PCI in the long lesion

Percutaneous coronary intervention Microchapters
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Patient Information
Overview
Risk Stratification and Benefits of PCI
Preparation of the Patient for PCI
Equipment Used During PCI
Pharmacotherapy to Support PCI
Vascular Closure Devices
Recommendations for Perioperative Management–Timing of Elective Noncardiac Surgery in Patients Treated With PCI and DAPT
Post-PCI Management
Risk Reduction After PCI
Post-PCI follow up
Hybrid coronary revascularization
PCI approaches
PCI Complications
Factors Associated with Complications Vessel Perforation Dissection Distal Embolization No-reflow Coronary Vasospasm Abrupt Closure Access Site Complications Peri-procedure Bleeding Restenosis Renal Failure Thrombocytopenia Late Acquired Stent Malapposition Loss of Side Branch Multiple Complications
PCI in Specific Patients
Cardiogenic Shock Left Main Coronary Artery Disease Refractory Ventricular Arrhythmia Severely Depressed Ventricular Function Sole Remaining Conduit Unprotected Left Main Patient Adjuncts for High Risk PCI
PCI in Specific Lesion Types
Classification of the Lesion The Calcified Lesion The Ostial Lesion The Angulated or Tortuous Lesion The Bifurcation Lesion The Long Lesion The Bridge Lesion Vasospasm The Chronic Total Occlusion The Left Internal Mammary Artery Multivessel Disease Distal Anastomotic Lesions Left Main Intervention The Thrombotic Lesion
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

A diffuse lesion is defined as a coronary artery lesion of greater than 20 mm in length. It may also be referred to as diffuse disease, extensive lesion or long lesion. Resistance to coronary blood flow in a coronary vessel is not only due to the severity of a focal stenosis, but also to the length of that stenosis. Long lesions that are moderate in nature may therefore cause a significant resistance to flow.

PCI in The Long Lesion

Treatment

• A single stent that is very long should be placed to minimize stent overlap which is associated with greater risk of stent thrombosis.
• If a bare metal stent is placed, it should be remembered that the risk of restenosis proportional to the length of the bare metal stent placed in the segment.
• There some data to suggest that glycoprotein IIbIIIa inhibition is of greater use in longer lesions given the greater extent of vessel injury.

Complications

Long lesions are associated with a greater plaque burden and as such are likewise associated with a greater risk of no reflow. Longer lesions are also associated with an increased risk of side branch occlusion.