Stenting in chronic coronary occlusion (SICCO): randomized, controlled trial of adding stent implantation after successful angioplasty

Objectives. This study investigated whether stenting improves long-term results after recanalization of chronic coronary occlusions. Background. Restenosis is common after percutaneous transluminal coronary angioplasty (PTCA) of chronic coronary occlusions. Stenting has been suggested as means of improving results, but its use has not previously been investigated in randomized trial. Methods. We randomly assigned 119 patients with satisfactory result after successful recanalization by PTC of chronic coronary occlusion to 1) control (PTCA) group with no other intervention, or 2) group in which PTC was followed by implantation of Palmaz-Schatz stents with full anticoagulation. Coronary angiography was performed before randomization, after stenting and at 6-month follow-up. Results. Inguinal bleeding was more frequent in the stent group. There were no deaths. One patient with stenting had myocardial infarction. Subacute occlusion within 2 weeks occurred in four patients in the stent group and in three in the PTC group. At follow-up, 57% of patients with stenting were free from angin compared with 24% of patients with PTC only (p < 0.001). Angiographic follow-up dat were available in 114 patients. Restenosis (≥50% diameter stenosis) developed in 32% of patients with stenting and in 74% of patients with PTC only (p < 0.001); reocclusion occurred in 12% and 26%, respectively (p = 0.058). Minimal lumen diameter (mean ± SD) at follow-up was 1.92 ± 0.95 mm and 1.11 ± 0.78 mm, respectively (p < 0.001). Target lesion revascularization within 300 days was less frequent in patients with stenting than in patients with PTC only (22% vs. 42%, P = 0.025). Conclusions. Stent implantation improved long-term angiographic and clinical results after PTC of chronic coronary occlusions and is thus recommended regardless of the primary PTC result.