Regular paper
Fate of side branches after coronary arterial sirolimus-eluting stent implantation☆

https://doi.org/10.1016/S0002-9149(02)02657-7Get rights and content

Abstract

The sirolimus-eluting stent (SES) is emerging as a potential solution for the prevention of restenosis. Although the outcome of side branches after stenting with an uncoated metal stent (UMS) has been reported, the fate of side branches after SES implantation is unknown. Furthermore, the absence of spontaneous recanalization of occluded side branches following intracoronary brachytherapy has been previously described and has been related to a delayed healing process. We assessed the procedural and 6-month follow-up angiograms of 238 patients enrolled in the RAVEL study, a double-blind controlled trial of the SES versus the UMS. Any side branch seen on the preprocedure angiogram and subsequently covered by the stent was evaluated. The side branch Thrombolysis In Myocardial Infarction (TIMI) flow grade was assessed at baseline and at follow-up by 2 observers. One hundred twenty-eight patients with ≥1 side branches were identified (63 patients in the SES group with 118 side branches, 65 patients in the UMS group with 124 side branches). Side branch occlusion occurred after stenting in 12 branches (10%) in the SES group and in 9 branches (7%) in the UMS group (p = NS). Of these occluded branches, spontaneous recanalization was observed in 11 branches (92%) in the SES group and in 6 branches (67%) in the UMS group at follow-up angiography (p = NS). Thus, the fate of side branches after SES implantation is favorable and at least as good as after UMS implantation.

Section snippets

Patient group:

From August 2000 to January 2001, 238 patients were enrolled in the RAVEL trial.3 They had a single de novo lesion of a native coronary artery that could be covered by a single 18-mm stent. Patients were excluded if they had a target lesion involving a side branch >2.5 mm in diameter that would require side branch stenting. Enrolled patients were randomized 1:1 in a double-blind manner to receive either an uncoated metal Bx VELOCITY stent or a sirolimus-eluting Bx VELOCITY stent (Cordis Corp.,

Patient characteristics:

Sixty-three patients, who had 63 target lesions and 118 involved side branches, were randomized to receive a SES; 65 patients, who had 65 target lesions and 124 involved side branches, were assigned to the UMS group. With the exception of a higher percentage of men in the UMS group (85% vs 68%, p = 0.03), there were no significant differences between the 2 groups in terms of baseline clinical characteristics such as age, coronary risk factors, prior myocardial infarction, prior coronary

Discussion

The major findings of the present study are as follows: (1) the frequency of side branch occlusion after SES implantation and UMS implantation was similar; (2) SES implantation did not adversely affect the spontaneous recanalization rate of occluded side branches or flow improvement at follow-up; (3) there was no significant difference between the SES group and the UMS group in the rate of delayed side branch occlusion or the rate of flow deterioration at follow-up; (4) the change in side

Acknowledgements

We greatly appreciate the assistance provided by Brian Firth, MD, PhD, in reviewing and editing this manuscript.

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☆

This study was supported by a grant from Cordis Corporation, a Johnson & Johnson Company, Warren, New Jersey.

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