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AS-33: The Impact of the Style of Overlapping during Kissing Balloon Inflation on the Final Configuration of the Main Vessel Stent
Thursday, April 28 –29, 2010
O R A L A B S T R A C T S
AS-31 WITHDRAWN
AS-32 Sirolimus-Eluting Stent in Coronary Chronic Total Occlusion Revascularization (SECTOR Trial). Alfredo Ruggero Galassi, SD Tomasello, MB Campisano, L Costanzo, C Tamburino. Ferrarotto Hospital, Catania, Italy. Background: Some randomized trials have demonstrated the benefits of sirolimus-eluting stents (SES) over bare metal stents implantation in chronic total occlusions (CTO). Recently, the Across/TOSCA 4 study showed the efficacy of SES in CTO. However, no prospective realworld studies have been executed on the systematic SES used in the setting of CTO. We sought to examine angiographic and clinical outcomes after SES implantation in coronary CTO with an estimated duration of at least 3 months. Methods: From January 2006 to November 2008, 167 consecutive patients with 173 lesions underwent CTO percutaneous revascularization. In all successful procedures, SES were prospectively implanted. However, if the lesion required multiple stent implantation, paclitaxeleluting stents were used when SES was not available. The primary endpoint was the evaluation of restenosis at 9 –12 months; rates of major cardiac adverse event (MACE) were also assessed (see Table). Procedural success was obtained in 138/173 lesions (79.8%). Among these, 96 lesions (69.6%) received only SES (group I) and 42 lesions (30.4%) received SES/PES (group II). The mean of stent length implanted was 68.98 ⫾ 28.02 mm. The angiographic 11.1 ⫾ 3.1 months follow-up was completed in 103/138 (74.6%) of patients. Table 2 shows angiographic and clinical outcome.
Multivariable analysis showed that diabetes, CTO length, total stent length, and heterogeneous overlapping are predictors of restenosis, whereas total stent length was a predictor of diffuse restenosis or reocclusion. Moreover, the rate of reocclusion was higher in patients with heterogeneous overlapping. Conclusion: This study confirms the efficacy and safety of SES implantation after CTO recanalization. Higher stent restenosis and TLR were found among patients with diabetes, longer stent length, and heterogeneous overlapping stents.
AS-33 The Impact of the Style of Overlapping during Kissing Balloon Inflation on the Final Configuration of the Main Vessel Stent. Yoshinobu Murasato, Yasunori Suematsu, Masataka Horiuchi. New Yukuhashi Hospital, Yukuhashi, Japan. Background: Recent studies demonstrated the ineffectiveness of kissing balloon inflation (KBI) in the 1-stent strategy for the coronary bifurcation lesion (COBIS and Nordic-Baltic III). However, there has not yet been standardization for the KBI technique, and its variety might result in these unexpected results. Methods: We investigated the final configuration of the main vessel (MV) stent after KBI comparing minimal and long overlapping. The crossover stenting was performed in the coronary bifurcation models with various angles. In the long-overlapping group, the MV stent was dilatated by the KBI according to the operator’s decision or under the instruction of placing proximal markers of both balloons at the proximal edge of MV stent. In the minimal overlapping group, the bifurcation was dilatated by the KBI with minimal overlapping with the proximal MV dilatated by a large balloon. The stent configuration was investigated using microfocus computed tomography. Results: The variety in the overlapping style and proximal position of the side branch balloon made various configurations of the proximal MV stent. X-shape and long balloon overlapping resulted in nonuniform overdilatation in the proximal MV. According to the degree of the bifurcation angle, the style of the overlapping was changed from the lateral position, longitudinal overlapping, into the x shape. The stent lumen was deformed to oval shape and overdilatated by the twisting of the balloons. In the minimal-overlapping group, the stent configuration maintained uniform round shape even in the high bifurcation angle. Conclusion: This study demonstrated that the balloon overlapping style during KBI has a great impact on the final configuration of the MV stent. Minimal balloon overlapping has the possibility of standardizing the KBI procedure because a similar expansion effect is obtained that is not dependent on the operator’s skill.
