Drug-eluting stents are preferred therapy for revascularization of chronic total occlusions

A systematic review of medical evidence has determined drug-eluting stents (DES) outperform bare metal stents (BMS) for revascularization of chronic total occlusions. Researchers found coated stents reduce restenosis and target revascularization, offering a safe approach with similar adverse events as BMS. Full findings are available in the February issue of Catheterization and Cardiovascular Interventions, a journal published by Wiley-Blackwell on behalf of The Society for Cardiovascular Angiography and Interventions.

Medical evidence maintains that chronic total occlusions (CTOs) — with routinely low procedural success and high incidence of target vessel failure — represent the most challenging type of coronary lesion in interventional cardiology. While specialized guidewires and advanced techniques have improved CTO angioplasty, high rates of restenosis and reocclusion remain a challenge.

To determine the performance of DES implantation in CTOs, Emmanouil Brilakis, MD, PhD, FSCAI — of VA North Texas Healthcare System and the University of Texas Southwestern Medical Center in Dallas — and colleagues performed a systematic review of medical literature published in online databases (PubMed, EMBASE, Cochrane Library) and cardiology societies’ websites. The researchers found 17 published studies that reported outcomes for sirolimus- or paclitaxel-eluting stents and BMS implantation for coronary occlusions.

“Our findings confirm that treatment of total coronary occlusions with DES is associated with significant reductions in angiographic and clinical restenosis, compared with BMS,” said Dr. Brilakis. Analysis of angiographic outcomes in the studies revealed less restenosis with DES implantation compared to BMS (odds ratio — 0.15). At 6 to 12 months, target lesion and vessel revascularization were also consistently lower among DES-treated patients (odds ratio of 0.13 and 0.18, respectively). In a 19-month follow-up period the cumulative incidence of mortality, heart attack, or stent thrombosis was similar between DES and BMS in all studies.

Dr. Brilakis concluded, “The consistency and magnitude of treatment effect in the individual studies and meta-analysis establish DES as the standard therapy for CTO revascularization. Large, prospective trials that offer additional information on the role of DES in CTO, and determine if second generation DES could provide even more favorable outcomes are needed.” Currently, three such studies are underway in the Netherlands, Spain, and the U.S. which will provide further medical evidence on the use of DES in treating total occlusions.

This study is published in Catheterization and Cardiovascular Interventions. Media wishing to receive a PDF of the article may contact [email protected].

Full citations: “Use of Drug-Eluting Stents for Chronic Total Occlusions: A Systematic Review and Meta-analysis.” Bilal Saeed, David E. Kandzari, Pierfrancesco Agostoni, William L. Lombardi, Bavana V. Rangan, Subhash Banerjee, and Emmanouil S. Brilakis. Catheterization and Cardiovascular Interventions; Published Online: June 14, 2010 (DOI: 10.1002/ccd.22690); Print Issue Date: February 2011. http://onlinelibrary.wiley.com/doi/10.1002/ccd.22690/abstract

Catheterization and Cardiovascular Interventions is the official journal of The Society for Cardiovascular Angiography and Interventions. This international journal covers the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability. For more information, please visit http://onlinelibrary.wiley.com/journal/10.1002/(ISSN)1522-726X..

The Society for Cardiovascular Angiography and Interventions (SCAI) is the primary professional association for invasive and interventional cardiologists, representing over 4,300 physicians in 60 countries. The Society’s mission is to promote excellence in invasive and interventional cardiovascular medicine through physician education and representation, its monthly journal Catheterization and Cardiovascular Interventions, and the advancement of quality standards to enhance patient care. For more information, please visit www.scai.org or SCAI’s comprehensive patient education website, www.secondscount.org.

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