| Background Coronary artery ectasia (CAE) is a well-recognized yet rare abnormality of the coronary anatomy. The safety and success of coronary intervention in stenotic ectatic coronary segments is not well known, just a few studies and cases reports supported its feasibility. Malaposition and aneurysm after coronary stenting especially for drug eluting stent (DES) implantation are big concerns for interventionists, it is postulated that cytokine-induced tissue inflammation is an underlying contributor of vascular remodeling. With the advent of drug eluting stent (DES), more efficacy results superior to bare metal stent (BMS) leaded to widely usage even with off-label indications. But, malaposition and aneurysm after coronary stenting especially for DES implantation are always big concerns for interventionists, even there is no strong evidence so far to indicate the correlation between them and cardiac events. So the outcomes for stenting at narrowing lesions with adjacent ectasia need to be identifed.Objectives This study was designed to identify the efficient PCI for narrowing lesion with adjacent ectasia including DES and BMS.Methods From April 2004 to October 2008,136 consecutive Chinese patients underwent stent implantation for narrowing lesions with adjacent ectasia including 53 bare metal stent (BMS) and 83 drug eluting stent (DES) were analyzed. Clinical follow-up was performed by telephone contact or office visit at 1,6 months and 1,2, 3 and 4 years after the index procedure, angiographic follow-up was scheduled between 6 and 8 months post-procedure unless clinically indicated earlier. Angiographic success of stent implantation was defined as fully covering the target lesion with residual stenosis less than 20%. Major adverse cardiac events (MACE) included cardiac death, nonfatal myocardial infarction (MI) and target vessel revascularization (TVR).Results (1) There was more male patients in DES group (95.2% vs.77.4%; p=0.003); (2) There was more AMI in BMS group(17.0% vs.2.4%; p=0.003);(3) There was more RCA disease involved in BMS group (62.3%, p=0.000);(4) There was more LAD disease in DES group (49.4%,p=0.000);(5) The follow-up period ranged from 132 to 1056 days [(566±234) days for BMS group and (478±251) days for DES group]. (p=0.000);(6) During procedure, predilitation and postdilitation were more often performed in DES group (88.0% vs.67.9%; p=0.007,31.3% vs. 5.7%;p=0.000);(7) There was only 2 cardiac death (cardiogenic shock one day after acute myocardial infarction) in BMS group and 1 no fatal myocardial infarction 378 days after percutaneous coronary intervention (PCI) and 1 target vessel revascularization (TVR) in DES group (no significant difference of any of cardiac events). (8) Except for 1 very late probable stent thrombosis in DES group (1.2%), no other stent thrombosis episodes were found.19 patients (6 in BMS group and 13 in DES group) experienced 7 month coronary angiogram follow up, none of them suffered restenosis, stent malaposition or aneurysm, and original ectasias did not changed.Conclusion From these long term follow up results, PCI for narrowing lesion with adjacent ectasia including DES was safe and efficient.
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