Kissing stents in the aortic bifurcation

F. O. Mendelsohn, R. M. Santos, J. J. Crowley, R. J. Lederman, F. R. Cobb, H. R. Phillips, N. J. Weissman, R. S. Stack

Research output: Contribution to journalArticle

43 Citations (Scopus)

Abstract

Background: We report the first series of simultaneously delivered stents used to treat stenosis of the oartic bifurcation. Surgical treatment of aortoiliac occlusive disease carries up to a 3% mortality rate. Percutaneous balloon techniques to treat aortic bifurcation stenosis, although safer, are still associated with up to a 9% incidence of dissection, thrombosis, or significant residual stenosis. Kissing stent insertion should decrease the incidence of these complications. Methods: Twenty patients underwent kissing stent insertion. Suitable candidates included patients with symptoms of lower limb ischemia and significant atherosclerotic lesions in both ostial common lilac arteries (n = 15) or with extremely complex single ostial iliac stenoses (n = 5). Palmaz stents were delivered simultaneously to both limbs of the aortic bifurcation. Results: Kissing stent insertion was successfully performed in all 20 patients without acute complications. Mean percent stenosis decreased from 46.2% ± 24.8% to -6.8% ± 13.3% (P = .0001) in the right iliac artery, 42.3% ± 22.8% to -1.6% ± 18.1% (P = .0001) in the left iliac artery, and 19.1% ± 16.6% to 2.3% ± 16.4% (P = .0008) in the distal aorta. Intermittent claudication symptoms were improved in 18 (95%) of 19 patients with 12 (63%) of 19 patients becoming totally asymptomatic. The strongest predictor of clinical outcome after kissing stent insertion was the preprocedural extent of femoropopliteal disease: 8 (89%) of 9 patients with femoropopliteal narrowing <75% bilaterally became completely asymptomatic at follow-up compared with only 3 (30%) of 10 patients with more severe stenoses (P = .02). Conclusions: We have demonstrated in 20 patients that stenoses of the aortic bifurcation can be treated effectively with kissing stents with few serious adverse events.

Original languageEnglish
Pages (from-to)600-605
Number of pages6
JournalAmerican Heart Journal
Volume136
Issue number4 I
DOIs
StatePublished - Nov 3 1998
Externally publishedYes

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Stents
Pathologic Constriction
Iliac Artery
Aortic Valve Stenosis
Intermittent Claudication
Incidence
Aorta
Dissection
Lower Extremity
Thrombosis
Ischemia
Extremities
Arteries
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Mendelsohn, F. O., Santos, R. M., Crowley, J. J., Lederman, R. J., Cobb, F. R., Phillips, H. R., ... Stack, R. S. (1998). Kissing stents in the aortic bifurcation. American Heart Journal, 136(4 I), 600-605. https://doi.org/10.1016/S0002-8703(98)70005-5

Kissing stents in the aortic bifurcation. / Mendelsohn, F. O.; Santos, R. M.; Crowley, J. J.; Lederman, R. J.; Cobb, F. R.; Phillips, H. R.; Weissman, N. J.; Stack, R. S.

In: American Heart Journal, Vol. 136, No. 4 I, 03.11.1998, p. 600-605.

Research output: Contribution to journalArticle

Mendelsohn, FO, Santos, RM, Crowley, JJ, Lederman, RJ, Cobb, FR, Phillips, HR, Weissman, NJ & Stack, RS 1998, 'Kissing stents in the aortic bifurcation', American Heart Journal, vol. 136, no. 4 I, pp. 600-605. https://doi.org/10.1016/S0002-8703(98)70005-5
Mendelsohn FO, Santos RM, Crowley JJ, Lederman RJ, Cobb FR, Phillips HR et al. Kissing stents in the aortic bifurcation. American Heart Journal. 1998 Nov 3;136(4 I):600-605. https://doi.org/10.1016/S0002-8703(98)70005-5
Mendelsohn, F. O. ; Santos, R. M. ; Crowley, J. J. ; Lederman, R. J. ; Cobb, F. R. ; Phillips, H. R. ; Weissman, N. J. ; Stack, R. S. / Kissing stents in the aortic bifurcation. In: American Heart Journal. 1998 ; Vol. 136, No. 4 I. pp. 600-605.
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abstract = "Background: We report the first series of simultaneously delivered stents used to treat stenosis of the oartic bifurcation. Surgical treatment of aortoiliac occlusive disease carries up to a 3{\%} mortality rate. Percutaneous balloon techniques to treat aortic bifurcation stenosis, although safer, are still associated with up to a 9{\%} incidence of dissection, thrombosis, or significant residual stenosis. Kissing stent insertion should decrease the incidence of these complications. Methods: Twenty patients underwent kissing stent insertion. Suitable candidates included patients with symptoms of lower limb ischemia and significant atherosclerotic lesions in both ostial common lilac arteries (n = 15) or with extremely complex single ostial iliac stenoses (n = 5). Palmaz stents were delivered simultaneously to both limbs of the aortic bifurcation. Results: Kissing stent insertion was successfully performed in all 20 patients without acute complications. Mean percent stenosis decreased from 46.2{\%} ± 24.8{\%} to -6.8{\%} ± 13.3{\%} (P = .0001) in the right iliac artery, 42.3{\%} ± 22.8{\%} to -1.6{\%} ± 18.1{\%} (P = .0001) in the left iliac artery, and 19.1{\%} ± 16.6{\%} to 2.3{\%} ± 16.4{\%} (P = .0008) in the distal aorta. Intermittent claudication symptoms were improved in 18 (95{\%}) of 19 patients with 12 (63{\%}) of 19 patients becoming totally asymptomatic. The strongest predictor of clinical outcome after kissing stent insertion was the preprocedural extent of femoropopliteal disease: 8 (89{\%}) of 9 patients with femoropopliteal narrowing <75{\%} bilaterally became completely asymptomatic at follow-up compared with only 3 (30{\%}) of 10 patients with more severe stenoses (P = .02). Conclusions: We have demonstrated in 20 patients that stenoses of the aortic bifurcation can be treated effectively with kissing stents with few serious adverse events.",
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AU - Santos, R. M.

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