Premium
Mechanism of luminal patency of the self‐expanding sideguard sidebranch stent: Evaluation by intravascular ultrasound and optical coherence tomography
Author(s) -
Ma Shixin,
Maehara Akiko,
Hauptmann Karl E.,
Guagliumi Giulio,
Valsecchi Orazio,
Vassileva Angeli.,
Appelman Yolande,
Sangiorgi Giuseppe,
Prati Francesco,
Mintz Gary S.
Publication year - 2014
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.25582
Subject(s) - medicine , intravascular ultrasound , lumen (anatomy) , neointimal hyperplasia , optical coherence tomography , stent , ostium , radiology , balloon , nuclear medicine , restenosis , surgery
Background The Cappella Sideguard (CS) sidebranch stent is a self‐expanding, thin‐strut, nitinol device with anatomic flaring at the sidebranch ostium designed to treat bifurcation lesions. Objective To evaluate the mechanism of long‐term lumen patency of the novel, self‐expanding CS sidebranch stent compared with a balloon‐expandable stent in the main vessel. Methods We performed intravascular ultrasound postintervention and at follow‐up in 24 CS stents and in 28 balloon‐expandable drug‐eluting stents deployed in the corresponding main vessel. Thirteen patients also had optical coherence tomography (OCT) at follow‐up to evaluate neointimal hyperplasia and strut coverage. Results CS stent area at the sidebranch carina increased significantly from 3.8 ± 1.2 mm 2 postintervention to 4.6 ± 1.2 mm 2 at follow‐up ( P < 0.001), resulting in no change in lumen area (3.8 ± 1.2 mm 2 to 3.7 ± 1.2 mm 2 , P = 0.72) despite a neointimal area at follow‐up of 0.9 ± 0.8 mm 2 . Volumetric changes were similar, and the distribution of neointimal hyperplasia peaked 1–2 mm distal to the carina. Change of lumen volume inversely correlated to the neointimal volume ( R = −0.48, P < 0.001), but correlated positively to the change in stent volume ( R = 0.52, P < 0.0001). By OCT, most CS struts were covered (100% [98.9, 100]) at the bifurcation site, whereas 61% of floating DES struts that crossed the sidebranch were covered by smooth tissue with a similar texture compared with neointima. Conclusion Although neointimal hyperplasia accumulates within the CS stent mainly 1–2 mm distal to the carina, the self‐expanding CS stent may be effective in maintaining an adequate patency in the sidebranch by continued stent expansion noted at follow‐up. © 2014 Wiley Periodicals, Inc.