AS-34 Long-Term Serial Angiographic Outcomes after SirolimusEluting Stent Implantation. Euihong Ko, Kenya Nasu, Tsuyoshi Itou, Souichirou Ebisawa, Masato Habara, Nobuyoshi Tanaka, Masashi Kimura, Tatsuya Itou, Yoshihisa Kinoshita, Mariko Ehara, Etsuo Tsuchigane, Mitsuyasu Terashima, Yasushi Asakura, Osamu Katou, Takahiko Suzuki. Toyohashi Heart Center, Toyohashi, Japan. Background: Percutaneous coronary intervention with drug-eluting stents has significantly reduced the rate of repeated target lesion revascularization. Although late regression was observed in the bare metal stent era, long-term angiographic outcomes after sirolimus-eluting stent (SES) implantation still have not been sufficiently evaluated. There are limited data on serial angiographic analysis after SES implantation. Methods: A total of 3240 lesions were treated with SES from June 2004 to May 2009 in our institution. Of those, 306 lesions without restenosis at first follow-up (11.2 ⫾ 2.1 months; range 9.3–12.4
14B
The American Journal of Cardiology姞 APRIL 28 –29 2010 ANGIOPLASTY SUMMIT ABSTRACTS/Oral
O R A L A B S T R A C T S
AS-31 WITHDRAWN
AS-32 Sirolimus-Eluting Stent in Coronary Chronic Total Occlusion Revascularization (SECTOR Trial). Alfredo Ruggero Galassi, SD Tomasello, MB Campisano, L Costanzo, C Tamburino. Ferrarotto Hospital, Catania, Italy. Background: Some randomized trials have demonstrated the benefits of sirolimus-eluting stents (SES) over bare metal stents implantation in chronic total occlusions (CTO). Recently, the Across/TOSCA 4 study showed the efficacy of SES in CTO. However, no prospective realworld studies have been executed on the systematic SES used in the setting of CTO. We sought to examine angiographic and clinical outcomes after SES implantation in coronary CTO with an estimated duration of at least 3 months. Methods: From January 2006 to November 2008, 167 consecutive patients with 173 lesions underwent CTO percutaneous revascularization. In all successful procedures, SES were prospectively implanted. However, if the lesion required multiple stent implantation, paclitaxeleluting stents were used when SES was not available. The primary endpoint was the evaluation of restenosis at 9 –12 months; rates of major cardiac adverse event (MACE) were also assessed (see Table). Procedural success was obtained in 138/173 lesions (79.8%). Among these, 96 lesions (69.6%) received only SES (group I) and 42 lesions (30.4%) received SES/PES (group II). The mean of stent length implanted was 68.98 ⫾ 28.02 mm. The angiographic 11.1 ⫾ 3.1 months follow-up was completed in 103/138 (74.6%) of patients. Table 2 shows angiographic and clinical outcome.
Multivariable analysis showed that diabetes, CTO length, total stent length, and heterogeneous overlapping are predictors of restenosis, whereas total stent length was a predictor of diffuse restenosis or reocclusion. Moreover, the rate of reocclusion was higher in patients with heterogeneous overlapping. Conclusion: This study confirms the efficacy and safety of SES implantation after CTO recanalization. Higher stent restenosis and TLR were found among patients with diabetes, longer stent length, and heterogeneous overlapping stents.
AS-33 The Impact of the Style of Overlapping during Kissing Balloon Inflation on the Final Configuration of the Main Vessel Stent. Yoshinobu Murasato, Yasunori Suematsu, Masataka Horiuchi. New Yukuhashi Hospital, Yukuhashi, Japan. Background: Recent studies demonstrated the ineffectiveness of kissing balloon inflation (KBI) in the 1-stent strategy for the coronary bifurcation lesion (COBIS and Nordic-Baltic III). However, there has not yet been standardization for the KBI technique, and its variety might result in these unexpected results. Methods: We investigated the final configuration of the main vessel (MV) stent after KBI comparing minimal and long overlapping. The crossover stenting was performed in the coronary bifurcation models with various angles. In the long-overlapping group, the MV stent was dilatated by the KBI according to the operator’s decision or under the instruction of placing proximal markers of both balloons at the proximal edge of MV stent. In the minimal overlapping group, the bifurcation was dilatated by the KBI with minimal overlapping with the proximal MV dilatated by a large balloon. The stent configuration was investigated using microfocus computed tomography. Results: The variety in the overlapping style and proximal position of the side branch balloon made various configurations of the proximal MV stent. X-shape and long balloon overlapping resulted in nonuniform overdilatation in the proximal MV. According to the degree of the bifurcation angle, the style of the overlapping was changed from the lateral position, longitudinal overlapping, into the x shape. The stent lumen was deformed to oval shape and overdilatated by the twisting of the balloons. In the minimal-overlapping group, the stent configuration maintained uniform round shape even in the high bifurcation angle. Conclusion: This study demonstrated that the balloon overlapping style during KBI has a great impact on the final configuration of the MV stent. Minimal balloon overlapping has the possibility of standardizing the KBI procedure because a similar expansion effect is obtained that is not dependent on the operator’s skill.
AS-34 Long-Term Serial Angiographic Outcomes after SirolimusEluting Stent Implantation. Euihong Ko, Kenya Nasu, Tsuyoshi Itou, Souichirou Ebisawa, Masato Habara, Nobuyoshi Tanaka, Masashi Kimura, Tatsuya Itou, Yoshihisa Kinoshita, Mariko Ehara, Etsuo Tsuchigane, Mitsuyasu Terashima, Yasushi Asakura, Osamu Katou, Takahiko Suzuki. Toyohashi Heart Center, Toyohashi, Japan. Background: Percutaneous coronary intervention with drug-eluting stents has significantly reduced the rate of repeated target lesion revascularization. Although late regression was observed in the bare metal stent era, long-term angiographic outcomes after sirolimus-eluting stent (SES) implantation still have not been sufficiently evaluated. There are limited data on serial angiographic analysis after SES implantation. Methods: A total of 3240 lesions were treated with SES from June 2004 to May 2009 in our institution. Of those, 306 lesions without restenosis at first follow-up (11.2 ⫾ 2.1 months; range 9.3–12.4
14B
The American Journal of Cardiology姞 APRIL 28 –29 2010 ANGIOPLASTY SUMMIT ABSTRACTS/Oral