Clinical and angiographic follow-up after long versus short stenting in unselected chronic coronary occlusions

Background: Few data are available on the efficacy of long stenting for lesions in unselected chronic total occlusion (CTO). Hypothesis: The study was undertaken to evaluate the angiographic restenosis and long-term clinical outcomes after long stent implantation in patients with CTO. Methods: Our retrospective analysis includes a consecutive series of stent implantation in 220 patients with CTO. We compared angiographic restenosis, target lesion revascularization, and long-term clinical outcomes of short stenting (<20 mm, Group 1, n = 113) with a concurrent series of long stenting (≥ 20 mm, Group 2, n = 107). Results: Angiographic follow-up was obtained in 174 patients (79.5% of those eligible), and the rates of angiographic restenosis were 19.3% in Group 1 and 33.7% in Group 2 (p<30.05). In multivariate analysis, the postinterventional minimal lumen diameter was the only independent predictor of restenosis (odds ratio = 0.20, 95% confidence interval 0.08-0.49, p<0.01). The angiographic restenosis rate was significantly lower in Group 1 than in Group 2 in patients with final minimal lumen diameter <3.0 mm (28.9 vs. 55.9%, respectively, p<0.05). However, the angiographic restenosis rate was not significantly different between the two groups in patients with final minimal lumen diameter ≥3 mm (12.0 vs. 19.2%, respectively, p = NS). During the follow-up (29.1 ± 10.8 months), there was no difference between the two groups in death, nonfatal myocardial infarction, and target lesion revascularization. Conclusions: The use of long (≥20 mm) versus short (<20 mm) stents in patients with CTO is associated with a higher angiographic restenosis rate, but there is an equivalent risk of restenosis in selected patients with relatively large-sized vessels.