Stent jail: A minimum-security prison

Coronary stents have emerged as effective therapy for the treatment of selected obstructive athero-sclerotic coronary lesions and now compose up to 50% of coronary interventional procedures in our catheterization laboratory. Complications of coronary stent placement are uncommon but include inability to place the device, stent embolization, dissection distal to the stent, and acute or subacute thrombosis.(1-4) Another potential complication is narrowing or occlusion of the ostium of a side branch spanned by the stent, due to longitudinal redistribution of atherosclerotic plaque (''snowplowing'') during expansion of the lesion in the parent vessel. This complication occurs in 6% to 13% of side branches after stent implantation.(5-8) When similar snowplowing of side branches occurs after balloon angioplasty, it can often be treated successfully by balloon angioplasty of the affected branch.(9-14) In contrast, stent placement across a side branch results in partial blockade of the side-branch ostium by stent struts (stent jail), which restricts access to the side branch and theoretically makes branch angioplasty technically difficult. This study, however, describes a series of-patients in whom angioplasty through a stent diamond or articulation site was attempted for treatment of-compromised side branches.