Stent implantation in severely angulated lesions: safety, efficacy, and morphological remodelling

Balloon angioplasty of severely angulated lesions is associated with a higher complication rate and lower success rate compared with non-angulated lesions. Whether this is true also of stenting such lesions is not know, nor has the alteration of vessel morphology produced by placing stents in these angulated segments been systematically investigated. We retrospectively analysed data from 60 patients who underwent stent implantation. Thirty patients formed a consecutive group whose stents were implanted in severely angulated lesions (> 45 degrees, group A). The other 30 were a a consecutive contemperaneous group whose stents were implanted in straight or less angulated lesions (group S). Change in morphology was assessed using a straightening index. In group A, 29 of the 30 patients had a successful angiographic and clinical outcome. In group S, 27 of the 30 patients had a successful outcome. Thus, unlike simple balloon angioplasty, stenting severely angulated lesions was not associated with a high-complication or low-success rate. Change in stented vessel morphology (straightening index) was greatest for right coronary (0.45 +/- 0.05), similar for left anterior descending (0.27 %/- 0.08) and circumflex (0.30 +/- 0.03), and least for vein grafts (0.14 +/- 0.10). The straightening index did not correlate with the preangioplasty lesion angulation, the maximum pressure used to inflate the stent, the size of the artery stented, or the type of stent used.