Abstract
The aim of this study was to assess the efficacy of a biolimus A9-eluting stent in patients with a right coronary artery (RCA) ostial lesion. Ostial lesions of the RCA have been a limitation of percutaneous coronary intervention even in the drug-eluting stent (DES) era. However, clinical outcomes after the deployment of a second generation DES to an RCA ostial lesion with intravascular ultrasound (IVUS) guidance have not been fully elucidated. From September 2011 to March 2013, 74 patients were enrolled in 17 centers from Japan. RCA ostial lesion was defined as de novo significant stenotic lesion located within 15 mm from ostium. IVUS was used for all cases to confirm the location of ostium and evaluate stent coverage of ostium. Patients with hemodialysis were excluded. The primary endpoint is a major adverse cardiac event (MACE) at 1 year. Forty two percent of patients had multi-vessel disease. Angiographically severe calcification was observed in 26% of the lesions. The mean stent diameter was 3.3 ± 0.3 mm (3.5 mm, 72%, 3.0 mm, 25%, and 2.75 and 2.5 mm, 3%), stent length was 17.5 ± 5.8 mm, and dilatation pressure of stenting was 15.6 ± 4.1 atm. RCA ostium was covered by stent in all lesions in IVUS findings. Post dilatation was performed for 64% of lesions (balloon size 3.7 ± 0.6 mm). MACE rate at 1 year was 5.4% (target lesion revascularization 5.4%, myocardial infarction 1.2%, and no cardiac death). The biolimus A9-eluting stent for RCA ostial lesions with IVUS guidance showed favorable results at 1-year follow-up.
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Topol EJ, Ellis SG, Fishman J, Leimgruber P, Myler RK, Stertzer SH, et al. Multicenter study of percutaneous transluminal angi-oplasty for right coronary artery ostial stenosis. J Am Coll Cardiol. 1987;9:1214–8.
Hoffmann R, Mintz GS, Mehran R, Pichard AD, Kent KM, Satler LF, et al. Intravascular ultrasound predictors of angiographic restenosis in lesions treated with Palmaz–Schatz stents. J Am Coll Cardiol. 1998;31:43–9.
Popma JJ, Brogan WC 3rd, Pichard AD, Satler LF, Kent KM, Mintz GS, et al. Rotational coronary atherectomy of ostial stenoses. Am J Cardiol. 1993;71:436–8.
Eigler NL, Weinstock B, Douglas JS Jr, Goldenberg T, Hartzler G, Holmes D, et al. Excimer laser coronary angioplasty of aorto-ostial stenoses. Results of the excimer laser coronary angioplasty(ELCA) registry in the first 200 patients. Circulation. 1993;88:2049–57.
Zampieri P, Colombo A, Almagor Y, Maiello L, Finci L. Results of coronary stenting of ostial lesions. Am J Cardiol. 1994;73:901–3.
Kurbaan AS, Kelly PA, Sigwart U. Cutting balloon angioplasty and stenting for aorto-ostial lesions. Heart. 1997;77:350–2.
Jain SP, Liu MW, Dean LS, Babu R, Goods CM, Yadav JS, et al. Comparison of balloon angioplasty versus debulking devices versus stenting in right coronary ostial lesions. Am J Cardiol. 1997;79:1334–8.
Kotani J, Ikari Y, Kyo E, Nakamura M, Yokoi H, Furuno K, et al. Five-year outcomes of Cypher™ coronary stent: report from J-PMS Study. Cardiovasc Interv Ther. 2012;27(2):63–71 Epub 2012 Jan 17.
Kyono H, Kozuma K, Shiratori Y, Maeno Y, Iino R, Takada K, et al. Angiographic and clinical outcomes of 100 consecutive severe calcified lesions requiring rotational atherectomy prior to sirolimus-eluting stent implantation in hemodialysis and non-hemodialysis patients. Cardiovasc Interv Ther. 2011;26(2):98–103.
Morice MC, Serruys PW, Sousa JE, Fajadet J, Ban Hayashi E, Perin M, et al. A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med. 2002;346:1773–80.
Sakamoto H, Ishikawa T, Mutoh M, Imai K, Mochizuki S. Angiographic and clinical outcomes after sirolimus-eluting stent implantation to de novo ostial lesion of the right coronary artery: a retrospective study. Circ J. 2008;72:880–5.
Luz A, Hughes C, Magalhães R, Bisceglia T, Descoutures F, Tamamm K, Tchetche D, Sauguet A, Farah B, Fajadet J. Stent implantation in aorto-ostial lesions: long-term follow-up and predictors of outcome. EuroIntervention. 2012;7:1069–76.
Rensing BJ, Hermans WR, Strauss BH, Serruys PW. Regional differences in elastic recoil after percutaneous transluminal coronary angioplasty: a quantitative angiographic study. J Am Coll Cardiol. 1991;17:34B–8B.
Ota T, Ishii H, Sumi T, et al. Impact of coronary stent designs on acute stent recoil. J Cardiol. 2014;64:347–52.
Fujii K, Carlier SG, Mintz GS, Yang YM, Moussa I, Weisz G, et al. Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: an intravascular ultrasound study. J Am Coll Cardiol. 2005;45:995–8.
Cutlip DE, Windecker S, Mehran R, et al. Clinical end points in coronary stent trials: a case for standardized definitions. Circulation. 2007;115:2344–51.
Ko E, Natsuaki M, Toyofuku M, et al. Sirolimus-eluting implantation for ostial right coronary artery lesions: five-year outcomes from the j-Cypher registory. Cardiovasc interv and Ther. 2014;29:200–8.
Stewart JT, Ward DE, Davies MJ, Pepper JR. Isolated coronary ostial stenosis: observations on the pathology. Eur Heart J. 1987;8:917–20.
Popma JJ, Dick RJ, Haudenschild CC, Topol EJ, Ellis SG. Atherectomy of right coronary ostial stenoses: initial and long-term results, technical features and histologic findings. Am J Cardiol. 1991;67:431–3.
Takebayashi H, Mintz GS, Carlier SG, Kobayashi Y, Fujii K, Yasuda T, et al. Non-uniform strut distribution correlates with more neointimal hyperplasia after sirolimus-eluting stent implantation. Circulation. 2004;110:3430–4.
Boucek RJ, Takeshita R, Brady AH. Microanatomy and intra-mural physical forces within the coronary arteries (man). Anat Rec. 1965;153:233–41.
Williams PD, Appleby CE, Chowdhary S, et al. A method for treating acute stent recoil and luminal filling defects. Eurointervention. 2011;6:846–53.
Lam MK, Sen H, Tandjung K, et al. Clinical outcome of patients with implantation of second-generation drug-eluting stents in the right coronary ostium: insights from 2-year follow-up of the TWENTE trial. Catheter Cardiovasc Interv. 2015;85:524–31.
Iakovou I, Ge L, Michev I, et al. Clinical and angiographic outcome after sirolimus-eluting stent implantation in aorto-ostial lesions. J Am Coll Cardiol. 2004;44:967–71.
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Nasu, K., Oikawa, Y., Habara, M. et al. Efficacy of biolimus A9-eluting stent for treatment of right coronary ostial lesion with intravascular ultrasound guidance: a multi-center registry. Cardiovasc Interv and Ther 33, 321–327 (2018). https://doi.org/10.1007/s12928-017-0487-4
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DOI: https://doi.org/10.1007/s12928-017-0487-4