In vivo assessment of stent expansion and recoil in normal porcine coronary arteries: differential outcome by stent design.

Abstract

Despite the routine use of high pressure, coronary stents generally fail to achieve a cross-sectional area (CSA) >60% to 80% of the nominal CSA of their dilating balloon. The extent to which incomplete balloon expansion and postdeflation stent recoil contribute to this failure has not been fully evaluated. Thirty-two stents (8 Gianturco-Roubin II, 8 Palmaz-Schatz, 8 MultiLink, and 8 NIR) were deployed in nondiseased coronary arteries of 8 Yorkshire pigs. All stents were then expanded according to 1 of 3 balloon strategies: appropriately sized compliant balloons, oversized compliant balloons, or oversized noncompliant balloons. Continuous ultrasound imaging was performed during stepwise balloon inflation and deflation, with an 0.018-in imaging core positioned within the guidewire lumen of the balloon. In these normal arteries, balloon underexpansion relative to the nominal size was not observed. After balloon deflation, however, all stents showed significant recoil from their maximum inflated CSA. Recoil was significantly greater for the coil Gianturco-Roubin II stent (30% CSA) than for the 3 slotted-tube stent designs (15% to 17% CSA). In normal, compliant coronary arteries, stent recoil is the predominant mechanism by which stents fail to achieve the nominal CSA of their dilating balloon. The magnitude of this in vivo stent recoil is significantly greater than reported from bench testing and varies with stent design (coil versus slotted tube). Postdilatation strategies that result in controlled stent overexpansion are needed to overcome this recoil phenomenon and result in a final stent CSA that approximates the reference artery CSA.