STENT JAIL - A MINIMUM-SECURITY PRISON

Coronary stents have emerged as effective therapy for the treatment of selected obstructive athero-sclerotic coronary lesions and now compos e up to 50% of coronary interventional procedures in our catheterizati on laboratory. Complications of coronary stent placement are uncommon but include inability to place the device, stent embolization, dissect ion distal to the stent, and acute or subacute thrombosis.(1-4) Anothe r potential complication is narrowing or occlusion of the ostium of a side branch spanned by the stent, due to longitudinal redistribution o f atherosclerotic plaque (''snowplowing'') during expansion of the les ion in the parent vessel. This complication occurs in 6% to 13% of sid e branches after stent implantation.(5-8) When similar snowplowing of side branches occurs after balloon angioplasty, it can often be treate d successfully by balloon angioplasty of the affected branch.(9-14) In contrast, stent placement across a side branch results in partial blo ckade of the side-branch ostium by stent struts (stent jail), which re stricts access to the side branch and theoretically makes branch angio plasty technically difficult. This study, however, describes a series of-patients in whom angioplasty through a stent diamond or articulatio n site was attempted for treatment of-compromised side branches.