Páez L, Moreno R, Alcocer A, Pérez-Vizcayno MJ, Hernández R, Alfonso F, Escaned J, Sabaté M, Bañuelos C, Azcona L, Pérez-Rodríguez J, Salazar A, Macaya C

Language: Spanish
References: 22
Page: 252-259
PDF size: 106.56 Kb.

ABSTRACT

Aim: The aim of the study was to evaluate the compromise of side branches when jailed by a coronary stent implanted without balloon predilation. Patients and methods: 56 patients in which at least a coronary stent was implanted without balloon predilation and covering a side brach (58 stents, 1.04 ± 0.19 per patient) were studied. The effect of direct coronary stent implantation over side branch flow, as well as the characteristics associated were studied. Results: The main vessel was left anterior descending in 63%, left circumflex in 21%, right coronary in 14%, and left main in one case. An angiographic successful result in the main vessel was obtained in all cases. Coronary flow was TIMI 3, 2, 1, and 0 in 95%, 3%, 0%, and 2% before the procedure, in comparison with 86%, 2%, 3%, and 9% after stent implantation (p = 0.204). The incidence of side branch occlusion was 12% (7/58). In one case, the side branch was dilated across the stent struts, and thus the rate of side branch loss at the end of the procedure was 10% (6/58). In cases of side branch occlusion, there was a more severe stenosis at its origin before stent implantation (30.2 ± 31.3% vs 16.8 ± 11.1%, p = 0.028). Fifty percent of side branches occluded after direct coronary stent implantation and angiographically re-evaluated at follow-up became patent, and 88% of side branches not affected after stent implantation remained patent at 6.2 ± 1.9 months. Conclusion: The rate of side branch occlusion after direct stent implantation in our series was 12%, that is not different from that reported for conventional stent implantation. Thus, the decision of using direct or conventional coronary stenting should not be conditioned by the presence of side branches arising from the target lesion. (Arch Cardiol Mex 2005; 75: 252-259)

REFERENCES

1. Fischman DL, Savage MP, Leon MB, Schatz RA, Ellis S, Cleman MW, et al: Fate of lesion-related side branches after coronary artery stenting. J Am Coll Cardiol 1993; 22: 1641-6.

2. Iniguez A, Macaya C, Alfonso F, Goicolea J, Hernandez R, Zarco P. Early angiographic changes of side branches arising from a Palmaz-Schatz stented coronary segment: results and clinical implications. J Am Coll Cardiol 1994; 23: 911-5.

3. Pan M, Medina A, Suarez de Lezo J, Romero M, Melian F, Pavlovic D, et al: Follow-up patency of side branches covered by intracoronary Palmaz-Schatz stent. Am Heart J 1995; 129: 436-440.

4. Poerner TC, Kralev S, Voelker W, Sueselbeck T, Latsch A, Pfleger S, et al: Natural history of small and medium-sized side branches after coronary stent implantation. Am Heart J 2002; 143: 627-35.

5. Mazur W, Grinstead WC, Hakim AH, Dabugui SF, Abukhalil JM, Ali NM, et al: Fate of side branches after intracoronary implantation of the Gianturco-Roubin flex-stent for acute or threatened closure after percutaneous transluminal coronary angioplasty. Am J Cardiol 1994; 74: 1207-1210.

6. Martinez-Elbal L, Ruiz-Nodar JM, Zueco K, Lopez-Minguez JR, Moreu J, Calvo I, et al: Direct coronary stenting versus stenting with balloon pre-dilation: immediate and follow-up results of a multicentre, prospective, randomized study. The DISCO trial. Eur Heart J 2002; 23: 633-640.

7. IJsselmuiden AJ, Serruys PW, Scholte A, Kiemeneij F, Slagboom T, vd Wieken LR, et al: Direct coronary stent implantation does not reduce the incidence of in-stent restenosis or major adverse cardiac events: six month results of a randomized trial. Eur Heart J 2003; 24: 421-9.

