title: Incomplete stent apposition in a left main bifurcated lesion after kissing stent implantation.
abstract: We present the case of a 75-year-old female who developed restenosis after the deployment of kissing sirolimus-eluting stents at the left main coronary artery (LMCA) bifurcation. Restenosis occurred at the left circumflex (LCx) artery ostium, where a stent deployed from the LMCA to the LCx arteries overlapped another stent deployed from the LMCA to the left anterior descending (LAD) artery. We investigated the stent expansion and deformation after kissing stent implantation using a phantom three-dimensional model depicting a LMCA bifurcation. Stent overlap was detected at the distal LMCA whether the LAD stent was positioned over the left circumflex (LCx) stent or vice versa. Stent overlap created a gap beneath the overlapped portion of the stent. Thus, we found that kissing stent implantation using different-sized stents produced compression of the LCx stent at the distal LMCA. Incomplete stent apposition caused by stent overlap and stent deformation is thought to be the main mechanism for restenosis after kissing stent implantation procedures.
authors.affiliation: Division of Cardiovascular Medicine, Chikuho Social Insurance Hospital, Cardiovascular Medicine, Nogata, Japan. y.murasato@chikuhou-hp.jp
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Murasato
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Suzuka
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Suzuki
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006328:Cardiac Catheterization / Q000379:methods; D017023:Coronary Angiography; D023903:Coronary Restenosis / Q000000981:diagnostic imaging / Q000628:therapy*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis / Q000628:therapy*; D019233:Retreatment; D020123:Sirolimus / Q000494:pharmacology; D015607:Stents; D016896:Treatment Outcome
chemical_list: D020123:Sirolimus