Manuseio Percutâneo das lesöes coronarias >20mm através dos stents. Existe uma estratégia de primeira escolha?

OBJECTIVE - This study compared the early and late results of the use of one single stent with those of the use of multiple stents in patients with lesions longer than 20mm. METHODS - Prospective assessment of patients electively treated with stents, with optimal stent deployment and followed-up for more than 3 months. From February '94 to January '98, 215 patients with lesions >20mm were treated. These patients were divided into 2 groups as follows: Group A - 105 patients (49 percent) with one stent implanted; Group B - 110 patients (51 percent) with multiple stents implanted. RESULTS - The mean length of the lesions was 26mm in group A (21-48mm) versus 29mm in group B (21-52mm) (p=0.01). Major complications occurred in one patient (0.9 percent) in group A (subacute thrombosis, myocardial infarctionand death) and in 2 patients (1.8 percent) in group B (one emergency surgery and one myocardial infarction) (p=NS). The results of the late follow-up period (6 months) were similar for both groups (group A = 82 percent vs group B = 76 percent; p=NS), and we observed an event-free survical in 89 percent of the patients in group A and in 91 percent of the patients in group B (p=NS). Angina (group A = 11 percent vs group B =7percent) and lesion revascularization (group A = 5 percent vs group B = 6 percent; p=NS) also occurred in a similar percentage. No infarction or death was observed in the late follow-up period; restenosis was identified in 33 percent and 29 percent of the patients in groups A and B, respectively (p=NS). CONCLUSION - The results obtained using one stent and using multiple stents were similar; the greater cost-effectiveness of one stent implantation, however, seems to make this strategy the first choice (AU)