Small Vessel Coronary Artery Disease: Rationale for Standardized Definition and Critical Appraisal of the Literature

Overview

Journal J Soc Cardiovasc Angiogr Interv

Specialty Cardiology & Vascular Diseases

Date 2024 Aug 12

PMID 39131458

Authors

Jorge Sanz-Sanchez

Mauro Chiarito

Gauravpal S Gill

Liefke C van der Heijden

Yigal Pina

Bernardo Cortese

Fernando Alfonso

Clemens von Birgelen

Jose Luis Diez Gil

Ron Waksman

Hector M Garcia-Garcia

Affiliations

Soon will be listed here.

Abstract

Small vessel coronary artery disease (CAD) is present in 30% to 67% of patients undergoing percutaneous coronary intervention according to different series, representing an unmet clinical need in light of an increased risk of technical failure, restenosis, and need for repeated revascularization. The definition of small vessel is inconsistent across trials, and no definite cutoff value has yet been determined. The lack of consensus on the definition of small vessel CAD has contributed to the high degree of heterogeneity in the safety and efficacy of the various revascularization options. Therefore, the aim of this article is to provide a critical appraisal of existing reports and to propose a reference vessel diameter of <2.5 mm definition of small vessel CAD to guide future clinical trials and clinical decision-making.

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References

Zaman A, de Winter R, Kogame N, Chang C, Modolo R, Spitzer E . Safety and efficacy of a sirolimus-eluting coronary stent with ultra-thin strut for treatment of atherosclerotic lesions (TALENT): a prospective multicentre randomised controlled trial. Lancet. 2019; 393(10175):987-997. DOI: 10.1016/S0140-6736(18)32467-X. View

Akiyama T, Moussa I, Reimers B, Ferraro M, Kobayashi Y, Blengino S . Angiographic and clinical outcome following coronary stenting of small vessels: a comparison with coronary stenting of large vessels. J Am Coll Cardiol. 1998; 32(6):1610-8. DOI: 10.1016/s0735-1097(98)00444-6. View

Stefanini G, Alfonso F, Barbato E, Byrne R, Capodanno D, Colleran R . Management of myocardial revascularisation failure: an expert consensus document of the EAPCI. EuroIntervention. 2020; 16(11):e875-e890. DOI: 10.4244/EIJ-D-20-00487. View

Vural K, Sener E, Tasdemir O . Long-term patency of sequential and individual saphenous vein coronary bypass grafts. Eur J Cardiothorac Surg. 2001; 19(2):140-4. DOI: 10.1016/s1010-7940(00)00629-1. View

Shah P, Gordon I, Fuller J, Seevanayagam S, Rosalion A, Tatoulis J . Factors affecting saphenous vein graft patency: clinical and angiographic study in 1402 symptomatic patients operated on between 1977 and 1999. J Thorac Cardiovasc Surg. 2003; 126(6):1972-7. DOI: 10.1016/s0022-5223(03)01276-5. View

Giannini F, Latib A, Jabbour R, Costopoulos C, Chieffo A, Carlino M . Comparison of paclitaxel drug-eluting balloon and paclitaxel-eluting stent in small coronary vessels in diabetic and nondiabetic patients - results from the BELLO (balloon elution and late loss optimization) trial. Cardiovasc Revasc Med. 2016; 18(1):4-9. DOI: 10.1016/j.carrev.2016.12.008. View

Oliveira F, Mattos L, Abizaid A, Abizaid A, Costa J, Costa R . Miniaturized self-expanding drug-eluting stent in small coronary arteries: late effectiveness. Arq Bras Cardiol. 2013; 101(5):379-87. PMC: 4081161. DOI: 10.5935/abc.20130199. View

Morice M . Stenting for small coronary vessels. J Invasive Cardiol. 2003; 15(7):377-9. View

Li H, Xie B, Gu C, Gao M, Zhang F, Wang J . Distal end side-to-side anastomoses of sequential vein graft to small target coronary arteries improve intraoperative graft flow. BMC Cardiovasc Disord. 2014; 14:65. PMC: 4023697. DOI: 10.1186/1471-2261-14-65. View

10.