8. Baim DS, Flatey M, Caputo R, O’Shaughnessy C, Low R, Fanelli C, et al: Comparison of PRE-dilation vs Direct stenting in Coronary Treatment using the Medtronic AVE S670 coronary stent system (the PREDICT trial). Am J Cardiol 2001; 88: 1364-1369.

9. Brito FS, Caixeta AM, Perin MA, Rati M, Arruda JA, Cantarelli M, et al, on behalf of the DIRECT Study Investigators: Comparison of direct stenting versus stenting with predilation for the treatment of selected coronary narrowings. Am J Cardiol 2002; 89: 115-120.

10. Carrie D, Khalife K, Citron B, Izzaz K, Hamon M, Juiliard JM, et al: Comparison of direct coronary stenting with and without balloon predilatation in patients with stable angina pectoris. BET (Benefit Evaluation of Direct Coronary Stenting) Study Group. Am J Cardiol 2001; 87: 693-698.

11. Ormiston JA, Wbster MW, Ruggrok PN, Elliot JM, Simmonds MB, Meredith IT, et al: A randomized study of direct coronary stent delivery compared with stenting after predilatation: the NIR future trial. On behalf of the NIR Future Trial Investigators. Catheter Cardiovasc Interv 2000; 50: 377-381.

12. Burzotta F, Trani C, Prati F, Hamon M, Mazzari MA, Mongiardo R, et al: Comparison of outcomes (early and six-month) of direct stenting with conventional stenting (a meta-analysis of ten randomized trials). Am J Cardiol 2003; 91: 790-796.

13. Ryan J, Faxon DP, Gunnar RM, Kennedy JW, King III SB, Loop FD, et al: Guidelines for percutaneous transluminal coronary angioplasty. A report of the American College of Cardiology/American Heart Association Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty). Circulation 1988; 78: 486-502.

14. Al Suwaidi J, Yeh W, Cohen HA, Detre KM, Williams DO, Holmes DR Jr: Immediate and on-year outcome in patients with coronary bifurcation lesions in the modern era (NHLBI dynamic registry). Am J Cardiol 2001; 87: 1139-44.

15. Caputo RP, Chafizadeh ER, Stoler RC, Lopez JJ, Cohen DJ, Kuntz RE, et al: Stent jail: a minimum security prison. Am J Cardiol 1996; 77: 1226-1230.

16. Aliabadi D, Tilli FV, Bowers TR, Benzuly KH, Safian RD, Goldstein JA, et al: Incidence and angiographic predictors of side branch occlusion following high-pressure intracoronary stenting. Am J Cardiol 1997; 80: 994-7.

17. Tanabe K, Serruys PW, Degertekin M, Regar E, van Domburg RT, Sousa JE, et al: Fate of side branches after coronary arterial sirolimus-eluting stent implantation. Am J Cardiol 2002; 90: 937-41.

18. Hernández JM, Goicolea J, Durán JM, Auge JM: Registro Español de Hemodinámica y Cardiología Intervencionista. XI Informe Oficial de la Sección de Hemodinámica y Cardiología Intervencionista de la Sociedad Española de Cardiología (años 1990-2001). Rev Esp Cardiol 2002; 55: 1173-1184.

19. Torre JM, Riesco JF, Rodriguez F, Figueroa A, Zueco Gil J, Colman T. Stent directo sin predilatación. Experiencia con 300 lesiones. Rev Esp Cardiol 1999; 52: 301-307.

20. Alfonso F, Hernandez C, Perez-Vizcayno MJ, Hernandez R, Fernandez-Ortiz A, Escaned J, et al: Fate of stent-related side branches after coronary intervention in patients with in-stent restenosis. J Am Coll Cardiol 2000; 36: 1549-56.

21. Timurkaynak T, Ciftci H, Ozdemir M, Cengel A, Tavil Y, Kaya M, et al: Sidebranch occlusion after coronary stenting with or without balloon predilation: direct versus conventional stenting. J Invasive Cardiol 2002; 14: 497-501.

22. Wilson SH, Berger PB, Mathew V, Bell MR, Garratt KN, Rihal CS, et al: Immediate and late outcomes after direct stent implantation without balloon predilation. J Am Coll Cardiol 2000; 35: 937-943.