Dedicated everolimus-eluting side branch access system: XIENCE SBA

Abstract

J155 Background Coronary atherosclerotic lesions often develop at branching points, presumably dictated by altered shear stress profiles. Percutaneous treatment of coronary bifurcation lesions is challenging due to technical difficulties and suboptimal long-term clinical results. There are different techniques currently used for the treatment of coronary bifurcation lesions, depending on the lesion type. With the one-stent technique only the main branch (MB) is stented, while a second stent is only used when the side branch (SB) perfusion is jeopardised (provisional SB stenting). Using the multiple-stent technique, the intended stenting strategy is that both the MB and SB receive a separate stent. Current consensus is that provisional SB stenting is the best strategy for the treatment of bifurcation lesions with conventional stents. This consists of stenting the main vessel across the SB, followed by the opening of a stent cell with a kissing balloon inflation in the SB and if deemed necessary followed by stent implantation in the proximal SB. However, this strategy is technically limited by the inability to cross the “jailed” SB with the guidewire or balloon. Even in case of successful SB stenting, inadequate coverage of the SB ostium often occurs. Furthermore, the use of the multiple-stent technique was associated with long procedural times and high contrast utilisation, contributing to a higher incidence of periprocedural complications and adverse clinical events. The introduction of bare metal dedicated side-branch access systems, designed to reduce most technical difficulties of treating such lesions, did not translate into an improvement in the long-term clinical results, mainly due to restenosis at the SB ostium. Moreover, while for non-bifurcation lesions the introduction of drug-eluting stents has reduced the incidence of restenosis as compared to bare metal stents, the treatment of bifurcation lesions with conventional DES proved less effective. Thus the combination of drug-elution and a dedicated system for the complex geometry of the bifurcation seems a useful approach. The new everolimus-coated dedicated side branch access (XIENCE SBA) system is one of the first platforms combining these two advantages. The present study evaluated in a preclinical setting the procedural difficulty and short-term (acute and seven days followup) implantation efficacy of the SBA stent in coronary bifurcations of swine.