Reduced incidence of clinical restenosis with newer generation stents, stent oversizing, and high‐pressure deployment: Single‐operator experience

Background : Over the last 4 years, several newer generation stents have become available, promising to change the scenery of coronary angioplasty (PTCA) with its attendant restenosis rate. Hypothesis : The aim of this study was to review prospectively the results of a single operator adopting a uniform approach with approximately 0.5 mm stent oversizing and high‐pressure (≥ 12‐16 bar) deployment and compare them with conventional PTCA in a series of 244 consecutive patients. Methods : The study included 203 men and 41 women, aged 59 ± 11 years, who presented with stable angina and/or positive exercise testing (n = 75), unstable angina (n = 161), or acute myocardial infarction (n = 8). Dilated vessels included the left anterior descending artery (n = 139), the right coronary artery (n = 86), the left circumflex artery (n = 47), the ramus branch (n = 4), or venous grafts (n = 2). Stents were implanted for dissection, suboptimal PTCA result, and electively. Two groups were compared: 83 patients who underwent balloon PTCA alone and 161 patients who also received stent(s). Results : The two groups had similar demographics, age (58 ± 10 vs. 59 ± 11 years), initial vessel stenosis (92 ± 7 vs. 93 ± 6%), and left ventricular ejection fraction (51 ± 9 vs. 51 ± 8%). Procedural success was also similar (97.6 vs. 99.4%), but as expected the residual stenosis was much lower in the stent group (≤ 0 vs. 17%). The following stents were employed: J & J (n = 1), NIR (n = 117), ACS (n = 59), AVE (n = 9), Inflow GoldFlex (n = 9), Crossflex (n = 5), Wictor (n = 1), Jostent (n = 16), R stent (n = 9), Seaquence (n = 2) and Wallstent (n = 1). Single stents were used in 118 patients, two stents in 31 patients, three in 6 patients, and four in 6 patients. There was one in‐hospital death at 3 days unrelated to the procedure. There were no events of subacute stent thrombosis; all patients in the stent group received combined therapy with aspirin and ticlopidine, the latter for 1 month. During 18 ± 14 months, the clinical rèstenosis rate was significantly lower in the stent group (6.9%) than in the PTCA group (28.4%) (p = 0.001). Conclusion : In a series of 244 consecutive patients, newer generation stents and a consistent approach of stent oversizing and high‐pressure stent deployment by a single operator resulted in high procedural success (99%), lack of stent thrombosis (0%), and a very low clinical restenosis rate (7%).