Use of drug-eluting stents for chronic total occlusions: A systematic review and meta-analysis


  • Conflict of Interest:

    Dr. Saeed: None.

    Dr. Kandzari: Research/grant support and consulting honoraria: Abbott Vascular, Cordis Corporation, Medtronic CardioVascular.

    Dr. Agostoni: Consultant for Genae associates NV.

    Dr. Lombardi: Consultant for Abbott Vascular (also serves on the medical advisory board), Bridgepoint Medical Systems, and Medtronic; speaker for Abbott Vascular, Medtronic, and Cordis.

    Dr. Rangan: None.

    Dr. Banerjee: Speaker honoraria from St. Jude Medical, Medtronic, and Johnson & Johnson and research support from Boston Scientific and The Medicines Company.

    Dr. Brilakis: Research funding from the Department of Veterans Affairs. Speaker honoraria from St Jude Medical; consulting fees from Medicure; research support from Abbott Vascular; salary support from Medtronic (spouse).


Aim: To perform a systematic review and meta-analysis of studies reporting outcomes after drug-eluting stent (DES) implantation in chronic total occlusions (CTOs). Methods: A review of publications and online databases in January 2010 retrieved 17 published studies that reported outcomes after DES implantation in CTOs: eight uncontrolled studies, seven nonrandomized comparative studies with bare-metal stents (BMS), one post-hoc analysis of a randomized trial, and one randomized trial. Data were pooled using random-effects meta-analysis models. Results: All published studies evaluated sirolimus- or paclitaxel-eluting stents. All studies reporting comparative angiographic outcomes revealed less binary angiographic restenosis with DES implantation compared to BMS (odds ratio: 0.15, 95% CI: 0.08, 0.26). Over a mean follow-up period of 18.9 ± 16.5 months, the cumulative incidence of death, myocardial infarction, or stent thrombosis was similar between DES and BMS in all studies. Target lesion revascularization (odds ratio: 0.13, 95% CI: 0.06, 0.26) and target vessel revascularization (odds ratio 0.18, 95% CI: 0.11, 0.31) at 6–12 months were consistently lower among DES-treated patients. Similar patterns of safety and efficacy event rates were also observed in studies reporting >12 month outcomes. Conclusions: Compared with BMS, treatment of chronic total coronary occlusions with DES is associated with significant reductions in angiographic and clinical restenosis with similar safety. The consistency and magnitude of treatment effect across both individual trials and the pooled analysis establish DES as the preferred therapy for percutaneous revascularization of CTOs. © 2010 Wiley-Liss, Inc.