Drug-eluting stent implantation for chronic total occlusions: comparison between the Sirolimus- and Paclitaxel-eluting stent.

Aims: Long-term results following percutaneous coronary intervention (PCI) with bare metal stents in the treatment of chronic total occlusions (CTOs) is hindered by a significant rate of restenosis and re-occlusion. Drug-eluting stents have shown dramatically reduced restenosis rates for the treatment of relatively simple non-occlusive lesions, though there is only limited data as to the efficacy in CTO's. We evaluated the long-term results of the sirolimus-eluting stent (SES) and paclitaxel-eluting stent (PES) for the treatment of CTOs. Methods and results: From April 2002, all patients at our institution were treated with SES as the device of choice during PCl. During the first quarter of 2003 the default strategy changed to the use of PES. Drugeluting stent implantation was carried out in CTOs (defined as >3 months' duration) in 9% of de novo PCl procedures. A total of 76 consecutive patients were treated with SES implantation, followed by a consecutive series of 57 patients treated with PES implantation. These patients were compared with a similar group of patients (n=26) treated with BMS in the 6-month period preceding April 2002. At 400 days, the cumulative survival-free of target vessel revascularization was 80.8% in the BMS group versus 97.4% and 96.4% in the SES and PES groups respectively (p=0.01). Conclusions: The use of both the SES and PES in the treatment of chronic total coronary occlusions reduces the need for target vesser revascularization compared to bare metal stents.