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  • Editorial - Stenting Long Coronary Lesions: Can One Stent Do the Job of Two?

    Since the early days of balloon angioplasty, long coronary lesions have been recognized as a high-risk lesion subset because of a higher rate of dissection, abrupt vessel closure, and restenosis as compared to focal lesions. With the introduction of bare metal stents, outcomes improved, but long lesions and long stent lengths were associated with higher rates of periprocedural myocardial infarction and restenosis rates that exceeded 40%. In the drug-eluting-stent (DES) era, lesion and stent length appear to be less important predictors of restenosis compared to bare metal stents; this is particularly true for the newer-generation DES. In a study of over 8000 patients, Choi et al. found that stent length > 32 mm was associated with higher rates of stent thrombosis and target vessel revascularization in patients treated with a first-generation DES but not in patients treated with second-generation DES. However, there remain ongoing concerns about risk of stent thrombosis and restenosis with the use of long stents, particularly in the case of very long stent lengths, known as the “full metal jacket”.

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