Optimal Stent Expansion by Stent Balloon Multiple Inflation at Nominal Pressure in Resistant Lesions: A New Technique

Document Type: Original Article

Authors

1 Resident of Cardiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Cardiologist,Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

3 Cardiologist, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Introduction: This study aimed to evaluate the effects of four-time inflation of the stent balloon at nominal pressure on optimal stent expansion in resistant lesions.
Materials and Methods: This interventional study was conducted on 39 patients with coronary artery lesions, in whom Zotarolimus-eluting stents (N=20), Paclitaxel-eluting stents (N=11) and other stents (N=8) were deployed four times at nominal inflation pressure and increased inflation times (5, 15, 30 and 45 seconds). After the deployments, enhanced stent visualization imaging technique (IC stent) was used to assess stent placement and artery expansion.
Results: In this study, early success rate was estimated at 79.5% using the enhanced stent visualization imaging technique. In addition, major adverse cardiac event (MACE) was determined at 2.6%. Also, conventional methods resulted in lower success rate and higher MACE in resistant lesions.
Conclusion: According to the results of this study, four-time stent balloon inflation at nominal pressure could allow adequate stent expansion in resistant lesions leading to lower MACE.

Keywords


  1. Hoffmann R, Mintz GS, Mehran R, Pichard AD, Kent KM, Satler LF, et al. Intravascular ultrasound predictors of angiographic restenosis in lesions treated with Palmaz-Schatz stents. J Am Coll Cardiol. 1998; 31:43-9.
  2. Kastrati A, Schomig A, Elezi S, Schuhlen H, Dirschinger J, Hadamitzky M, et al. Predictive factors of restenosis after coronary stent placement. J Am Coll Cardiol. 1997; 30:1428-36.
  3. Kasaoka S, Tobis JM, Akiyama T, Reimers B, Di Mario C, Wong ND, et al. Angiographic and intravascular ultrasound predictors of in-stent restenosis. J Am Coll Cardiol. 1998; 32:1630-5.
  4. Nakazawa G. Stent thrombosis of drug eluting stent: pathological perspective. J Cardiol. 2011; 58:84-91.
  5. Takayama T, Hiro T, Hirayama A. Stent thrombosis and drugeluting stents. J Cardiol. 2011; 58:92-8.
  6. Stone GW, St Goar FG, Hodgson JM, Fitzgerald PJ, Alderman EL, Yock PG, et al. Analysis of the relation between stent implantation pressure and expansion. Optimal Stent Implantation (OSTI) Investigators. Am J Cardiol. 1999; 83:1397-400.
  7. Cheneau E, Satler LF, Escolar E, Suddath WO, Kent KM, Weissman NJ, et al. Underexpansion of sirolimus-eluting stents: incidence and relationship to delivery pressure. Catheter Cardiovasc Interv. 2005; 65:222-6.
  8. Mori F, Tsurumi Y, Hagiwara N, Kasanuki H. Impact of postdilatation with a focal expanding balloon for optimization of intracoronary stenting. Heart Vessels. 2007; 22:152-7.
  9. Trindade IS, Sarmento-Leite R, Santos de Freitas M, Gottschall CA. Determination of the minimum inflation time necessary for total stent expansion and apposition: an in vitro study. J Invasive Cardiol. 2008; 20:396-8.
  10. Asano T, Kobayashi Y, Fukushima K, Iwata Y, Kitahara H, Ishio N, et al. Effect of balloon inflation time on expansion of sirolimus-eluting stent. Heart Vessels. 2009; 24:335-9.
  11. Kawasaki T, Koga H, Serikawa T, Orita Y, Ikeda S, Mito T, et al. Impact of a prolonged delivery inflation time for optimal drug-eluting stent expansion. Catheter Cardiovasc Interv. 2009; 73:205-11.
  12. Javaid A, Chu WW, Cheneau E, Clavijo LC, Satler LF, Kent KM, et al. Comparison of paclitaxel-eluting stent and sirolimus-eluting stent expansion at incremental delivery pressures. Cardiovasc Revasc Med. 2006; 7:208-11.
  13. Daemen J, Wenaweser P, Tsuchida K, Abrecht L, Vaina S, Morger C, et al. Early and late coronary stent thrombosis of sirolimus-eluting and paclitaxel-eluting stents in routine clinical practice: data from a large two-institutional cohort study. Lancet. 2007; 369:667-78.
  14. Kimura T, Morimoto T, Nakagawa Y, Tamura T, Kadota K, Yasumoto H, et al. Antiplatelet therapy and stent thrombosis after sirolimus-eluting stent implantation. Circulation. 2009; 119:987-95.