting stents are rapidly replacing bare metal stents and there has been a tendency toward longer stented segment lengths, given the full lesion coverage from a proximal to a distal "angiographically normal" segment to avoid stent gaps and the incomplete coverage of lesions which have been associated with restenosis after DES implantation.[5,8] However, the clinical effect of very long and overlapping DES implantation in the so-called full metal jacket approach and the potential effects of increased metal and local drug exposures are unknown. In this report, we investigate the clinical outcome after very long sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) implantations in a consecutive group of 122 patients (124 lesions) who were treated with at least 64 mm of DES without any gap in the same vessel.

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