Cardiovascular Revascularization Medicine
Volume 10, Issue 4 , Pages 255-258, October 2009

Funneling: enhancing results of small-vessel stenting

  • Edo Kaluski

      Affiliations

    • Corresponding Author InformationCorresponding author. Invasive Cardiology and Cardiac Catheterization Laboratories, University Hospital, University of Medicine and Dentistry of New Jersey, 185 South Orange Ave, MSB I-538, Newark, NJ 07101, USA. Tel.: +1 973 972 4731, +1 973 7382603 (Cellular); fax: +1 973 972 1592.
  • ,
  • Christine Gerula
  • ,
  • Preet Randhawa
  • ,
  • Marc Klapholz

Department of Cardiology, University of Medicine and Dentistry, Newark, NJ, USA

Received 22 December 2008; accepted 9 January 2009.

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

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PII: S1553-8389(09)00039-6

doi:10.1016/j.carrev.2009.01.004

Cardiovascular Revascularization Medicine
Volume 10, Issue 4 , Pages 255-258, October 2009