Bifurcation stenting

Ohki T, Marin ML, Lyon RT et al. Ex vivo human carotid artery bifurcation stenting correlation of lesion characteristics with embolic potential. J Vase Surg 1998 27 463-471. 

PCI for Multivessel Disease and Complex Lesions 49 PCI for Left Main Disease 49 Bifurcation Stenting 51 PCI for Chronic Total Occlusions 51 PCI and CABG Complementary Rather than Competitive Strategies 54 Antiplatelet and Antithrombotic Therapies in PCI 54 Role of Newer Imaging Strategies and PCI 55... 

Recent developments of plastic stents have aimed to improve the resistance of plastic stents to external compression forces. Therefore, metal has been incorporated into the plastic material of the stent. One of the latest developments is the dynamic bifurcation stent made of silicone (Freitag et al. 1994). This Dynamic stent (Riisch, Kernen, Germany) is reinforced with horseshoe-shaped steel struts. A posteriorly located flexible membrane allows dynamic compression of the stent during coughing, whereas the steel struts prevent airway compression from external forces. Theoretically, this stent mimics the mechanical dynamics of the normal trachea. The distal end is a Y shape which rides on the carina to prevent distal migration. 

The Medtronic Endurant bifurcated stent graft was approved for commercial use by the FDA in December 2010 (FDA, 2013). It consists of two components, the main bifurcated body and the contralateral limb (Fig. 21.10). The main body consists of a multifilament polyester fabric coupled with laser-cut nitinol stents, sewn together using polyester sutures. A bare nitinol stent is affixed to the proximal end of the main body using ultra-high molecular weight polyethylene sutures. This stent allows the device to be fixed above the renal arteries without preventing arterial blood flow to the kidneys, and is referred to as the suprarenal stent. There are barbs on the top of... 

Among these 76 patients, 109 bare-coronary stents were deployed in 103 de novo lesions in an equal number of major native epicardial vessels. Patients with in-stent restenosis, bifurcation lesions, vein graft lesions, lesion length of >0.20 mm, acute myocardial infarction in the previous 72 hours, poor left ventricular function (ejection fraction <35%), renal failure defined as creatinine concentration of >2 mg, or under immunosuppressive treatment were excluded from the study. 

The major advantages of the systemic approach to restenosis should be the relatively inexpensive and also powerful and safety method to reduce restenosis in selected group of patients. Oral rapamycin can also be used in determining high risk subsets of patients such as those with diabetes, bifurcations, and in-stent restenotic lesions, alone or in conjunction with DES. In insulin-dependant diabetic patients, oral rapamycin together with DES may help to reduce the still higher than acceptable risk of restenosis that is currently reported with DES. 

Colombo A, Moses JW, Morice MC, etal. Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions. Circulation 2004 109 1244-1249. 

Abdominal aortic aneurysms bifurcated supported stent graft (Excluder, Gore). 

Carroccio A, Faries PL, Morrissey NJ, et al. Predicting iliac limb occlusions after bifurcated aortic stent grafting anatomic and device-related causes, J Vase Surg 2002 36(4) 679-684,... 

A 64-year-old obese man with a history of radiocontrast-induced nephropathy had an MRI scan, which confirmed the presence of an aortic aneurysm from just below the renal arteries to the aortic bifurcation (31). Percutaneous stenting of the aortic aneurysm... 

FIGURE 3.2 Bifurcation lesion algorithm for coronary intervention. (DES, drug-eluting stent SB, side branch MB, main branch SKS, simultaneous kissing stents KB, kissing balloons.)... 

Pan M, de Lezo JS, Medina A, et al. Rapamycin-eluting stents for the treatment of bifurcated coronary lesions a randomized comparison of a simple versus complex strategy. Am Heart J 2004 148 (5) 857—64. 

FIGURE 44.10 (a) Endoluminal stent-grafts of straight and bifurcated configurations and sizes currently under... 

Fig. 15.2a-c. Embolization of IIA before aortic stent graft implantation (courtesy of Dr Luc Stockx). a Right common iliac angiogram demonstrating the internal and external iliac arteries. b,c Coil embolization of the proximal llA. Note the extension of the aneurysm to the level of iliac bifurcation... 

Brandname Type of graft Stent location Aortic diameter sizes Aortic length sizes Bifurcated diameter sizes Bifurcated length sizes... 

A two-component AneuRx bifurcated AAA stent graft with asymmetrical limbs and an ipsilateral extension introduced through the contralateral femoral artery. 

The Medtronic Talent device is a stent graft constructed from a plain woven polyester fabric and a nitinol stent frame. The bifurcated device for the abdominal aorta has a bare suprarenal stent, but no hooks or barbs. The thoracic stent graft has been replaced by the Valiant device (see below). Early Talent devices had a rigid longitudinal bar that was meant to provide columnar support. However, this component signihcantly decreased the flexibility of the device, and so has been discontinued in more recent models. 

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