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Shin Y, Won Y, Yang T, Kim J, Lee J, Seo J, Jang AY, Kim M, Oh PC, Lee K, Kang WC, Han SH, Suh SY. Safety and Efficacy of Post-Dilation in Percutaneous Coronary Intervention Using Polymer-Free Ultrathin Strut Sirolimus-Probucol Coated Drug-Eluting Stents. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1649. [PMID: 37763768 PMCID: PMC10536641 DOI: 10.3390/medicina59091649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 08/18/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Polymer-free ultrathin strut sirolimus- and probucol-eluting stents (PF-SES) are recognized as safe and effective in diverse patient populations, although the implications of post-dilation during stent implantation remain underexamined. Materials and Methods: In this study, patients implanted with PF-SES at Gachon University Gil Medical Center between December 2014 and February 2018 were evaluated. Major adverse cardiovascular events (MACE), encompassing nonfatal myocardial infarction (MI), nonfatal stroke, and cardiovascular death were identified as primary outcomes, with secondary outcomes including target vessel revascularization (TVR), target lesion revascularization (TLR), and in-stent restenosis (ISR). Results: Of the 384 initial patients, 299 were considered eligible for analysis. The groups, delineated by those undergoing post-dilation (143 patients) and those not (156 patients), exhibited comparable rates of primary outcomes [hazard ratio (HR), 2.17; 95% confidence interval (CI), 0.40 to 11.87; p = 0.37]. The outcomes remained consistent irrespective of the post-dilation status and were similarly unaffected in multivariate analyses (HR, 2.90; 95% CI, 0.52 to 16.34; p = 0.227). Conclusions: These results suggest that the clinical outcomes of patients with post-dilation were similar to that of those without post-dilation in those with the polymer-free sirolimus- and probucol-eluting stents.
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Affiliation(s)
- Yonghoon Shin
- Department of Critical Care Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea;
| | - Yoonsun Won
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Taeil Yang
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Joohan Kim
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Joonpyo Lee
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Jeongduk Seo
- Department of Internal Medicine, Cardiovascular Center, Chinjujeil Hospital, Jinju 52709, Republic of Korea
| | - Albert Youngwoo Jang
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Minsu Kim
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Pyung Chun Oh
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Kyounghoon Lee
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Woong Chol Kang
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Seung Hwan Han
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
| | - Soon Yong Suh
- Department of Cardiology, Gil Medical Center, Gachon University College of Medicine, Incheon 21565, Republic of Korea
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Pasceri V, Pelliccia F, Pristipino C, Roncella A, Irini D, Varveri A, Bisciglia A, Speciale G. Clinical effects of routine postdilatation of drug-eluting stents. Catheter Cardiovasc Interv 2013; 83:898-904. [DOI: 10.1002/ccd.24999] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 05/12/2013] [Accepted: 05/12/2013] [Indexed: 11/09/2022]
Affiliation(s)
- Vincenzo Pasceri
- Interventional Cardiology; San Filippo Neri Hospital; Rome Italy
| | | | | | - Adriana Roncella
- Interventional Cardiology; San Filippo Neri Hospital; Rome Italy
| | - Diego Irini
- Interventional Cardiology; San Filippo Neri Hospital; Rome Italy
| | - Antonio Varveri
- Interventional Cardiology; San Filippo Neri Hospital; Rome Italy
| | - Andrea Bisciglia
- Interventional Cardiology; San Filippo Neri Hospital; Rome Italy
| | - Giulio Speciale
- Interventional Cardiology; San Filippo Neri Hospital; Rome Italy
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Recanalization Results After Intracranial Stenting of Atherosclerotic Stenoses. Cardiovasc Intervent Radiol 2009; 33:914-20. [DOI: 10.1007/s00270-009-9744-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2009] [Accepted: 10/12/2009] [Indexed: 10/20/2022]
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Romagnoli E, Sangiorgi GM, Cosgrave J, Guillet E, Colombo A. Drug-Eluting Stenting. JACC Cardiovasc Interv 2008; 1:22-31. [DOI: 10.1016/j.jcin.2007.10.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Revised: 10/16/2007] [Accepted: 10/25/2007] [Indexed: 02/02/2023]
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Shehab M, Michalis LK, Rees MR. Balloon angioplasty optimization: should we measure balloon volume as well as pressure? Cardiovasc Intervent Radiol 2007; 31:149-57. [PMID: 17943350 DOI: 10.1007/s00270-007-9193-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 07/30/2007] [Accepted: 08/29/2007] [Indexed: 11/29/2022]
