Abstract
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.
Highlights
Percutaneous coronary intervention (PCI) is a wellestablished method of revascularization
Introduction of coronary stents and their further developments resulted in the reduction of the risk of acute PCI complications and improved long-term results through decrease of in-stent restenosis and stent thrombosis [1]
The in-stent optical coherence tomography (OCT) and intravascular ultrasound (IVUS) measurements obtained at respective time-points are summarized in Table 2 and in Figures 2 and 3
Summary
Percutaneous coronary intervention (PCI) is a wellestablished method of revascularization. Introduction of coronary stents and their further developments resulted in the reduction of the risk of acute PCI complications (i.e., acute vessel closure, dissection) and improved long-term results through decrease of in-stent restenosis and stent thrombosis [1]. Stent expansion is the result of a balance between compressive and expanding forces. The first is largely related to vessel characteristics: the wall stiffness and the plaque morphology. The latter depends on the properties of the expanding balloon (compliance), applied pressure, and deployment time. It is influenced by stent design strut thickness and cell design. There is substantial evidence documenting that prolonged inflation (of at least 30 seconds) shows greater stent expansion
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