Impact of stent platform on longitudinal stent deformation: an in vivo frequency domain optical coherence tomography study

Abstract

Recently, longitudinal coronary stent deformation has been highlighted as a possible cause of drug-eluting stent failure. Although bench tests and in vivo studies have demonstrated difference in longitudinal stent strength among the stents with different platforms, its clinical impact is still unknown. Furthermore, it is unknown if modified stent platform favorably affect the incidence of stent deformation. The aim of this study was to investigate the longitudinal deformation of the everolimus-eluting stents (EES) with different stent platforms by using frequency domain optical coherence tomography (FD-OCT). Seventy-eight lesions treated with EES (Xience Prime: n = 26, Promus element: n = 29, Promus premier: n = 23) were studied. After successful stent implantation, FD-OCT was performed and stent length was measured using three-dimensional reconstruction of the images in vivo. Percent longitudinal stent shortening (%SS) was defined as the in vivo stent length divided by nominal stent length. Longitudinal stent deformation was defined as %SS > 10 %. Patients' and procedural characteristics were similar among 3 EESs. There was no difference in mean %SS between Xience Prime, Promus Element and Promus Premier (1.0 ± 5.8, 2.9 ± 6.7 and 0.8 ± 3.7 %, p = 0.322). Incidence of the longitudinal stent deformation was significantly higher in Promus Element than the other stents (0, 13.8 and 0 %, p = 0.028). Incidence of longitudinal stent deformation was different between EESs with different stent platforms. Stent material, stent design and/or stent delivery balloon may affect longitudinal stent deformation.

Effectiveness of the proximal optimization technique for longitudinal stent elongation caused by post‐balloon dilatation

“…Recent reports have identified risk factors for stent deformation, which included stent design; post‐balloon dilatation; complex lesions; ostial, bifurcation, and left main trunk lesions; extra support devices; guiding catheter; guidewires; and low stent inflation pressure . In addition to the procedural and morphological characteristics, stent types have been reported to be associated with stent deformation.…”

“…14 We hypothesized that, as the mechanism of this longitudinal stent elongation after post-balloon dilatation, although the force of postballoon dilatation typically exerted toward the radial axis of the catheter; guidewires; and low stent inflation pressure. [9][10][11] In addition to the procedural and morphological characteristics, stent types have been reported to be associated with stent deformation. A previous OCT study reported that, compared to cobalt-chromium everolimus-eluting stents, platinum-chromium everolimus-eluting stents showed a lower tendency for malapposed struts, 19 but in contrast, recent studies reported that the Promus Element® stent (platinum-chromium stent) often demonstrated deformation 8,9,20 The vast majority of stent design included in this study was second-and third-generation drug eluting stents ( Supplemental Table S1).…”

“…Longitudinal stent deformation has been reported to cause major complications including stent thrombosis, emergency coronary artery bypass graft, and death, which accounts for 7% and 14% of cases in two reports from the MAUDAE complication database . Although longitudinal stent deformation is mainly described as focal or overall longitudinal stent shortening, some recent case reports have also described the occurrence of longitudinal stent elongation as a type of longitudinal stent deformation . Previous reports have identified predictors of longitudinal stent deformation including stent design, post‐balloon dilatation, complex lesions, guide extension catheter devices, and low stent inflation pressure .…”

“…[1][2][3][5][6][7][8] Although longitudinal stent deformation is mainly described as focal or overall longitudinal stent shortening, some recent case reports have also described the occurrence of longitudinal stent elongation as a type of longitudinal stent deformation. [9][10][11] Previous reports have identified predictors of longitudinal stent deformation including stent design, post-balloon dilatation, complex lesions, guide extension catheter devices, and low stent inflation pressure. [9][10][11] A study using intravascular ultrasound (IVUS) reported that post-balloon dilatation after stent deployment often leads to longitudinal stent deformation as a mechanical complication.…”

“…[9][10][11] Previous reports have identified predictors of longitudinal stent deformation including stent design, post-balloon dilatation, complex lesions, guide extension catheter devices, and low stent inflation pressure. [9][10][11] A study using intravascular ultrasound (IVUS) reported that post-balloon dilatation after stent deployment often leads to longitudinal stent deformation as a mechanical complication. 12 However, the mechanism underlying this relationship is still unclear.…”