7/25/2023 0 Comments Small caliber vessel meaning![]() Even when binary restenosis rates are considered, SES remains the best-ranked intervention, while BMS and BA the worst. ![]() Both BMS and BA provided poorer clinical and angiographic results. In this analysis early generation SES were found to be the most effective treatment in terms of percentage diameter stenosis, followed by PES and DCB. This had been chosen under the correct assumption that the treatment of small vessel disease may have a limited clinical effect which is therefore hard to measure and may lead to under detection of some real differences. The primary angiographic outcome measure was percentage diameter stenosis at follow-up. A total of 19 randomized clinical trials evaluating the five mentioned interventions with 5,072 patients, were analyzed with long-term angiographic data available from 16 trials including 4,349 patients. The meta-analysis published by Siontis et al. Previously published trials are insufficient in helping the operator to reach a sound, evidence based decision which would most likely lead to the best result as good data are lacking and some of the techniques used in these trials are becoming obsolete. Moreover trials incorporating the use of drug eluting stents have only used first generation stents which are known to be inferior to currently used DESs with regards to target lesion restenosis in larger vessels.Īnd so when attempting to treat small vessel lesions we find ourselves in uncharted waters since these lesions are not only ill defined but are also notoriously known to be technically challenging and with higher rates of restenosis. However the amount of good quality data from randomized trials is scarce and some interventions were never assessed in a head to head trial. Also, there is a great variation is vessel size estimation compared to core lab QCA analyses.įive different interventions were evaluated before for the treatment of small coronary arteries. We believe that most operators would consider a small vessel to be under 2.5 mm. While some trials used the cutoff of 3 mm to define small coronary artery vessels others define it as 2.5 mm. When analyzing data on small caliber vessels we face the issue of definition. We also know that interventions in small coronary vessels are often challenging and associated with a higher rate of restenosis and therefore also a higher rate of repeat revascularizations regardless of the chosen technique for treatment ( 4, 5).Īccelerated late lumen loss is partly explained by the fact that the rate of neointimal hyperplasia is equal in small and large vessels and thus the relative lumen reduction is more pronounced in small vessels per a fixed amount of hyperplasia, i.e., if the neointimal hyperplasia is 0.5 mm in a 4.0-mm the minimal lumen diameter will be 3.0 mm while in a 2.3-mm vessel it will be only 1.3 mm ( 6). All of which harbor higher risk for poor outcome. What we do know is that patients with small vessel disease often have other comorbidities such as diabetes mellitus, multi vessel disease and often longer lesions. ![]() Yet, to date there is very limited evidence to assist in choosing the best strategy for treating these patients. Treating small vessels has become very common and is currently estimated to account for 30–40% of all coronary procedures ( 1- 3). Percutaneous coronary intervention (PCI) of small coronary arteries represents a difficult task for the operator. Rappaport - Faculty of Medicine, Technion - Israel Institute of Technology, Haifa 31096, Israel. Interventional Cardiology, Rambam Medical Center, B.
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