Sidebranch Occlusion After Coronary Stenting
Sidebranch Occlusion After Coronary Stenting
Direct stenting (DS) is a novel approach in percutaneous treatment of coronary artery lesions. Several studies confirmed the safety and feasibility of the procedure with success rates greater than 90%. However, the data regarding the incidence of sidebranch occlusion (SBO) after DS are scarce. The purpose of this study was to evaluate SBO (> 1 mm) after DS and compare it to conventional stenting (CS) with balloon predilation. The study population consisted of 151 patients (88 underwent DS, 63 underwent CS) with 185 sidebranches jailed by the stent (110 in DS group, 75 in CS group). SBO was observed in 20 out of 110 patients in the DS group (18.2%) and 18 out of 75 patients in the CS group (24%). Although the incidence of SBO was higher in the CS group compared to the DS group (24% vs. 18.2%, respectively), these values did not reach statistical significance (p > 0.05). Most of the SBOs were observed in cases with type D sidebranch morphology (p < 0.001) and in cases with sidebranch ostial diameter stenosis ≥ 50% (p = 0.019). None of the other clinical and angiographic variables predicted the SBO. To the best of our knowledge, this is the first report comparing incidence of SBO between two different PCI methods (CS vs DS). Randomized studies with larger patient populations should be conducted to compare this approach with conventional stenting.
Sidebranch occlusion (SBO) is a challenging problem during interventional procedures. Although occlusion of branches smaller than 2 mm was reported to be of little clinical importance, this may lead to angina or myocardial infarction. Sidebranches with ostial lesions were observed to occlude more than the ones without any lesion. Plaque shift, plaque embolization, spasm, thrombus formation, design of the stent struts and high-pressure balloon predilation (> 10 atm) are reported to be the mechanisms responsible for SBO.
Direct stenting (DS; stenting without balloon predilation) is a novel approach in percutaneous treatment of coronary artery lesions. Stenting without previous balloon dilation may decrease trauma, incidence of dissection and distal embolization, leading to a better outcome. However, the data evaluating SBO after stenting without balloon predilation are scarce. The aim of this study was to evaluate the impact of DS, a novel percutaneous coronary intervention (PCI) technique, on sidebranch occlusion and compare it to conventional stenting with balloon predilation (CS).
Direct stenting (DS) is a novel approach in percutaneous treatment of coronary artery lesions. Several studies confirmed the safety and feasibility of the procedure with success rates greater than 90%. However, the data regarding the incidence of sidebranch occlusion (SBO) after DS are scarce. The purpose of this study was to evaluate SBO (> 1 mm) after DS and compare it to conventional stenting (CS) with balloon predilation. The study population consisted of 151 patients (88 underwent DS, 63 underwent CS) with 185 sidebranches jailed by the stent (110 in DS group, 75 in CS group). SBO was observed in 20 out of 110 patients in the DS group (18.2%) and 18 out of 75 patients in the CS group (24%). Although the incidence of SBO was higher in the CS group compared to the DS group (24% vs. 18.2%, respectively), these values did not reach statistical significance (p > 0.05). Most of the SBOs were observed in cases with type D sidebranch morphology (p < 0.001) and in cases with sidebranch ostial diameter stenosis ≥ 50% (p = 0.019). None of the other clinical and angiographic variables predicted the SBO. To the best of our knowledge, this is the first report comparing incidence of SBO between two different PCI methods (CS vs DS). Randomized studies with larger patient populations should be conducted to compare this approach with conventional stenting.
Sidebranch occlusion (SBO) is a challenging problem during interventional procedures. Although occlusion of branches smaller than 2 mm was reported to be of little clinical importance, this may lead to angina or myocardial infarction. Sidebranches with ostial lesions were observed to occlude more than the ones without any lesion. Plaque shift, plaque embolization, spasm, thrombus formation, design of the stent struts and high-pressure balloon predilation (> 10 atm) are reported to be the mechanisms responsible for SBO.
Direct stenting (DS; stenting without balloon predilation) is a novel approach in percutaneous treatment of coronary artery lesions. Stenting without previous balloon dilation may decrease trauma, incidence of dissection and distal embolization, leading to a better outcome. However, the data evaluating SBO after stenting without balloon predilation are scarce. The aim of this study was to evaluate the impact of DS, a novel percutaneous coronary intervention (PCI) technique, on sidebranch occlusion and compare it to conventional stenting with balloon predilation (CS).
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