Abstract
PURPOSE To investigate the influence that measurement of balloon volume as a controlled variable in addition to balloon pressure has on the outcome of balloon angioplasty in an experimental model. METHODS One hundred and three segments of explanted normal porcine carotid arteries were obtained. Five were used as controls, and the remaining 98 were subjected to balloon angioplasty with simultaneous measurement of balloon volume and pressure. These arteries were randomized into two groups. In one group the endpoint of the angioplasty was determined by balloon pressure (pressure-limited group, PLG) and in the other group by balloon volume (volume-limited group, VLG). Pressure/volume curves for each procedure were constructed by continuous measurement of both parameters by a purpose-designed computer-controlled inflation device. The diameter of each arterial segment was measured by intravascular ultrasound (IVUS) and the ratio of the inflated balloon to arterial diameter calculated. Arterial appearances after angioplasty were recorded using IVUS. RESULTS The balloon volumes measured at the endpoint of angioplasty were significantly smaller in the PLG compared with the VLG (p < 0.001). Three types of pressure/volume curves were identified: A, B, and C. In the type A curves, IVUS identified fissures in 28% (17/60) and the examination was normal in 72% (43/60). In the type B curves, IVUS identified fissures in 44% (4/9), dissections in 22% (2/9), and the examination was normal in 33% (3/9). In the type C curves, IVUS identified fissures in 44% (4/9) and dissection in 56% (5/9) with no normal examinations. In undamaged arterial segments a very high correlation was achieved between balloon volume and the balloon/artery ratio (Pearson correlation = -0.979, R(2) = 0.957, p < 0.0001, n = 27). CONCLUSION The measurement of pressure and volume during angioplasty enabled the construction of pressure/volume curves that showed deviations from the curves obtained in air. The balloon volume results, and significant deviation of the curve shape from the control curve shape, predicted vessel damage, which was confirmed by the IVUS appearance of the vessel after angioplasty. When pressure was used as the endpoint of balloon inflation the balloons were significantly underdilated compared with the manufacturer's nominal sizes. These data indicate that monitoring of pressure and volume during angioplasty may provide an alternative method of predicting vessel damage.
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Affiliation(s)
- M Shehab
- Department of Radiology, Bristol Royal Infirmary, Level 1, Marlborough Street, Bristol BS2 8HW, UK
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Werner GS, Bahrmann P, Mutschke O, Emig U, Betge S, Ferrari M, Figulla HR. Determinants of target vessel failure in chronic total coronary occlusions after stent implantation. The influence of collateral function and coronary hemodynamics. J Am Coll Cardiol 2003; 42:219-25. [PMID: 12875755 DOI: 10.1016/s0735-1097(03)00624-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The goal of this study was to assess the influence of collateral function, coronary hemodynamics, and the angiographic result on the risk of target vessel failure (TVF) after recanalization of a chronic total coronary occlusion (CTO). BACKGROUND Collaterals may have an adverse effect on TVF. METHODS In 111 consecutive patients, a CTO (duration >2 weeks) was successfully recanalized with stent implantation. Collateral function was assessed by intracoronary Doppler flow velocity and pressure recordings distal to the occlusion. Baseline collateral function was determined before the first balloon inflation, and recruitable collateral function after stenting during a balloon reocclusion. Finally, the coronary flow velocity reserve (CFVR) and the fractional flow reserve (FFR) were measured. RESULTS Angiographic follow-up after 5 +/- 4 months in 106 patients showed a reocclusion in 17% and a restenosis in 36%. The major determinants of TVF were the stent length (p < 0.01) and number of implanted stents (p < 0.01). No difference was observed in baseline or recruitable collateral function between patients with and without TVF; 52% of patients had a CFVR >or= 2.0, and only 18% a CFVR >or=2.5 after percutaneous transluminal coronary angioplasty, but neither cutoff-value predicted TVF. A low FFR discriminated patients with reocclusion (0.81 +/- 07 vs. 0.86 +/- 08, p < 0.05) but not with restenosis (0.87 +/- 0.06). CONCLUSIONS This study showed that there is no relation between a well-developed collateral supply and the risk of TVF in recanalized CTOs. This was rather determined by the stented segment length. There was also no adverse effect of the frequently observed impaired CFVR on TVF, whereas a low FFR was associated with a higher risk of reocclusion.
