Funneling: enhancing results of small-vessel stenting

Abstract 

Until October 2008, coronary drug-eluting stents with a diameter of ≤2.5 mm were not approved by the FDA. Target vessels of ≤2 mm in diameter pose a major challenge in view of high restenosis rates when stented bare metal stents (BMS) are used and distal edge dissection when oversized stents are deployed. Described is a method (“funneling”) to optimize stenting of small vessels. This strategy combines stenting the distal part of the lesion with short (8–12 mm length) 2-mm bare metal stent while stenting with a larger-diameter (≥2.5 mm) drug-eluting stent (DES) with considerable DES–BMS overlap (leaving only the distal 4–6 mm of the BMS not overlapped by a DES). The two stents create a funnel that is for the most part drug eluting. With funneling, both drug elution and larger diameter are attained, minimizing both edge dissection and restenosis.

Abbreviations: PCI, percutaneous coronary intervention, DES, drug-eluting stent, BMS, bare metal stent, RCA, right coronary artery, PES, paclitaxel-eluting stent, SES, sirolimus-eluting stent, ISRS, in-stent restenosis

Keywords: Drug eluting stents, PCI, stents