PCI in the long lesion

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Key Words and Synonyms: diffuse disease, extensive lesion, long lesion

Overview

A diffuse lesion is defined as a coronary artery lesion of greater than 20 mm in length. 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.

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 2b3a 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.