Efficiency of everolimus-eluting stents of different generations after functionally adequate myocardial revascularization in patients with diffuse and multivessel coronary artery disease

Objective. To evaluate the effectiveness of everolimus-eluting stents of various generations in patients with diffuse and multivessel coronary artery disease after functionally adequate myocardial revascularization. Material and methods. There were 68 patients. All percutaneous coronary interventions were performed using intravascular imaging methods. Measurement of fractional flow reserve in diffusely altered arteries was performed under maximum hyperemia between stenoses by passage the sensor starting from the distal segment. Optical coherence tomography was performed to determine the area of stent implantation. Long-term results of stenting were assessed after 24 months using similar imaging methods. Results. Intravascular imaging methods were performed in 105 non-occluded arteries. Mechanical recanalization of chronic occlusions was performed in 26 patients. After fractional flow reserve measurement, the number of non-occluded arteries with severe stenoses decreased by 31.4% (from 105 to 72). Stenting was performed in 93 affected arterial segments. Considering patients with occlusions, we implanted 163 everolimus-eluting stents (75 (46%) stents of the 2nd generation and 88 (54%) stents of the 3rd generation, p>0.05). Complete (functional adequate) myocardial revascularization confirmed by fractional flow reserve was achieved in 62 (91.2%) patients. Left ventricular ejection fraction significantly increased after 24 months. Overall incidence of major cardiovascular complications was 11.8%. According to coronary angiography data, restenosis was observed in 24 (32%) stents of the 2nd generation and 19 (21.6%) stents of the 3rd generation (p>0.05). Optical coherence tomography revealed intimal hyperplasia with stenosis up to 50% in 14 (18.6%) stents of the 2nd generation and 13 (14.8%) stents of the 3rd generation (p>0.05), >50% — 8 (10.7%) stents of the 2nd generation and 6 (6.8%) stents of the 3rd generation (p>0.05). Redo interventions were performed on 6 (8%) stents of the 2nd generation and 6 (6.8%) stents of the 3rd generation (p>0.05). Conclusion. Everolimus-eluting stents of the 2nd and 3rd generations demonstrate low rates of redo interventions and cardiovascular complications in patients with diffuse coronary lesions after functionally adequate myocardial revascularization.