Side-Branch Ostial Constraint and Protrusion of a Nitinol-Based Dedicated Side-Branch Stent Strut Into the Main Vessel Lumen

Abstract

Percutaneous coronary interventions for bifurcation lesions were historically associated with reduced procedural success and a higher rate of restenosis. The Cappella Sideguard stent (Cappella Medical Devices Limited, Galway, Ireland) was developed to improve side-branch ostial patency.1 We report a case of Cappella Sideguard stent deformation and stent strut protrusion into the main vessel lumen demonstrated during follow-up intravascular ultrasound (IVUS), 6 months after the index procedure. A 47-year-old man with stable angina had significant bifurcation stenosis of the proximal left anterior descending artery (LAD) and first diagonal (D1) (Medina 1,1,1, side-branch take-off >50°), severe stenosis in the distal LAD, and moderate stenosis in the circumflex artery (Figure 1A). The LAD bifurcation was dealt with after first treating the distal lesion. Both branches were predilated, and a Cappella Sideguard stent (2.5 mm×8 mm) was deployed in the D1 branch. A Promus Element stent (2.5 mm×32 mm) was deployed distally, overlapping with the distal edge of the Cappella stent. The LAD was stented with a Promus Element stent (3.5 mm×38 mm), (Figure 1B and 1C). All the stents were postdilated, and a kissing inflation in the LAD and D1 (3.5 mm and 2.5 mm noncompliant balloons, …