Stenting the stent.
BACKGROUND
Stents are constructed with predefined radial strength which, on occasion, may be insufficient to support a resistant lesion.


METHODS
We prospectively assessed the need for, and safety of, implanting a second stent within the first, during the index procedure, in a consecutive series of 500 patients undergoing percutaneous coronary intervention (PCI) by a single operator in the period 1998 2001. The indication was a lesion that appeared angiographically suboptimal after full balloon/stent expansion to high pressure with appropriate sizing. Visible thrombus was an exclusion. Stents were slotted tubes or ring designs whenever possible. Clinical follow-up was > 1 year and angiographic re-study was performed when indicated.


RESULTS
We identified 18 patients/lesions (3.6%) that required implantation of a stent within a stent. The appearance was due to tissue/stent prolapse in 72%, edge dissection in 17%, narrow stent inflow/outflow in 5.5% and inadvertent stent detachment in 5.5%. There were no lesion-related acute or in-hospital complications. There was no late thrombosis or death. Follow-up was 21   10 months, and revealed 11% target lesion revascularization, of which half were at the site of stent overlap.


CONCLUSIONS
Stenting the stent, where extra support is required, is safe and effective.
Morton
Allison C
AC
Department of Cardiology, Sheffield Teaching Hospitals NHS Trust, United Kingdom.
Gunn
Julian
J
D000328:Adult; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D019917:Blood Vessel Prosthesis Implantation; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000628:therapy; D023903:Coronary Restenosis / Q000209:etiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D015607:Stents / Q000592:standards*; D016896:Treatment Outcome