Prevention of lesion recurrence in chronic total coronary occlusions by paclitaxel-eluting stents

• Published in: Journal of the American College of Cardiology Vol. 44; no. 12; pp. 2301 - 2306
• Main Authors: Werner, Gerald S., Krack, Andreas, Schwarz, Gero, Prochnau, Dirk, Betge, Stefan, Figulla, Hans R.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 21.12.2004; Elsevier Science; Elsevier Limited
• Subjects: Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Chronic Disease; Cohort Studies; Coronary Angiography; Coronary Disease - diagnostic imaging; Coronary Disease - prevention & control; Coronary Disease - therapy; Coronary heart disease; Coronary Restenosis - diagnostic imaging; Coronary Restenosis - epidemiology; Coronary Restenosis - mortality; Coronary Restenosis - prevention & control; Coronary Restenosis - therapy; Coronary vessels; Diabetic Angiopathies - diagnostic imaging; Diabetic Angiopathies - prevention & control; Diabetic Angiopathies - therapy; Female; Heart; Heart attacks; Humans; Incidence; Male; Medical sciences; Middle Aged; Paclitaxel - administration & dosage; Secondary Prevention; Stents; Survival Analysis; Treatment Outcome; MLD; MACE; TVF; PCI; BMS; LV; TLR; MI; CTO; Human; Occlusion; Endoprosthesis; Recurrence; Relapse; Coronary artery; Instrumentation therapy; Cardiovascular disease; Coronary heart disease; Stent; Coated material; Prevention; Restenosis; Chronic; Paclitaxel; Lesion; Drug eluting stent
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/j.jacc.2004.09.040

The aim of this research was to assess the efficacy of paclitaxel-eluting stents in chronic total coronary occlusions (CTO). Percutaneous coronary interventions for CTOs are characterized by a high target vessel failure rate. In 48 consecutive patients, paclitaxel-eluting stents (Taxus, Boston Scientific Corp., Natick, Massachusetts) were implanted after successful recanalization of a CTO (duration >2 weeks). Patients underwent an angiography after 6 months and were followed clinically for 12 months. They were compared with 48 lesion- and risk-matched patients with CTOs treated with bare metal stents (BMS). Primary clinical end point was the one-year incidence of major adverse cardiac events (MACE) (death, myocardial infarction, repeat revascularization); secondary end points were the rate of restenosis and re-occlusion. In-hospital MACE was 4.2% with Taxus, and 2.1% with BMS (p = NS). The one-year MACE rate was 12.5% in the Taxus group, and 47.9% in the BMS group (p < 0.001), which was due to a reduced need for repeat revascularization. The angiographic restenosis rate was 8.3% with Taxus versus 51.1% with BMS (p < 0.001). There was only one late re-occlusion with Taxus (2.1%) as compared with 23.4% with BMS (p < 0.005). The late loss was reduced in the Taxus group by 84% as compared with BMS. All nonocclusive restenoses in the Taxus group were focal and successfully treated by implanting an additional Taxus stent. The treatment of CTOs with a paclitaxel-eluting stent drastically reduces MACE and restenosis, and almost eliminates re-occlusion, which is typically frequent with BMS in CTOs. Chronic total coronary occlusion should be a preferred indication for drug-eluting stents.