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Sidebranch occlusion in direct intracoronary stenting: predictors and results
1Department of Cardiology, Akdeniz University, Antalya, Turkey. drhy@um.turkcell.com.tr
Insights
Direct intracoronary stenting (DS) showed a low incidence of sidebranch occlusion (SBO), especially with favorable morphology. High-pressure post-stent dilation was a procedural predictor of SBO, but overall outcomes were favorable.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Biology
Background:
- Sidebranch occlusion (SBO) is a known risk following coronary angioplasty and stenting.
- The specific impact of direct stenting (DS) on sidebranch patency has not been extensively studied.
Purpose of the Study:
- To evaluate angiographic predictors and outcomes of major sidebranch occlusion after direct intracoronary stenting.
- To assess the influence of lesion morphology and procedural factors on SBO in DS.
Main Methods:
- Analysis of 111 sidebranches in 86 patients undergoing direct stenting.
- Evaluation of sidebranch type, take-off angle, ostial involvement, and procedural characteristics.
- Correlation of morphological and procedural factors with the incidence of SBO.
Main Results:
- A total of 8% of stent-covered sidebranches experienced occlusion.
- Unfavorable morphology (stenosis >50% at or near the ostium) was a strong predictor of SBO (OR: 8.0).
- High-pressure post-stent dilation was identified as a procedural predictor of SBO.
Conclusions:
- Direct stenting is associated with a lower-than-expected incidence of SBO and favorable outcomes.
- Identifying unfavorable sidebranch morphology is crucial for risk stratification.
- Careful procedural management, particularly regarding post-stent dilation, may mitigate SBO risk.
Abstract:
We assessed the angiographic predictors and results of major (> 1 mm) sidebranch occlusion (SBO) following direct intracoronary stenting (DS) in 86 patients. The occlusion of a sidebranch is a well-defined risk after balloon angioplasty and stenting. However, the impact of direct stenting without predilatation on the coronary flow of sidebranches emerging within the stented segment has not been studied solely. A total of 111 sidebranches were analyzed. Sidebranch type, take-off angle, ostial involvement and procedural characteristics were evaluated. Nine out of 111 (8%) stent-covered sidebranches were occluded. Sidebranches with > 50% stenosis that take off within or just beyond the diseased portion of the lesion (unfavorable morphology) were the most powerful morphologic predictor of SBO (odds ratio: 8.0; 95% confidence interval: 1.5--40.8; p = 0.007). Take-off angle of the sidebranch was not found to have any effect on SBO. Post-stent dilation using high-pressure inflation (15.0 +/- 2.1 atmospheres), inflation (odds ratio: 1.1; 95% CI: 1.0--1.2; p = 0.038), and 3 times inflation (odds ratio: 4.5; 95% CI: 1.1--18.3; p = 0.023) were the procedural predictor of SBO. Of those 40 unfavorable morphologies, seven (17.5%) were occluded compared to 2.8% (2/71) of the favorable morphologies. Nine out of 9 (100%) occluded after high-pressure inflation. Three patients complained of chest pain and 1 had non-Q wave myocardial infarction attributed to SBO. These findings indicate that the incidence of SBO and complications are less than expected and has a favorable outcome in direct intracoronary stenting.