Effectiveness of the Stent Pull-Back Technique for Nonaorto Ostial Coronary Narrowings

Abstract

Coronary stenting of nonaorto ostial coronary lesions is challenging because of plaque shift into the main vessel, triggering the use of additional stents. Furthermore, inappropriate coverage of the ostium of the side branch increases the risk of restenosis and target vessel revascularization (TVR). To improve the treatment of nonaorto ostial coronary lesions with a novel interventional technique, we tested the hypothesis that inflating a balloon in the main vessel before stenting the side branch (stent pull-back technique) will limit plaque shifting and reduce the use of additional stents. In addition, proper coverage of the side branch ostium may also reduce 8-month TVR. A case-control design with 100 consecutive patients who underwent drug-eluting stent placement was performed; 55 patients were treated with the stent pull-back technique and 45 patients with a conventional stent technique. Procedural success was 100% for the 2 techniques. The use of additional stents was reduced in the stent pull-back group compared with the conventional stent group (2% vs 18%, p = 0.007). A tendency toward lower ostial miss was also observed in the stent pull-back group (4% vs 13%, p = 0.11). The incidence of in-hospital and 30-day cardiac events was similar between the 2 groups. TVR was lower in the stent pull-back group compared with the conventional group (5% vs 20%; p = 0.03). In conclusion, the stent pull-back technique improves the percutaneous treatment of nonaorto ostial coronary lesions. The technique is associated with a lower use of additional stents and improved clinical outcome, reducing TVR at 8 months of follow-up.