Open Access 13-04-2018 | Original Article
Five-year clinical follow-up of the STENTYS self-apposing stent in complex coronary anatomy: a single-centre experience with report of specific angiographic indications
Gepubliceerd in: Netherlands Heart Journal | Uitgave 5/2018
Abstract
Objectives
Background
Methods
Results
Conclusions
What’s new
-
This is the first registry reporting on the indications that made interventionalists opt for the use of the STENTYS self-apposing technique in daily clinical practise with a 5-year clinical follow-up.
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This single-centre registry showed that operators tend to choose this stent technique in complex lesions, including coronary artery disease with aneurysm (30%), ectasia (19%), tapering (27%), bifurcation lesions (8%), saphenous vein graft lesions (16%) and absolute target vessel diameters (22%).
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At 5‑year follow-up, overall stent thrombosis rate was 3.8%, which is reasonable considering the complexity of this cohort where proper sizing with tubular balloon-expandable stents could be difficult in vessel segments with varying vessel diameters.
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The multi-centre enrolling SIZING registry will give us insights into the performance of this device in lesions with vessel diameter variance.
Introduction
Materials and methods
Study patients and setting
Study device
Angiographic data acquisition and definitions
Follow-up and outcomes
Statistical analysis
Results
Baseline patient characteristics and procedural characteristics
Angiographic indications and results
Angiographic indications for STENTYS | DES | BMS |
p-value
| |
---|---|---|---|---|
L = 124 | L = 104 | L = 20 | ||
Aneurysm | 37 (30%) | 31 (30%) | 6 (30%) | 0.99 |
Ectasia | 24 (19%) | 17 (16%) | 7 (35%) | 0.07 |
Tapering | 33 (27%) | 24 (23%) | 9 (45%) | 0.04 |
Diameters 4.0–5.0 mm | 27 (22%) | 21 (20%) | 6 (30%) | 0.38 |
Bifurcation lesion | 10 (8%) | 10 (10%) | 0 | 0.36 |
Saphenous vein graft | 19 (16%) | 16 (16%) | 3 (15%) | 1 |
All patients | Aneurysm & ectasia | Tapering | Absolute Diameters | Bifurcation (MB only) | SVG | |||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Parameter | Pre | Post | Pre | Post | Pre | Post | Pre | Post | Pre | Post | Pre | Post |
RVD proximal edge (mm) | 3.72 ± 0.85 | 3.87 ± 0.75 | 3.84 ± 0.85 | 4.02 ± 0.77 | 3.93 ± 1.01 | 3.97 ± 0.87 | 4.31 ± 0.97 | 4.34 ± 0.77 | 3.26 ± 0.44 | 3.37 ± 0.34 | 3.76 ± 0.99 | 3.97 ± 0.76 |
RVD in-stent (mm) | 3.47 ± 0.84 | 3.56 ± 0.70 | 3.61 ± 0.82 | 3.73 ± 0.71 | 3.39 ± 0.87 | 3.53 ± 0.76 | 4.09 ± 0.93 | 4.11 ± 0.59 | 2.84 ± 0.45 | 2.95 ± 0.31 | 3.85 ± 1.00 | 3.98 ± 0.78 |
RVD distal edge (mm) | 3.20 ± 1.01 | 3.33 ± 0.81 | 3.40 ± 1.11 | 3.55 ± 0.84 | 2.97 ± 0.93 | 3.10 ± 0.76 | 3.91 ± 0.81 | 3.93 ± 0.58 | 2.43 ± 0.60 | 2.63 ± 0.43 | 4.04 ± 1.01 | 3.96 ± 0.80 |
MLD in-stent (mm) | 0.99 ± 0.58 | 2.90 ± 0.57 | 1.02 ± 0.54 | 3.00 ± 0.59 | 0.97 ± 0.36 | 2.86 ± 0.57 | 1.09 ± 0.73 | 3.30 ± 0.41 | 0.78 ± 0.32 | 2.47 ± 0.39 | 1.14 ± 0.84 | 3.20 ± 0.48 |
DS in-stent (%) | 71.4 ± 13.5 | 18.2 ± 7.9 | 71.3 ± 14.7 | 19.7 ± 8.0 | 71.1 ± 8.8 | 18.5 ± 5.9 | 74.3 ± 13.0 | 19.3 ± 6.7 | 72.4 ± 10.4 | 16.5 ± 8.7 | 71.5 ± 17.1 | 18.2 ± 9.7 |
D-mean (mm) | 3.06 ± 0.72 | 3.43 ± 0.62 | 3.15 ± 0.72 | 3.57 ± 0.62 | 3.03 ± 0.68 | 3.34 ± 0.64 | 3.56 ± 0.75 | 3.87 ± 0.53 | 2.55 ± 0.48 | 2.97 ± 0.32 | 3.56 ± 0.75 | 3.87 ± 0.53 |
D-max (mm) | 4.53 ± 1.00 | 4.82 ± 1.08 | 4.60 ± 1.04 | 5.11 ± 0.89 | 3.99 ± 0.82 | 5.06 ± 1.10 | ||||||
Lesion length (mm) | 12.67 ± 7.40 | 14.33 ± 8.89 | 14.89 ± 8.38 | 14.23 ± 7.74 | 12.22 ± 5.50 | 11.90 ± 7.23 | ||||||
Acute gain (mm) | 1.95 ± 0.68 | 2.00 ± 0.67 | 1.93 ± 0.59 | 2.22 ± 0.69 | 1.74 ± 0.47 | 2.07 ± 0.92 |
Clinical outcomes
Clinical event | Total | DES | BMS | p-value | |||
---|---|---|---|---|---|---|---|
(n = 120) | (n = 101) | (n = 19) | |||||
n
| Event rate |
n
| Event rate |
n
| Event rate | ||
Target vessel failure
| |||||||
Cardiac death, TV-MI and TVR | 25 | 24.1% | 19 | 22.8% | 6 | 33.0% | 0.26 |
Target Vessel Failure between 2 and 5 years
| |||||||
Cardiac death, TV-MI and TVR | 10 | 13.1% | 8 | 13.3% | 2 | 15.2% | 0.73 |
Other composite endpoints
| |||||||
Cardiac death and TV-MI | 11 | 10.5% | 8 | 9.7% | 3 | 15.8% | 0.31 |
Cardiac death, TV-MI and TLR | 22 | 21.7% | 16 | 20.0% | 6 | 33.0% | 0.13 |
Components of composite endpoints
| |||||||
Cardiac death | 6 | 5.7% | 3 | 4.0% | 3 | 15.8% | 0.02 |
TV-MI | 5 | 4.9% | 5 | 5.7% | 0 | 0.0% | 0.34 |
TVR | 19 | 19.0% | 16 | 19.2% | 3 | 20.5% | 0.98 |
Stent thrombosis
| |||||||
Definite | 4 | 3.8% | 4 | 4.5% | 0 | 0.0% | 0.39 |
Probable | 1 | 1.6% | 1 | 2.0% | 0 | 0.0% | 0.61 |
Other events
| |||||||
Clinically indicated TLR | 16 | 16.4% | 13 | 16.1% | 3 | 20.5% | 0.71 |
Non-cardiac death | 3 | 3.2% | 3 | 3.8% | 0 | 0.0% | 0.46 |
MI not related to target vessel | 2 | 1.9% | 2 | 2.2% | 0 | 0,0% | 0.55 |
Non-TVR | 15 | 13.3% | 15 | 15.7% | 0 | 0.0% | 0.09 |