A novel stent inflation protocol improves long‐term outcomes compared with rapid inflation/deflation deployment method

Vallurupalli, Srikanth; Kasula, Srikanth; Agarwal, Shiv Kumar; Pothineni, Naga Venkata K.; Abualsuod, Amjad; Hakeem, Abdul; Ahmed, Zubair; Uretsky, Barry F.

doi:10.1002/ccd.26930

Cited by 9 publications

(12 citation statements)

References 17 publications

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“…In the Cook et al study, stent inflation duration was determined by balloon pressure stability which has since been termed the “pressure optimized protocol” or POP where achieving stability of stent balloon pressure is used as an endpoint to determine the duration of inflation. When this protocol was utilized in a large group of lesions ( n = 615), inflation duration averaged 104 sec (range 30–380) , and was considerably longer than the time in the prolonged duration arms of other studies. Though this technique has not been compared directly with other prolonged duration techniques, it is interesting to note that the inflation time in the shorter duration arm in the Cook et al study (mean duration 46 ± 16 sec) would be considered a “prolonged” duration in the rest of the studies.…”

Section: Discussionmentioning

confidence: 94%

“…By increasing stent expansion, prolonged inflation will likely improve long‐term clinical outcomes, particularly decreasing the need for treatment of in‐stent restenosis. In a recent study, patients treated with POP had a significantly lower incidence of repeat target vessel revascularization compared to a contemporaneous group treated by rapid inflation/deflation stent implantation technique . A prospective randomized trial comparing POP with rapid inflation/deflation is required to fully validate the use of POP routinely although the current data are already strong enough to consider use in clinical practice, particularly in view of the results of the current meta‐analysis.…”

Section: Discussionmentioning

confidence: 99%

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Improved stent expansion with prolonged compared with short balloon inflation: A meta‐analysis

Saad

Bavineni

Uretsky

et al. 2018

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Improved stent expansion with prolonged compared with short balloon inflation: A meta‐analysis

Saad

Bavineni

Uretsky

et al. 2018

Cathet Cardio Intervent

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“…Since the seminal work by Colombo et al, high pressure stent balloon inflation has been the standard method of stent deployment [ 24 ]. Use of the pressure optimization protocol during stent balloon inflation in a recent study was associated with better long-term outcomes, particularly for target vessel revascularization [ 25 ]. However, duration of stent deflation, and particularly the velocity of balloon deflation, has not received as much attention.…”

Section: Discussionmentioning

confidence: 99%

Balloon Deflation Strategy during Primary Percutaneous Coronary Intervention in Acute ST-Segment Elevation Myocardial Infarction: A Randomized Controlled Clinical Trial and Numerical Simulation-Based Analysis

Yang

Liu

et al. 2020

Cardiology Research and Practice

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Background. Primary percutaneous coronary intervention (PCI) is the best available reperfusion strategy in patients with acute ST-segment elevation myocardial infarction (STEMI). However, PCI is associated with a serious problem known as no-reflow phenomenon, resulting in poor clinical and functional outcomes. This study aimed to compare the influences of different balloon deflation velocity on coronary flow and cardiovascular events during primary PCI in STEM as well as transient hemodynamic changes in in vitro experiments. Method and Results. 211 STEMI patients were randomly assigned to either a rapid or a slow balloon deflation group during stent deployment. The primary end point was coronary flow at the end of PCI procedure, and secondary end points included myocardial infarct size. Transient hemodynamic changes were evaluated through an in vitro experimental apparatus and a computer model. In clinical practice, the level of corrected TIMI frame count (cTFC) in slow balloon deflation after primary PCI was significantly lower than that of rapid balloon deflation, which was associated with smaller infarct size. Numerical simulations revealed that the rapid deflation led to a sharp acceleration of flow in the balloon-vessel gap and a concomitant abnormal rise in wall shear stress (WSS). Conclusion. This randomized study demonstrated that the slow balloon deflation during stent implantation improved coronary flow and reduced infarct size in reperfused STEMI. The change of flow in the balloon-vessel gap and WSS resulted from different balloon deflation velocity might be partly accounted for this results.

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“…Also, there is substantial evidence documenting that prolonged inflation (of at least 30 seconds) shows greater stent expansion than shorter inflation times [3–5]. Additionally, interesting mechanism of stent expansion has been shown, assuming that as long as inflation pressure decreases, stent expansion continues [6]. However the optimal protocol for the stent expansion time still needs to be established.…”

Section: Introductionmentioning

confidence: 99%

Impact of the Balloon Inflation Time and Pattern on the Coronary Stent Expansion

Skowroński

Wolny

Jastrzebski

et al. 2019

Journal of Interventional Cardiology

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Objectives. To assess the expansion pattern of coronary stents by using different balloon inflation times and pressures. Background. The selection of coronary stent size and its proper deployment is crucial in coronary artery interventions, having an impact on the success of the procedure and further therapy. Methods. Ten pairs of different stents were deployed under nominal pressure using sequential (5, 5, 10, and 10 seconds of repeated inflations, thus 30 seconds of summarized time) and continuous (30 seconds) deployment pattern. After each given time-point, intraluminal stent measurements were performed by optical coherence tomography (OCT) and intravascular ultrasound (IVUS). Results. Both in-stent diameters and cross-section areas (CSA) of paired stents measured by OCT at all sequential time-points were significantly smaller compared to given manufacturers charts’ values (90% to 94% for diameters and 81% to 88% for CSA, p<0.05). Significant increase of in-stent diameter and CSA was observed across the step-by-step deployment pattern. In-stent lumen measurements were significantly larger when sequential deployment pattern was applied compared to continuous deployment. Additional measurements were also done for overlapping segments of stents, showing smaller in-stent measurements of the latter compared to nonoverlapping segments. Validation of OCT and IVUS measurements using a phantom metallic tube showed perfect reproducibility with OCT and overestimation with IVUS (8% for diameters and 16% for CSA). Conclusions. Stent diameter after deployment is time-dependent and not only pressure-dependent. Different stent expansion behavior, depending on the applied deployment pattern (sequential and nonsequential), was observed.

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A novel stent inflation protocol improves long‐term outcomes compared with rapid inflation/deflation deployment method

Abstract: Stent deployment using POP led to reduced TVF compared to rapid I/D. These results recommend this method to improve long-term outcomes. © 2017 Wiley Periodicals, Inc.

Cited by 9 publications

References 17 publications

Improved stent expansion with prolonged compared with short balloon inflation: A meta‐analysis

Improved stent expansion with prolonged compared with short balloon inflation: A meta‐analysis

Balloon Deflation Strategy during Primary Percutaneous Coronary Intervention in Acute ST-Segment Elevation Myocardial Infarction: A Randomized Controlled Clinical Trial and Numerical Simulation-Based Analysis

Impact of the Balloon Inflation Time and Pattern on the Coronary Stent Expansion

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