Document Detail


Is provisional stenting the effective option? The WIDEST study (Wiktor stent in de novo stenosis). Widest Trial Investigators' Group.
MedLine Citation:
PMID:  11040014     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
AIM: To compare the immediate and late outcomes of patients treated by a policy of routine stent implantation with routine balloon angioplasty and the use of stents only when an ideal result has not been obtained. METHODS: A nine centre, multinational, randomised study of 300 patients with coronary artery disease thought suitable for treatment of a single lesion by balloon angioplasty or stent implantation. Only new lesions in patients who had not undergone previous bypass surgery were included, and totally occluded vessels were excluded. RESULTS: The initial procedure was considered successful in 96% of patients. There was more complete angiographic restoration of luminal diameter in patients treated by elective stent (minimum lumen diameter (MLD) 2.68 mm for stent v 2.27 mm for balloon; p < 0.007), but analysis of the subgroup of balloon angioplasty patients who crossed over to stenting showed that they achieved similar results to the elective stent group. Late luminal loss was greater in stented patients than in those undergoing balloon angioplasty only, and by six months the angiographic benefit of stenting had disappeared (MLD 1.90 mm for stent group v 2.00 mm for balloon angioplasty). Angiographic and clinical results in the balloon angioplasty group were assisted by the high crossover rate (30.1%). Both groups had similar symptom relief, with 58.9% of patients improving by two or more angina grades. The need for further revascularisation was also similar in the two groups at one year (18.2% in the stented group v 17.1% in the balloon angioplasty group). Haemorrhagic complications at the local arterial entry site were more common than expected and were distributed equally between the patients receiving full anticoagulation and those receiving antiplatelet treatment only. The results of both Wiktor stent placement and balloon angioplasty were similar to the findings in the stent group in previous randomised studies (Benestent II, STRESS). CONCLUSIONS: Provisional stenting appears to offer the same longer term outcome as elective stenting in this selected group of patients. Improvement in the results of conventional balloon angioplasty in the past 10 years means that a policy of obtaining an ideal result without the use of stents appears to be practicable in many of these patients, with consequent cost savings.
Authors:
D S Fluck; P Chenu; P Mills; A Davies; J Street; E Paul; R Balcon; C A Layton
Related Documents :
18493334 - The use of prosthetic stents in tracheobronchial, gastrointestinal, and genitourinary d...
12482564 - Role of igg-seropositivity to chlamydia pneumoniae in early thrombotic events after cor...
20603514 - Primary angioplasty and later elective multivessel stenting in a patient with dextrocar...
18498954 - Drug-eluting compared with bare-metal coronary stents among elderly patients.
3121334 - Effect of continued rt-pa administration on the residual stenosis after initially succe...
12652174 - Real-time cardiac catheter navigation on three-dimensional ct images.
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Multicenter Study; Randomized Controlled Trial    
Journal Detail:
Title:  Heart (British Cardiac Society)     Volume:  84     ISSN:  1468-201X     ISO Abbreviation:  Heart     Publication Date:  2000 Nov 
Date Detail:
Created Date:  2000-11-09     Completed Date:  2000-11-09     Revised Date:  2009-11-18    
Medline Journal Info:
Nlm Unique ID:  9602087     Medline TA:  Heart     Country:  ENGLAND    
Other Details:
Languages:  eng     Pagination:  522-8     Citation Subset:  IM    
Affiliation:
St Peter's Hospital, Guildford Road, Chertsey, Surrey, UK.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Angioplasty, Transluminal, Percutaneous Coronary / adverse effects,  methods*
Coronary Angiography
Coronary Disease / radiography,  therapy*
Female
Follow-Up Studies
Humans
Male
Middle Aged
Recurrence
Stents* / adverse effects
Treatment Outcome
Comments/Corrections
Comment In:
Heart. 2000 Nov;84(5):469-70   [PMID:  11040000 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


Previous Document:  Does primary stenting preserve cardiac function in myocardial infarction? A case-control study. NORT...
Next Document:  Complex stenosis morphology and vasomotor responses to inhibition of nitric oxide synthesis.