STENT IMPLANTATION IN SEVERELY ANGULATED LESIONS - SAFETY, EFFICACY, AND MORPHOLOGICAL REMODELING

Balloon angioplasty of severely angulated lesions is associated with a higher complication rate and lower success rate compared with non-ang ulated lesions. Whether this is true also of stenting such lesions is not known, nor has the alteration of vessel morphology produced by pla cing stents in these angulated segments been systematically investigat ed. We retrospectively analysed data from 60 patients who underwent st ent implantation. Thirty patients formed a consecutive group whose ste nts were implanted in severely angulated lesions (>45 degrees, group A ), The other 30 were a consecutive contemperaneous group whose stents were implanted in straight or less angulated lesions (group S). Change in morphology was assessed using a straightening index. In group A, 2 9 of the 30 patients had a successful angiographic and clinical outcom e. In group S, 27 of the 30 patients had a successful outcome. Thus, u nlike simple balloon angioplasty, stenting severely angulated lesions was not associated with a high-complication or low-success rate, Chang e in stented vessel morphology (straightening index) was greatest for right coronary (0.45+/-0.05), similar for left anterior descending (0. 27+/-0.08) and circumflex (0.30+/-0.03), and least for vein grafts (0. 14+/-0.10). The straightening index did not correlate with the preangi oplasty lesion angulation, the maximum pressure used to inflate the st ent, the size of the artery stented, or the type of stent used. (C) 19 97 Wiley-Liss, Inc.