Angioplasty and Percutaneous Intervention
Jeffrey J. Popma
Brigham and Women's Hospital, Boston, Massachusetts, USA

Dr. Popma described 3 abstracts of the 399 that had been accepted in this category for presentation at this year's meeting. He was particularly excited about the first study, involving the use of sirolimus-coated stents, which he said, "very likely represents the future of revascularization techniques."

For his review, Dr. Popma selected 3 abstracts of the 399 that had been accepted in this category for presentation at this year's meeting.
  1. Drs. Amanda G.M.R. Sousa and J. Eduardo M.R. Sousa presented "Comparison between Sirolimus-Coated and Noncoated Stent Implantation in Human Coronary Arteries." In this study, sirolimus (rapamycin) was used as a coating on stents in an attempt to suppress the process of restenosis following angioplasty. Sirolimus-coated stents were implanted in 30 patients requiring single-vessel elective angioplasty, and noncoated stents were implanted in 15 similar patients. After 6 months of follow-up, neointimal proliferation was virtually absent after implantation of sirolimus-coated stents, and there was no edge restenosis or in-stent restenosis in any of the vessels in this group.

  2. Dr. Ron Waksman presented the results of the Washington Radiation for In-Stent Restenosis Trial for Saphenous Vein Grafts (SVG WRIST), a randomized double-blind trial of Iridium-192 (192-Ir) gamma radiation therapy in 120 patients with diffuse in-stent restenosis in their saphenous vein grafts following coronary artery bypass surgery. At 30 days, there were no adverse events related to the radiation therapy, and at 6 months the restenosis rate was 16% in the irradiated group compared with 43% in the control group (P = .004). The need for repeat intervention was 10% in the irradiated group compared with 48% in the control group (p = 0.001). This study demonstrated that catheter-based gamma irradiation therapy is safe and effective in the reduction of the overall restenosis rate and the need for repeat revascularization in these patients.

  3. Dr. R.H. Stables presented the results of the Stent or Surgery (SOS) trial, a prospectively randomized trial designed to answer the question so many physicians have been asking for a long time: "For patients with multivessel coronary artery disease, is angioplasty with stenting better than bypass graft surgery?" A total of 988 patients were recruited in Europe and Canada and randomized to either surgery or angioplasty. They were followed for an average of 2 years. The results showed no significant differences between the two groups in rates of death or myocardial infarction (about 9.5% at 2 years). Both types of procedure had low adverse event rates. There was a trend toward a lower death rate with surgery, but the trend was not conclusive because the mortality rate was so low (only 2%). Continuing analysis of the data from this trial will provide information about health care costs and cost-benefit analyses, as well as patient-reported symptoms and quality of life, presumably leading to a better basis for comparison and clinical decision-making in the future.

Reporter: Andre Weinberger, MD


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