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Coronary Stent Deployment Technique

  • Srikanth Vallurupalli
  • Barry F. Uretsky
Chapter

Abstract

Stent underexpansion is an important cause of in-stent restenosis and early stent thrombosis, and is partly a result of suboptimal stent deployment. We discuss the effect of modifying stent deployment parameters such as stent size, balloon deployment pressure, and duration of inflation for optimizing stent expansion.

References

  1. 1.
    Fujii K, Mintz GS, Kobayashi Y, Carlier SG, Takebayashi H, Yasuda T, et al. Contribution of stent underexpansion to recurrence after sirolimus-eluting stent implantation for in-stent restenosis. Circulation. 2004;109:1085–8.CrossRefPubMedGoogle Scholar
  2. 2.
    Liu J, Maehara A, Mintz GS, Weissman NJ, Yu A, Wang H, Mandinov L, et al. An integrated TAXUS IV, V, and VI intravascular ultrasound analysis of the predictors of edge restenosis after bare metal or paclitaxel-eluting stents. Am J Cardiol. 2009;103:501–6.CrossRefPubMedGoogle Scholar
  3. 3.
    Cheneau E, Leborgne L, Mintz GS, Kotani J, Pichard AD, Satler LF, et al. Predictors of subacute stent thrombosis: results of a systematic intravascular ultrasound study. Circulation. 2003;108:43–7.CrossRefPubMedGoogle Scholar
  4. 4.
    Fujii K, Carlier SG, Mintz GS, Yang YM, Moussa I, Weisz G, et al. Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: anintravascular ultrasound study. J Am Coll Cardiol. 2005;45:995–8.CrossRefPubMedGoogle Scholar
  5. 5.
    Bertrand OF, De Larochellière R, Joyal M, Bonan R, Mongrain R, et al. Incidence of stent under-deployment as a cause of in-stent restenosis in long stents. Int J Cardiovasc Imaging. 2004;20:279–84.CrossRefPubMedGoogle Scholar
  6. 6.
    Im E, Kim B-K, Ko Y-G, Shin DH, Kim JS, Choi D, et al. Incidences, predictors, and clinical outcomes of acute and late stent malapposition detected by optical coherence tomography after drug-eluting stent implantation. Circ Cardiovasc Interv. 2014;7:88–96.CrossRefPubMedGoogle Scholar
  7. 7.
    Meneveau N, Souteyrand G, Moteff P, Caussin C, Amabile N, Ohlmann P, et al. Optical coherence tomography to optimize results of percutaneous coronary intervention in patients with non-ST-elevation acute coronary syndrome. Circulation. 2016;134:906–17.CrossRefPubMedGoogle Scholar
  8. 8.
    Chieffo A, Latib A, Caussin C, Presbitero P, Galli S, Menozzi A, et al. A prospective, randomized trial of intravascular-ultrasound guided compared to angiography guided stent implantation in complex coronary lesions: the AVIO trial. Am Heart J. 2013;165:65–72.CrossRefPubMedGoogle Scholar
  9. 9.
    Cook JR, Mhatre A, Wang FW, Uretsky BF. Prolonged high-pressure is required for optimal stent deployment as assessed by optical coherence tomography. Catheter Cardiovasc Interv. 2014;83:521.CrossRefPubMedGoogle Scholar
  10. 10.
    Casella G, Klauss V, Ottani F, Siebert U, Sangiorgio P, Bracchetti D. Impact of intravascular ultrasound-guided stenting on long-term clinical outcome: a meta-analysis of available studies comparing intravascular ultrasound-guided and angiographically guided stenting. Catheter Cardiovasc Interv. 2003;59:314–21.CrossRefPubMedGoogle Scholar
  11. 11.
    Klersy C, Ferlini M, Raisaro A, Scotti V, Balduini A, Curti M, et al. Use of IVUS guided coronary stenting with drug eluting stent: a systematic review and meta-analysis of randomized controlled clinical trials and high quality observational studies. Int J Cardiol. 2013;170:54–63.CrossRefPubMedGoogle Scholar
  12. 12.
    Witzenbichler B, Maehara A, Weisz G, Neumann FJ, Rinaldi MJ, Metzger DC, et al. Relationship between intravascular ultrasound guidance and clinical outcomes after drug-eluting stents: the assessment of dual antiplatelet therapy with drug eluting stents (ADAPT-DES) study. Circulation. 2014;129:463–70.CrossRefPubMedGoogle Scholar
  13. 13.
    Park SJ, Kim YH, Park DW, Lee SW, Kim WJ, Suh J, et al. Impact of intravascular ultrasound guidance on long-term mortality in stenting for unprotected left main coronary artery stenosis. Circ Cardiovasc Interv. 2009;2:167–77.CrossRefPubMedGoogle Scholar
  14. 14.
    Prati F, Di Vito L, Biondi-Zoccai G, Occhipinti M, La Manna A, Tamburino C, et al. Angiography alone versus angiography plus optical coherence tomography to guide decision-making during percutaneouscoronary intervention: the Centro per la Lotta contro l’ Infarto-optimisation of percutaneous coronary intervention (CLI-OPCI) study. EuroIntervention. 2012;8:823–9.CrossRefPubMedGoogle Scholar
