The concept of protective stent placement after successful recanalization of chronic total coronary occlusions: a matched pair analysis in 100 patients

OBJECTIVE: Interim results of successful balloon angioplasty for total coronary occlusions (TCO) are disappointing due to the high rate of restenosis and reocclusion. Adjunctive stenting has been suggested to improve patency rate after recanalization of total coronary occlusions (TCO); however, this concept of protective stenting has not been substantiated in a case control study. METHODS: To test the efficacy of protective stenting of TCO, 100 patients were subjected to a matched pair analysis (block design) comparing conventional PTCA with protective stenting (Palmaz-Schatz stents) after successful recanalization of TCO followed by a standard antithrombotic regimen. Matching parameters included age (+/- 3.5 years), sex, cardiovascular risk factor, and lesion anatomy. Coronary angiography and QCA were performed before pair assignment, after the intervention, and at a mean follow-up of 5 +/- 1.5 months. RESULTS: There were no deaths or myocardial infarctions related to the intervention in the entire study cohort; bleeding at the puncture site was observed in two patients in both groups. Binary reocclusion and restenosis (> or = 50%) rates were observed in 8% and 0% in stented patients versus 30% and 22% in the group with no protective stenting, respectively (p < 0.01). Target lesion reintervention was necessary in 8% after protective stenting as compared to 58% after PTCA alone (p < 0.001). At 6 months follow-up, 62% of stented patients were free of any symptoms versus 23% with PTCA (p < 0.01). CONCLUSIONS: Protective stenting improves the immediate and follow-up angiographic and clinical results of PTCA in chronic total coronary occlusions. Stenting of successfully recanalized total coronary occlusions should be a routine procedure.