Immediate procedural safety and long-term efficacy of Ultra-long 48 mm Xience-Xpedition stents: A real world experience from India

Cardiovascular disease (CVD) is the leading cause of mortality in India. Percutaneous coronary intervention (PCI) is a commonly used treatment modality for patients with coronary artery disease. Drug eluting stents (DES) are more efficient than the bare metal stents. Long lesions require treatment with longer balloons and stents, leading to greater arterial injury, which might result in exaggerated neointimal hyperplasia. Long DES is also an independent risk factor for subsequent myocardial infarction, which maybe associated with increased mortality. longer lesions can be treated either overlapping of two shorter stents or placement of a single long stent. Current data indicate that both stent length and stent overlap are associated with major adverse cardiac events. Stent overlap has been associated with increased neointimal proliferation and lumen loss due to delayed healing and increased inflammation. New stent designs with increase length are emerging as an increasingly utilized tool in PCI. The longest stent, called ultra long stent, approved by the USFDA is 38mm. In India, 48mm Xience Xpedition (Abbott Vascular, Santa Clara, Calif) is DGCI approved. The Xience Xpedition 48 mm EES is a proprietary L-605 cobalt-chromium alloy stent pre-mounted on a rapid exchange delivery system. The abluminal surface of the device is coated in a thin layer of durable fluoropolymer, which is used as a carrier for Everolimus. There is no large data available studying the efficacy of stents greater than 38mm. We thereby sought to assess the immediate procedural success and long term efficacy and safety ultra long 48mm Xience xpedition stents in our study.