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A Murine Model of Stent Implantation in the Carotid Artery for the Study of Restenosis
Published on: May 14, 2013
Fate of stent-related side branches after coronary intervention in patients with in-stent restenosis
F Alfonso1, C Hernández, M J Pérez-Vizcayno
1Interventional Cardiology Unit, Cardiovascular Institute, San Carlos University Hospital, Madrid, Spain.
Insights
Stent (ST)-related side branch (SB) occlusion is common during repeat intervention for in-ST restenosis, but most cases are clinically silent and resolve over time. Predictors include initial stenting, diabetes, and SB anatomy.
Area of Science:
- Cardiovascular Interventions
- Interventional Cardiology
- Coronary Artery Disease
Background:
- In-stent restenosis (ISR) presents a significant challenge in coronary interventions.
- The fate of side branches (SB) related to stents (ST) during repeat intervention for ISR is not well understood.
Purpose of the Study:
- To evaluate the outcomes of stent (ST)-related side branches (SB) following repeat coronary intervention in patients with in-stent restenosis.
- To identify predictors of SB occlusion and assess its clinical significance.
Main Methods:
- Prospective study of 100 consecutive patients undergoing repeat intervention for in-ST restenosis.
- Evaluation of 226 SB spanned by the ST, assessing size, type, ostium involvement, location, and take-off angle.
- Detailed assessment of SB TIMI (Thrombolysis in Myocardial Infarction) flow grade before, during, immediately after, and at late angiography.
Main Results:
- Occlusion occurred in 10% of SB, with flow deterioration in 25%.
- Independent predictors of SB occlusion included prior SB occlusion during initial stenting, diabetes, SB ostium involvement, baseline SB TIMI flow grade <3, and restenosis length.
- Late angiography showed 89% of initially occluded SB were patent again, with similar long-term event-free survival between patients with and without initial SB occlusion.
Conclusions:
- Stent (ST)-related side branch (SB) occlusion or flow deterioration is frequent during repeat intervention for in-stent restenosis.
- Anatomical factors are key predictors of SB occlusion.
- Most SB occlusions are clinically silent and often resolve spontaneously by follow-up.
Objectives:
We sought to assess the fate of stent (ST)-related side branches (SB) after coronary intervention in patients with in-ST restenosis.
Background:
In-ST restenosis constitutes a therapeutic challenge. Although the fate of lesion-related SB after conventional angioplasty or initial coronary stenting is well established, the outcome of ST-related SB in patients with in-ST restenosis undergoing repeat intervention is unknown.
Methods:
One hundred consecutive patients (age 61 +/- 11 years, 22 women) undergoing repeat intervention for in-ST restenosis (101 ST) were prospectively studied. Two hundred and twenty-six SB spanned by the ST were identified. The SB size, type, ostium involvement, location within the ST and take-off angle were evaluated. The SB TIMI (Thrombolysis in Myocardial Infarction trial) flow grade was studied in detail before, during, immediately after the procedure, and at late angiography.
Results:
Occlusion (TIMI flow grade = 0) was produced in 24 (10%) SB, whereas some degree of flow deterioration (> or = 1 TIMI flow grade) was observed in 57 SB (25%). The SB occlusion was associated with non-Q wave myocardial infarction in two patients (both had large and diseased SB). Side-branch occlusion at the time of initial stenting (RR [relative risk] 11.1, 95% CI [confidence interval] 3.5-35.5, p < 0.001), diabetes (RR 3.5, 95% CI 1.1-10.5, p = 0.02), SB ostium involvement (RR 5.0, 95% CI 1.4-17.2, p = 0.004), baseline SB TIMI flow grade <3 (RR 5.5, 95% CI 1.7-18.1, p = 0.005), and restenosis length (RR 1.05 95% CI 1.01-1.11, p = 0.03) were identified as independent predictors of SB occlusion. Late angiography in 19 initially occluded SB revealed that 17 (89%) were patent again. The long-term clinical event-free survival (81% vs. 82% at two years) in patients with and without initial SB occlusion was similar.
Conclusions:
Occlusion or flow deterioration of SB spanned by the ST is relatively common during repeat intervention for in-ST restenosis. Several factors (mainly anatomic features) are useful predictors of this event. However, most SB occlusions are clinically silent and frequently reappear at follow-up.
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