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The use of renal stents in percutaneous treatment of very large coronary arteries/Cok genis capli koroner arter darliklarinda renal stent kullanimi.

In current, absence of the large size coronary stents poses significant challenges to the operator. Both early and late outcomes after drug-eluting stents (DES) implantation are limited only by the available caliber of the DES (3.5 mm in the United States) and the mechanical limitations placed on current DES overexpansion (4.75 mm for Cypher, 4.25 mm for Taxus). This is also validated for bare metal stents (BMS) (3.5 to 5.0mm) and so, there is a significant need for a large size stent that addresses this clinical challenge. We considered that the renal "vascular' stents, which have larger size, might be use in percutaneous treatment of coronary lesions in large-size vessels.

Case 1 was a 65-year-old male with a history of severe chronic obstructive pulmonary disease who was transferred to our institution for coronary angiography, which revealed the significant ostial left main coronary artery lesion and proximal left anterior descending artery stenosis (Fig. 1A). Because he represented a poor operative risk due to severe pulmonary disease, it was decided to perform percutaneous cardiac intervention. Therefore, the left main artery was stented with 5.5 x12mm renal stent with postdilatation (Fig. 1B-C) and proximal left anterior descending artery was stented with 4.0x11mm bare-metal stent (Fig. 1D-E). Final angiographic appearance was normal with TIMI 3 flow (Fig. I E). The patient was angina free at 3 months follow-up.

Case 2 was a 61 years old male patient with stable angina pectoris was referred to coronary angiography, which demonstrated significant middle left circumflex coronary artery stenosis (Fig. 2A-D). The other coronary arteries had mild atherosclerosis only. Percutaneous transluminal coronary angioplasty, with implantation of one 6.0x12mm renal stent, was successfully performed (Fig. 2E-F). The patient did well, without symptoms over the following three months.

Whereas larger stents induce more trauma to vessels and therefore more intimal hyperplasia, more edge dissections and more coronary ruptures; underexpanded stents increase both the risk of restenosis and the likelihood of stent thrombosis. Therefore, stent size must be carefully matched with reference vessel diameter, generally aiming for a 1.1:1 balloon to artery ratio. Since standard coronary angioplasty balloons or stents have generally not been available in diameters exceeding 5 mm, placing coronary stents may still remain challenging when vessels are extremely large. Consequently, angioplasty of larger arteries and grafts is commonly performed with undersized balloons or stents. The observational data support the use of adjunctive balloon postdilatation following stent deployment in the great majority of patients (1-2). However, acute recoil after adequate expansion may occur either when the properties of the stent are altered (e.g., after overexpansion) or when important compressive forces are developed by a hard and calcified plaque as is commonly seen in ostial lesions. In past, Palmaz "biliary" non-vascular stents with greater radial compressive strength and more variable sizing (diameter and length) features were also used for this purpose (3, 4). The increased strut thickness of the renal stents confers greater radial compressive strength in exchange for decreased stent flexibility. Despite the no availability of follow-up data, these stents may be use percutaneous treatment of coronary lesions in very large-size vessels until technologic development of large size-specific coronary stent.

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References

(1.) Brodie BR. Adjunctive balloon postdilatation after stent deployment: is it still necessary with drug-eluting stents? J Interv Cardiol 2006; 19:43-50.

(2.) Saia F, Lemos PA, Arampatzis CA, Hoye A, McFadden E, Sianos G, et al. Clinical and angiographic outcomes after overdilatation of undersized sirolimus-eluting stents with largely oversized balloons: an observational study. Catheter Cardiovasc Interv 2004; 61: 455-60.

(3.) Chio FL, Liu MW, Al-Saif SM, Khan MA, Lawson D, Al-Mubarak N. Long-term clinical outcome after implantation of medium Palmaz (biliary) stents in very large native coronary arteries. Catheter Cardiovasc Interv 2002; 56: 35-9.

(4.) Khanal S, Scavetta K, Oh C, Abdel-Dayem T, Al-Zaibag M, Jutzy KR, et al. Immediate and long-term results comparing coronary versus biliary tubular-slotted stents to treat old obstructed saphenous vein grafts. Angiology 2000; 51: 647-57.

Ozcan Ozeke, Deniz Kumbasar (1), Erdogan Ilkay Department of Cardiology, MESA Hospital, Ankara

(1) Department of Cardiology, Faculty of Medicine, Ankara University, Ankara, Turkey

Address for Correspondence/Yazisma Adresi: Dr. Ozcan Ozeke MESA Hastanesi, Kardiyoloji Bolumu, Ankara, Turkiye Phone: +90 0 505 383 67 73 Fax: +90 312 292 99 10 E-mail: ozcanozeke@gmail.com
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Title Annotation:Letters to the Editor/Editore Mektuplar
Author:Ozeke, Ozcan; Kumbasar, Deniz; Ilkay, Erdogan
Publication:The Anatolian Journal of Cardiology (Anadolu Kardiyoloji Dergisi)
Article Type:Case study
Date:Aug 1, 2008
Words:725
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