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Basic Investigations
Distortion of Palmaz-Schatz Stent Geometry
Following Side-Branch Balloon Dilation
Through the Stent in a Rabbit Model
Richard M. Pomerantz,* MD, and Frederick S. Ling, MD
The compromise of side-branches following coronary angioplasty of the parent vessel
remains a limitation of the procedure. Reports of dilation through a Palmaz-Schatz stent to
salvage a compromised side-branch covered by the stent have been made. We examined
the distortion of stent geometry which occurs following this procedure in a rabbit model.
Palmaz-Schatz stents were placed at the aortoiliac bifurcation in 7 rabbits and the
contralateral iliac artery was dilated through the stent. Despite good angiographic results,
varied degrees of stent distortion were noted on gross pathologic analysis. Most
distortion occurred when the arteries were dilated through the ends of the struts or
through the diamonds, and least distortion occurred during dilation through the
mid-articulation site. While good stent deployment is thought to be necessary for
improved outcomes, the distortion of stents after balloon dilation through the stent,
despite good angiographic results, may have negative implications for both short- and
long-term outcomes. Cathet. Cardiovasc. Diagn. 40:422426, 1997. r 1997 Wiley-Liss, Inc.
Key words: angioplasty; coronary artery disease; restenosis
INTRODUCTION
METHODS
The occlusion or compromise of a side-branch following coronary angioplasty has remained a significant limitation of the procedure [1]. Multiple techniques have been
described for best handling this complication [2]. More
recently, the use of Palmaz-Schatz (P-S) coronary stenting has supplanted angioplasty in the treatment of many
lesions. Although some investigators report that the loss
of side-branches following stenting of the parent vessel is
a rare event [35], the conventional wisdom until recently
has been that covering of side-branches with a P-S stent
would result in irreversible jailing of the branch, making further dilation of the branch through the stented segment difficult, if not impossible. More recently, a number
of operators have employed angioplasty balloons to cross
the stented segment into the side-branch and perform
dilation of the compromised ostia of these branch vessels
[6]. Although a number of particular angioplasty balloons
have shown the ability to perform this in vitro and in vivo
[6,7], the resulting amount of stent distortion has not been
well studied. This study examines the distortion of P-S
stent geometry following side-branch dilation through the
stent in an in vivo animal model.
423
Fig. 1. A: P-S stent placed with the proximal end of the stent at
the iliac bifurcation and contralateral iliac artery dilated through
the end strut of the stent. Note the deformation of the end struts
bent into the central lumen of the abdominal aorta (black arrow).
B: Corresponding final angiogram showing excellent deployment of the stent and no significant residual stenosis at the
ostium of the contralateral iliac artery. White arrow shows
stented iliac vessel.
in the formalin for several more days and the stents were
then dissected out using a dissecting microscope. Care was
taken not to disturb the stent geometry during dissection
of the vessel. Multiple enlarged photographs were taken
of the stented segments in situ and are reproduced below.
RESULTS
424
425
Fig. 3. A: P-S stent placed with the articulation site at the iliac
bifurcation. A stent strut is seen in the central aortic lumen bent
toward the contralateral iliac artery (black arrow). B: Correspond-
426
REFERENCES
1. Meier B, Gruentzig AR, King SB, Douglas JS, Hollman J, Ishinger
T, et al: Risk of side-branch occlusion during coronary angioplasty.
Am J Cardiol 53:1014, 1984.
2. Osterle SN: Angioplasty techniques for stenoses involving coronary artery bifurcations. Am J Cardiol 61:29G32G, 1988.
3. Mazur W, Grinstead C, Hakim AH, Dabaghi SF, Abukhail 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 coronary angioplasty. Am J Cardiol 74:1207
1210, 1994.
4. Pan M, Medina A, Suarez de Lezo J, Romero M, Melian F,
Pavlovic D, et al: Follow-up of patency of side-branches covered
by intracoronary Palmaz-Schatz stent. Am Heart J 129:436440,
1995.
5. 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 22:16411646, 1993.
6. Caputo RP, Chafizadeh ER, Stoler RC, Lopez JJ, Cohen DJ, Kuntz
RE, et al: Stent jail: A minimum-security prison. Am J Cardiol
77:12261230, 1996.
7. Guarneri EM, Sklar MA, Russo RJ, Claire D, Schatz RA, Tierstein
PS: Escape from stent jail: An in-vitro model. Circulation 92:Suppl
I-688, 1995.
8. 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 23:911915, 1994.
9. Nakamura S, Hall P, Maiello L, Colombo A: Techniques for
Palmaz-Schatz stent deployment in lesions with a large sidebranch. Cathet Cardiovasc Diagn 34:353361, 1995.
10. Schomig A, Neumann FJ, Kastrati A, Schuhlen H, Blasini R,
Hadamitzky M, et al.: A randomized comparison of antiplatelet
and anticoagulant therapy after the placement of coronary-artery
stents. N Engl J Med 334:10841089, 1996.
11. Holmes DR, Garratt KN: Changing anticoagulation regimens for
intracoronary stenting. J Myocard Isch 7:162165, 1995.
12. Colombo A, Hall P, Nakamura S, Almagor Y, Maiello L, Martini G,
et al: Intracoronary stenting without anticoagulation accomplished
with intravascular ultrasound guidance. Circulation 91:1676
1688, 1995.
13. Colombo A, Maiello L, Itoh A, Hall P, Di Mario C, Blengino S, et
al: Coronary stenting of bifurcation lesions: Immediate and
follow-up results. J Am Coll Cardiol 27:277A, 1996.