title: Sandwich drug-eluting stenting: a novel method to treat high-risk coronary lesions.
abstract: OBJECTIVE
  To describe a novel approach to drug-eluting stent (DES) implantation, the sandwich technique, comprised of the simultaneous implantation of two completely overlapping DES in the same target lesion.
  
  
  BACKGROUND
  DES effectively prevent restenosis in selected coronary lesions. However, adverse lesion characteristics may detrimentally affect outcomes after DES implantation by means of plaque prolapse, recoil or excessive neointimal hyperplasia.
  
  
  METHODS
  From July 2002 to November 2004, the sandwich technique was performed in 10 patients with very high-risk lesions. Two DES of identical size and length were implanted, one inside the other, with almost complete overlap. High-pressure postdilatation (up to 28 atm) was carried out in 6 cases. The endpoints of this preliminary evaluation were: technical feasibility, early (30-day) safety, restenosis rate and freedom from adverse events at 9-month follow up.
  
  
  RESULTS
  Procedural and angiographic success was achieved in all cases. At follow-up, there were no deaths, myocardial infarctions or stent thromboses. All patients underwent angiographic follow-up; target lesion revascularization was carried out in 3 patients (30%). Of note, in no case was there evidence of aneurysmal remodeling.
  
  
  CONCLUSIONS
  This study suggests that implanting 2 DES, one inside the other in a sandwich fashion, is feasible and apparently safe. This approach could be considered in situations such as plaque prolapse or stent recoil where additional scaffolding may be needed.
authors.affiliation: Emodinamic Department, San Raffaele Hospital, via Olgettina 60, Milan, Italy.
authors.forename: Nuccia
authors.initials: N
authors.lastname: Morici
authors.forename: John
authors.initials: J
authors.lastname: Cosgrave
authors.forename: Ioannis
authors.initials: I
authors.lastname: Iakovou
authors.forename: Giuseppe Biondi
authors.initials: GB
authors.lastname: Zoccai
authors.forename: Worawut
authors.initials: W
authors.lastname: Tassanawiwat
authors.forename: Matteo
authors.initials: M
authors.lastname: Montorfano
authors.forename: Giuseppe Massimo
authors.initials: GM
authors.lastname: Sangiorgi
authors.forename: Antonio
authors.initials: A
authors.lastname: Colombo
mesh_terms: D000328:Adult; D000368:Aged; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000628:therapy*; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D009204:Myocardial Revascularization; D004364:Pharmaceutical Preparations / Q000008:administration & dosage*; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome
chemical_list: D004364:Pharmaceutical Preparations