Comparison of angiographic and clinical outcomes after stenting versus cutting balloon angioplasty in small coronary vessels

Abstract

Vessel size is inversely correlated with the risk of restenosis and adverse outcome after percutaneous coronary interventions.'' This is because a smaller vessel is more limited in the ability to accommodate lumen restenosis, which invariably occurs to some degree in most vessels after balloon dilatation.4•5 Interventions in small coronary vessels (<3.0mm) constitute a considerable proportion (30% to 504)! 3,6• 8 of more than one million coronary catheter based procedures performed worldwide each year. PTCA and stenting are the two most frequently used interventions in

patients with coronary artery disease. Large coronary vessels represent an established indication for stenting because of its superiority compared with PTCA, as shown in several randomized clinical trials.1 O-l 2 Stenting is associated with increased procedural costs ; however, the improved outcome ,with a reduction in the need for reinterventions, has rendered this technique more cost-effective in the long term than tPTCA.2. 13 A retrospective analysis has shown that stenting might be also superior

to conventional balloon angioplasty in small coronary vessels 14

However still carries

some risk of late instent restenosis or subacute thrombosis , and these are encountered more in patients with small coronary vessels. The cutting balloon is a new device for coronary angioplasty, which by the combination of incision and dilatation of the plaque, is believed to minimize arterial wall trauma, the neoproliferative response, and subsequent restenosis.14 Because of the absence of appropriately designed randomized studies, there are no well defined recommendations' regarding the intervention of choice in the setting of small coronary vessels. This is currently considered as a b limitation in interventional cardiology and represents a great challenge to all coronary