Frequency and Clinical Consequences Associated With Sidebranch Occlusion During Stent Implantation Using Zotarolimus-Eluting and Paclitaxel-Eluting Coronary Stents

Abstract

Background-Myocardial infarction (MI) after drug-eluting stent placement has been associated with an unfavorable late prognosis. Although the etiology of periprocedural MI is multifactorial, sidebranch occlusion may be an important contributing factor. We sought to identify the incidence of sidebranch occlusion during zotarolimus-eluting stent (ZES) and paclitaxel-eluting stent (PES) placement and to relate sidebranch occlusion to the occurrence of periprocedural MI. Methods and Results-Angiograms were reviewed from patients randomly assigned to treatment with a ZES (597 patients; 943 sidebranches) or a PES (619 patients; 977 sidebranches). Sidebranch occlusion was defined as Thrombolysis in Myocardial Infarction flow grade 0 or 1. Sidebranch occlusion was correlated with frequency of MI, as assessed by the creatine phosphokinase MB isoenzyme. Sidebranch occlusion occurred less often after the first stent deployment in patients treated with ZES (2.2%) than in patients treated with PES (4.0%; Pϭ0.032). A similar reduction in the frequency of sidebranch occlusion at any point during the procedure was found in patients treated with ZES (2.9% versus 4.8% in PES patients; Pϭ0.042). Multivariable predictors of sidebranch occlusion included baseline sidebranch stenosis, complex lesion morphology, smaller baseline minimal lumen diameters, and the use of a PES.Of the 20 patients with MI within 30 days of the procedure, 30% had evidence of sidebranch occlusion during the stent procedure. Conclusions-Patients

Evaluation of the effects of everolimus‐eluting and paclitaxel‐eluting stents on target lesions with jailed side branches: 2‐year results from the SPIRIT III randomized trial

“…This relatively larger vascular footprint of the PES would potentially create a physical barrier to flow to the jailed side branch, resulting in ischemia and/or occlusion. A recent study observing higher rates of branch vessel occlusion after PES compared to a thinner profile zotarolimus-eluting stent supports stent profile as an important determinant of periprocedural myonecrosis [22]. Differences also exist in the polymer coatings of the two stents.…”

“…There are physical differences in profile of the two stents. The PES has a strut thickness of 132 microns, and a polymer thickness of 19.6 lm, while the EES has a strut thickness of 81 lm and a polymer thickness of 7.8 lm [21][22][23]. This relatively larger vascular footprint of the PES would potentially create a physical barrier to flow to the jailed side branch, resulting in ischemia and/or occlusion.…”

A Randomized Comparison of the Endeavor Zotarolimus-Eluting Stent Versus the TAXUS Paclitaxel-Eluting Stent in De Novo Native Coronary Lesions

“…Importantly, in ENDEAVOR IV, of the 17 periprocedural non-Q-wave MIs after PES, 8 (47%) were large MIs with Ͼ10ϫ upper limit of normal creatine kinase-myocardial band rises. Other studies have indicated a higher than expected frequency of periprocedural MIs associated with PES implantation with a reported incidence of 3.5% to 5.4% (2,3) and post hoc angiographic analyses have suggested that disproportionate changes in PES covered side branches (both occlusion and/or reduced flow) may be partially responsible for these early clinical events (3,24).…”

TWENTE Study: The Real-World Endeavor Resolute Versus Xience V Drug-Eluting Stent Study in Twente: study design, rationale and objectives

“…25 These two DES differ in stent platform, which could have consequences for device flexibility and side branch access. 24 In addition, the DES use different coatings, which is reflected in their microscopic appearance. 13 Finally, both DES deliver different antiproliferative drugs.…”