  15. 15.
    Colombo A, Hall P, Nakamura S, Almagor Y, Maiello L, Martini G, et al. Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance. Circulation. 1995;91:1676–88.CrossRefPubMedGoogle Scholar
  16. 16.
    FDA. Class II special controls guidance document for certain percutaneous transluminal coronary angioplasty (PTCA) catheters; guidance for iIndustry and FDA. 2010. http://www.fda.gov/RegulatoryInformation/Guidances/ucm225145.htm. Accessed 29 Nov 2016.
  17. 17.
    Vallurupalli S, Bahia A, Ruiz-Rodriguez E, Ahmed Z, Hakeem A, Uretsky BF. Optimization of stent implantation using a high pressure inflation protocol. Catheter Cardiovasc Interv. 2016;87:65–72.CrossRefPubMedGoogle Scholar
  18. 18.
    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(8):396–8.PubMedGoogle Scholar
  19. 19.
    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 Vessel. 2009;24:335–9.CrossRefGoogle Scholar
  20. 20.
    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.CrossRefPubMedGoogle Scholar
  21. 21.
    Saha M, Poliacikova P, de Belder A, Holmberg S, Clarke M, Rajani R, et al. Coronary stent implantation technique: prolonged inflation time maximizes stent expansion. J Invasive Cardiol. 2013;25:28–31.PubMedGoogle Scholar
  22. 22.
    Hovasse T, Mylotte D, Garot P, Salvatella N, Morice MC, Chevalier B, et al. Duration of balloon inflation for optimal stent deployment: five seconds is not enough. Catheter Cardiovasc Interv. 2013;81(3):446–53.CrossRefPubMedGoogle Scholar
  23. 23.
    Ann SH, Chung J-W, DE Jin C, Lee JH, Kim JM, Garg S, et al. Better inflation time of stent balloon for second-generation drug-eluting stent expansion and apposition: an optical coherence tomography study. J Interv Cardiol. 2014;27:171–6.CrossRefPubMedGoogle Scholar
  24. 24.
    Iwamoto Y, Okamoto M, Hashimoto M, Fukuda Y, Iwamoto A, Iwasaki T, et al. Better stent expansion by two-time inflation of stent balloon and its responsible mechanism. J Cardiol. 2012;59:160–6.CrossRefPubMedGoogle Scholar
  25. 25.
    Vallurupalli S, Kasula S, Krishna Chand Pothineni N, Agarwal SK, Ahmed Z, Hakeem A et al. TCT-488 comparison of clinical outcomes between a novel prolonged stent inflation protocol with conventional rapid/inflation/deflation method. J Am Coll Cardiol. 2015;66(15):B200. doi: https://doi.org/10.1016/j.jacc.2015.08.504.CrossRefGoogle Scholar
  26. 26.
    Brodie BR, Cooper C, Jones M, Fitzgerald P, Cummins F. Is adjunctive balloon postdilatation necessary after coronary stent deployment? Final results from the POSTIT trial. Catheter Cardiovasc Interv. 2003;59:184–92.CrossRefPubMedGoogle Scholar
  27. 27.
    Russo RJ, Silva PD, Teirstein PS, Attubato MJ, Davidson CJ, DeFranco AC, et al. AVID investigators. A randomized controlled trial of angiography versus intravascular ultrasound-directed bare-metal coronary stent placement (the AVID trial). Circ Cardiovasc Interv. 2009;2(2):113–23.CrossRefPubMedGoogle Scholar
  28. 28.
    Aziz S, Morris JL, Perry RA, Stables RH. Postdilatation following coronary stent deployment: lesion and procedural characteristics associated with an increase in stent dimensions. J Invasive Cardiol. 2008;20:342–6.PubMedGoogle Scholar
  29. 29.
    Gao Z, Yang YJ, Xu B, Chen JL, Qiao SB, Yao M, et al. Is adjunctive balloon postdilatation necessary with drug-eluting stents? One center experience in Chinese patients. Chin Med J. 2008;121:513–7.PubMedGoogle Scholar
  30. 30.
    Fröbert O, Sarno G, James SK, Saleh N, Lagerqvist B. Effect of stent inflation pressure and post-dilatation on the outcome of coronary artery intervention. A report of more than 90,000 stent implantations. PLoS One. 2013;8:e56348.CrossRefPubMedPubMedCentralGoogle Scholar
  31. 31.
    Sorrentino S, De Rosa S, Ambrosio G, Mongiardo A, Spaccarotella C, Polimeni A, et al. The duration of balloon inflation affects the luminal diameter of coronary segments after bioresorbable vascular scaffolds deployment. BMC Cardiovasc Disord. 2015;15:169.CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Abbott Vascular. 2015 Absorb GT1. Instructions for use. https://www.vascular.abbott/us/products/coronary-intervention/absorb-bioresorbable-scaffold-dissolving-stent.html (accessed 28 August 2017)Google Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Division of CardiologyCentral Arkansas Veterans Healthcare System, University of Arkansas for Medical SciencesLittle RockUSA

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