Efficacy of biolimus A9-eluting stent for treatment of right coronary ostial lesion with intravascular ultrasound guidance: a multi-center registry

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.

Clinical Outcomes after Additional Dynamic Renal® Stent Implantation for Stent Recoil in Ostial Coronary Lesions

“…Long-term outcomes of PCI in aorto-ostial coronary lesions with DES is less favorable compared to the results of PCI in non-ostial lesions [5,6]. Several approaches, such as intravascular imaging and implantation of a stent with high radial strength [10], may improve the long-term success after PCI in this setting. Double Stenting for stenting recoil has been reported in case reports and small case series [12][13][14].…”

“…This might serve as an explanation for the comparable outcome of PCB treatment not adding radial force but further supporting the importance of lesion preparation. Also, ultrasound guidance for stent placement has been associated with better outcomes [10,15]. This effect on outcomes may be explained by the ability of IVUS to reduce geographical miss, whereas two-dimensional angiography frequently does not result in complete lesion coverage [16].…”

“…A recent analysis from an international multicenter registry showed that the use of newer-generation DES was associated with lower target lesion failure (TLF) rates whereas stent under-expansion was the strongest predictor for TLF, increasing the risk by 10-fold [8]. While the use of cutting balloons is still associated with a high rate of restenosis (16%) [9], PCI guidance by intravascular ultrasound (IVUS) and simultaneously implanting a stent with relatively high radial force showed the lowest TLR rates (5.3%) to date [10]. Compared to PCI of the right coronary ostium, PCI of the left main coronary ostium is associated with 10-fold lower risk of TLR [11].…”