Stents should match lesions

Main Category: Public Health
Article Date: 31 May 2004 - 6:00 PDT

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US researchers have advised physicians to match the length of bare metal stents to that of lesions in order to reduce the risk of restenosis, after finding that many patients are fitted with stents that are longer than necessary.

Laura Mauri (Brigham and Women's Hospital, Boston, Massachusetts) and colleagues found a direct relationship between the amount of excess stent length and risk of restenosis, which was independent of lesion length.

They say: "In this contemporary stent population, a strategy of parsimonious stenting in which the sites of major obstruction were covered, was the optimum strategy to prevent restenosis."

When stenting, physicians must decide whether to cover only the obstructive, flow-limiting portion of the lesion, or extend coverage to the nonobstructive portion, or even adjacent, normal coronary margins.

Although the length of the bare metal stent has been related to the risk of restenosis, the researchers say that it is unknown whether or not this is just a reflection of underlying lesion length.

To determine the independent contribution of bare metal stent coverage to restenosis, they examined the angiographic follow-up cohort from six Food and Drug Administration-regulated standard stent trials of de novo lesions in native coronary arteries (STARS, ASCENT, SMART, NIRVANA, EXTRA, and CCS).

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