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Affiliation(s)
- Gerald S Werner
- Clinic for Internal Medicine III, Friedrich-Schiller-University, Jena, Germany.
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Takano Y, Yeatman LA, Higgins JR, Currier JW, Ascencio E, Kopelson KA, Tobis JM. Optimizing stent expansion with new stent delivery systems. J Am Coll Cardiol 2001; 38:1622-7. [PMID: 11704372 DOI: 10.1016/s0735-1097(01)01618-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The purpose of this study was to assess whether the newer stent delivery systems provide a stented lumen cross-sectional area (CSA) that is equal to the delivery balloon nominal dimensions. BACKGROUND First generation stents were often not adequately expanded with their delivery system and frequently required higher pressure or a larger balloon after deployment. Newer stents were designed to optimize expansion with noncompliant, high-pressure balloons provided as the delivery systems. METHODS Intravascular ultrasound (IVUS) was used to evaluate 38 stents in 32 patients after deployment at 14 to 16 atm with their delivery balloon system. Minimum stent lumen CSA and stent minimum lumen diameter (MLD) were measured by IVUS imaging. The manufacturer's expected stent diameter was defined as the balloon diameter measured by the company at the maximum pressure used. The manufacturer's expected stent area was calculated based on the manufacturer's expected stent diameter. RESULTS The MLD (2.5 +/- 0.5 mm) and minimum stent CSA (6.0 +/- 1.7 mm(2)) by IVUS were significantly smaller than the manufacturer's expected stent diameter (3.5 +/- 0.4 mm) and area (9.5 +/- 1.9 mm(2)) (p < 0.0001, respectively). The mean MLD by IVUS was 72 +/- 8% of the expected stent diameter, and the mean minimum stent CSA by IVUS was 62 +/- 10% of the expected stent area. CONCLUSIONS Despite moderately high-pressure inflations, the mean minimum stent CSA actually achieved was, on average, only 62% of the manufacturer's expected stent area. To optimize stent deployment, these IVUS observations should be considered during coronary artery stenting.
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Affiliation(s)
- Y Takano
- University of California, Los Angeles Center for Health Sciences, Los Angeles, California 90095-1717, USA
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Abstract
Clinical studies demonstrated a reduction of acute complications by high-pressure stenting. This study was performed to correlate the histomorphologic changes of the vessel wall after coronary stenting with stent expansion pressure. We studied the effects of intravital and postmortem stenting on coronary morphology in human hearts. Artifact-free analysis and morphometry of the artery segments' cross section was performed after plastic resin embedding and cutting and grinding sectioning. By comparing intra- and postmortem findings we demonstrated that postmortem stent implantation can serve as an adequate model to study the mechanical effects of coronary stenting. A consistent histologic feature was eccentric stent expansion. Larger calcified areas of the vessel wall were not deformed by implanted stents. The highest degree of vessel injury and deformation was apparent in anatomically "nondiseased" or only slightly fibrotic parts of the arterial wall. Dissections were predominantly located directly adjacent to calcified plaques and appeared as "half-moon"-like tears reaching into the arterial media. A statistically significant stent lumen gain was found when the implantation pressure was increased up to 15 atm. Stent symmetry was not influenced by the applied implantation pressure but depended mostly on local coronary morphology. Thus, increasing implantation pressures during coronary stenting seemed to improve the stenting result up to 15 atm. When applying histomorphologic criteria, the higher pressures (>15 atm) did not cause further optimization of stent expansion. Morphometric analysis of stents implanted postmortemly and intravitally revealed comparable results. Postmortem stenting seems to be an appropriate model for studying stent expansion and stenting results in human coronary arteries.
