Long-Term Clinical Outcome and Routine Angiographic Follow-up After Successful Recanalization of Complex Coronary True Chronic Total Occlusion With a Long Stent Length: A Single-Center Experience

Objectives. To evaluate clinical and angiographic outcomes after successful recanalization of chronic total coronary occlusion (CTO) with implantation of a long total stent length (SL). Background. Routine follow-up angiogram (RFUA) data after successful recanalization of CTO with a long SL are lacking. Methods. RFUAs were performed at 6 months after successful recanalization of 106 CTOs using drug-eluting stents (DESs) with a long SL (>= 20 mm) in 102 consecutive patients. Results. Mean number of stents was 3.9 +/- 1.8 and mean total SL was 78 +/- 32 mm (range, 23-174 mm). Sirolimus-eluting stents (SESs) were used in 100 lesions. In-stent total reocclusion occurred in 2 cases (1 SES and 1 non-SES DES). Restenosis rate was 18% in the 100 SES subgroup (total SL, 79 +/- 33 mm; range, 23-174 mm; mean number of stents, 3.9 +/- 1.8); younger age and longer total SL were found to be independent predictors of restenosis (longer age: hazard ratio, 0.939; 95% confidence interval, 0.885-0.996; P=.035; longer total SL: hazard ratio, 1.017; 95% confidence interval, 1.00-1.03; P=.045). Restenosis type was diffuse in only 11% and 89% were successfully treated by repeat percutaneous coronary intervention. During a median follow-up of 2 years (interquartile range, 1-4.3 years), major cardiac events other than those angiographically driven at RFUA occurred in 2 patients. Conclusion. Angiographic restenosis rate remains acceptable in patients with complex CTO successfully treated by DES despite a long SL.