Sanz Sanchez J, Chiarito M, Cortese B, Moretti A, Pagnotta P, Reimers B . Drug-Coated balloons vs drug-eluting stents for the treatment of small coronary artery disease: A meta-analysis of randomized trials. Catheter Cardiovasc Interv. 2020; 98(1):66-75. DOI: 10.1002/ccd.29111. View

11.

Elgendy I, Gad M, Elgendy A, Mahmoud A, Mahmoud A, Cuesta J . Clinical and Angiographic Outcomes With Drug-Coated Balloons for De Novo Coronary Lesions: A Meta-Analysis of Randomized Clinical Trials. J Am Heart Assoc. 2020; 9(10):e016224. PMC: 7660863. DOI: 10.1161/JAHA.120.016224. View

12.

van der Heijden L, Kok M, Danse P, Schramm A, Hartmann M, Lowik M . Small-vessel treatment with contemporary newer-generation drug-eluting coronary stents in all-comers: Insights from 2-year DUTCH PEERS (TWENTE II) randomized trial. Am Heart J. 2016; 176:28-35. DOI: 10.1016/j.ahj.2016.02.020. View

13.

Jeger R, Pfisterer M, Pfister O, Rickenbacher P, Handke M, Gilgen N . First-generation paclitaxel- vs. second-generation zotarolimus-eluting stents in small coronary arteries: the BASKET-SMALL Pilot Study. Postepy Kardiol Interwencyjnej. 2016; 12(4):314-320. PMC: 5133319. DOI: 10.5114/aic.2016.63630. View

14.

Neumann F, Sousa-Uva M, Ahlsson A, Alfonso F, Banning A, Benedetto U . 2018 ESC/EACTS Guidelines on myocardial revascularization. EuroIntervention. 2019; 14(14):1435-1534. DOI: 10.4244/EIJY19M01_01. View

15.

Cortese B, di Palma G, Garcia Guimaraes M, Piraino D, Orrego P, Buccheri D . Drug-Coated Balloon Versus Drug-Eluting Stent for Small Coronary Vessel Disease: PICCOLETO II Randomized Clinical Trial. JACC Cardiovasc Interv. 2020; 13(24):2840-2849. DOI: 10.1016/j.jcin.2020.08.035. View

16.

Colombo A, Chieffo A . Drug-eluting stent update 2007: part III: Technique and unapproved/unsettled indications (left main, bifurcations, chronic total occlusions, small vessels and long lesions, saphenous vein grafts, acute myocardial infarctions, and multivessel disease). Circulation. 2007; 116(12):1424-32. DOI: 10.1161/CIRCULATIONAHA.106.621359. View

17.

Mehilli J, Dibra A, Kastrati A, Pache J, Dirschinger J, Schomig A . Randomized trial of paclitaxel- and sirolimus-eluting stents in small coronary vessels. Eur Heart J. 2006; 27(3):260-6. DOI: 10.1093/eurheartj/ehi721. View

18.

Wohrle J, Markovic S, Rottbauer W, Muramatsu T, Kadota K, Vazquez-Gonzalez N . Bioresorbable polymer sirolimus-eluting coronary stent compared with permanent polymer everolimus-eluting coronary stent implantation for treatment of small vessel coronary artery disease: CENTURY II trial. EuroIntervention. 2016; 12(2):e167-74. DOI: 10.4244/EIJV12I2A30. View

19.

Briguori C, Tobis J, Nishida T, Vaghetti M, Albiero R, Di Mario C . Discrepancy between angiography and intravascular ultrasound when analysing small coronary arteries. Eur Heart J. 2002; 23(3):247-54. DOI: 10.1053/euhj.2001.2730. View

20.

Caputo R, Leon M, Serruys P, Neumann F, Yeung A, Windecker S . Performance of the resolute zotarolimus-eluting stent in small vessels. Catheter Cardiovasc Interv. 2014; 84(1):17-23. DOI: 10.1002/ccd.25485. View