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Affiliation(s)
- P H Grewe
- Department of Cardiology, Institute of Pathology, University Hospital Bergmannsheil, Bochum, Germany.
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Werner GS, Gastmann O, Ferrari M, Scholz KH, Schünemann S, Figulla HR. Determinants of stent restenosis in chronic coronary occlusions assessed by intracoronary ultrasound. Am J Cardiol 1999; 83:1164-9. [PMID: 10215277 DOI: 10.1016/s0002-9149(99)00052-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic coronary occlusions have a high recurrence rate that can be reduced by stenting, but this rate remains higher than in nonocclusive lesions. To analyze possible determinants of restenosis in these lesions, intracoronary ultrasound was performed during the recanalization procedure. A chronic coronary occlusion of > or = 1 month duration (range 1 to 33 months; median 3.3) was successfully recanalized in 41 patients. Quantitative ultrasound analysis was performed before and after stent placement, with measurement of the luminal area, the extent of the plaque burden at the site proximal and distal to the occlusion, and within the occlusion and the subsequent stent. The degree of compensatory enlargement of the coronary artery within the occlusion was determined by comparing the average of the total vessel area of the proximal and distal reference with the lesion site. Early reocclusion (subacute stent thrombosis) was observed in 1 patient (2.4%). The angiographic control after 6 months showed restenosis in 9 patients with 1 late reocclusion. The overall recurrence rate was 24%. There was no difference in clinical and procedural characteristics between lesions with restenosis and without restenosis. The latter had a larger minimum stent area (7.59 +/- 1.96 mm2 vs 5.71 +/- 0.90 mm2; p <0.01), and there was evidence for more compensatory vessel enlargement in lesions without restenosis. Thus, intracoronary ultrasound showed that a smaller minimum stent area was a major predictor of angiographic restenosis, and it occurred more often in occlusions without compensatory vessel enlargement.
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Affiliation(s)
- G S Werner
- Clinic for Internal Medicine III, Friedrich-Schiller-University Jena, Germany.
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Leertouwer TC, Gussenhoven EJ, van Overhagen H, Man in 't Veld AJ, van Jaarsveld BC. Stent placement for treatment of renal artery stenosis guided by intravascular ultrasound. J Vasc Interv Radiol 1998; 9:945-52. [PMID: 9840039 DOI: 10.1016/s1051-0443(98)70428-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE To study the impact of intravascular ultrasound (IVUS) during renal artery stent placement. MATERIALS AND METHODS Patients (n = 22) with atherosclerotic renal artery stenosis were studied with IVUS after predilation and after angiographically successful stent deployment (diameter stenosis < 10%). After predilation, IVUS was used to assess whether the balloon size selected angiographically was correct (discrepancy balloon-reference lumen diameter < 20%). After stent placement, IVUS images were assessed for (i) complete stent-vessel wall apposition; (ii) complete stent expansion (discrepancy stent-reference lumen diameter < 20%), and (iii) complete lesion covering by the stent. Modification based on IVUS included selection of a larger balloon, additional dilation, and placement of a second stent. Clinical outcome was based on blood pressure, amount of antihypertensive drugs, and glomerular filtration rate during follow-up of 3 months. RESULTS Stent placement and ultrasound imaging were completed successfully in 18 patients. After predilation, IVUS warranted the use of a larger balloon in five patients. After stent placement, incomplete stent apposition (n = 1), discrepancy between stent and reference lumen diameter (n = 3), and lesion distal to the stent (n = 2) seen on IVUS were treated with additional dilation in five patients and with a second stent in one patient. A larger balloon was used in three patients. Mean blood pressure and amount of antihypertensive drugs decreased (P < .05). CONCLUSIONS In a number of patients, IVUS monitoring during renal artery stent placement resulted in additional lumen enlargement not considered necessary at angiography.
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Affiliation(s)
- T C Leertouwer
- Department of Internal Medicine, University Hospital Rotterdam-Dijkzigt and Erasmus University Rotterdam, The Netherlands
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