Spot Stenting Preferable in Long Diffuse Coronary Lesions

Abstract

The treatment of long and diffuse coronary lesions with percutaneous coronary intervention (PCI) has been problematic. Since the era of plain balloon angioplasty,  lesion  length  has been a factor related to higher rates of restenosis and target lesion revascularization (TLR). With the advent of bare-metal stents, long and multiple stents were used to completely cover the diseased segments in order to improve outcomes. It has been shown that stenting of long coronary lesions (>20 mm) is related to significantly higher rates of TLR than more discrete lesions and  lesion  length   remained  an independent risk factor for restenosis. The risk was further increased by the multiplicity of implanted stents. Full-cover stenting of long lesions is likely to give rise to diffuse, malignant in-stent restenosis which may necessitate multiple additional PCI procedures and often bypass surgery. Thus, covering the lesion with the least number of non-overlapping stents might reduce the risks of restenosis.  This strategy, called spot stenting,... (excerpt)