Outcomes of overlapping bare-metal stents with sirolimus-eluting stents for long lesions in small coronary vessels

Objectives: Compare outcomes of hybrid bare-metal stent (BMS)/sirolimus-eluting stent (SES) to BMS alone for the treatment of stenoses in small coronary arteries. Background: One approach to potentially reduce the risk of restenosis in long lesions with smaller distal reference diameters is to use a small (2.0-2.5mm) "BMS cap" (BMC) distally, telescoped in tandem with a SES(s) proximally, matched to a proximal segment where the diameter is ≥ 2.5 mm (creating a BMC/SES hybrid stent). Results from previous reports using "hybrid" drug-eluting stents and BMS are mixed. Methods: We performed a retrospective analysis of BMC/SES cases in small vessels at our institution and compared the outcomes with a control group (BMS) consisting of patients treated with at least one 2.0-2.5 mm BMS. Results: During the years 2003-2006, 41 BMC/SES and 62 BMS cases were identified and follow up was available in 33 and 49 patients, respectively. Baseline demographics, procedure indications and pertinent discharge medications for the two groups were similar. Despite the use of more stents and longer total stent length in the BMC/SES group compared to the BMS group (2.9 ± 0.79 vs. 1.4 ± 0.69 and 64 ± 21 mm vs. 26 ± 18 mm; p < 0.0001 for both comparisons), there was a significant decrease in the composite of restenosis, myocardial infarction and cardiac death (9% vs. 29%; p ≤ 0.033). Conclusions: The use of a "BMS cap" distally, telescoped in tandem with SES more proximally, may be a reasonable approach in treating long lesions in coronary arteries with distal reference diameters ≤ 2.5 mm.