Long-term follow-up study of coronary reconstruction with multiple stents,

Background Conventional balloon angioplasty of very long de novo coronary lesions or very long coronary dissection caused by angioplasty is associated with low success and high complication rates. Multiple intracoronary stents have been used to treat both conditions, although long-term efficacy has not been defined. Methods and Results Between June 1993 and December 1995, 47 consecutive patients underwent native coronary angioplasty and stenting with 4 or more stents covering at least 2 consecutive diseased coronary segments. Preangioplasty and poststenting diameter stenoses were 81% ± 13% and 21% ± 12%, respectively. Reference vessel diameters were 3.53 ± 0.55 mm proximal to the stents and 2.95 ± 0.62 mm distal to the stents. Average lesion length was 63 ± 20 mm. The number of stents used was 4.5 ± 1 per vessel (from 4 to 7). Gianturco Roubin I stents were used in all patients. Coronary Palmaz-Schatz stents were used as supplementary stents in 3 patients. Angiographic success was 100%. In-hospital outcomes include 1 death, 1 coronary bypass surgery, no Q-wave myocardial infarction, and 7 non–Q-wave myocardial infarctions. Long-term follow-up at 430 ± 199 days was completed in all patients. Thirty-five (76%) patients were asymptomatic, 8 (17%) had class 1 or 2 angina, 1 had a myocardial infarction, 13 (28%) underwent repeat angioplasty, 2 patients had subsequent elective bypass surgery, and 3 died during follow-up. Conclusions Multiple intracoronary stents for very long lesions or dissection can be performed with acceptable immediate and long-term outcomes. (Am Heart J 1999;137:292-7.)