Immediate and medium-term outcomes following the treatment of very long (> or =50 mm) chronic total coronary artery occlusions.

Objective. The follow-up patency rates and associated clinical and angiographic variables following stenting of very long (> 50 mm) and chronic (> 6 months) total coronary artery occlusive lesions are not well documented.The aim of the present study was to evaluate the early results and mid-term outcomes following angioplasty of such lesions. Methods. Between January 2000 and June 2002, we treated 278 chronic coronary occlusions. Of these, eighty-nine occlusions (89 patients) were with lesions ≥ 50 mm long; these patients constituted the study population. Results. Mean duration of occlusion was 7 ′ 2 months (range, 6-13 months). Procedural success was obtained in 81 patients. A total of 211 coronary stents (2.6 ′ 1.1 stents/patient) were implanted, and mean stent length was 59 ′ 9 mm. In 3 patients, TIMI flow 1-2 was observed after stent implantation. Thus, the angiographic success was considered to be 78/89 patients (87.6%). Periprocedural major adverse cardiac events occurred in 6 patients (6.7%). Clinical success was obtained in 74 patients (83%). During a 9.6 ′ 2 month follow-up, forty-three patients (55.1%) remained angina free, thirty-two (41%) had recurrence of angina, three patients (3.9%) had a new myocardial infarction and no deaths were reported. Target vessel revascularization was required in 34 patients (43.6%). Angiographic follow-up was obtained in 70 patients (90%) at a mean of 7.4 ′ 2 months. Restenosis was observed in 36 patients (51%), six of whom had reocclusion. A significant correlation was observed between the need for reintervention and stent length (R 0.52), residual stenosis (R 0.73) and diabetes mellitus (0.68). Conclusion. Although coronary artery stenting for very long (≥ 50 mm) chronically occlusive lesions is feasible, safe and associated with a low incidence of periprocedural adverse clinical events, these complex and expensive procedures still have a high 6-month restenosis rate. These results might be significantly improved with the advent of drug-eluting stents.