Influence of platform design of six different drug-eluting stents in provisional coronary bifurcation stenting by rePOT sequence: a comparative bench analysis.

Abstract

The rePOT (proximal optimisation technique) sequence proved significantly more effective than final kissing balloon (FKB) with two drug-eluting stents (DES) in a bench test. We sought to validate efficacy experimentally in a large range of latest-generation DES. On left main fractal coronary bifurcation bench models, five samples of each of the six main latest-generation DES (Coroflex ISAR, Orsiro, Promus PREMIER, Resolute Integrity, Ultimaster, XIENCE Xpedition) were implanted on rePOT (initial POT, side branch inflation, final POT). Proximal elliptical ratio, side branch obstruction (SBO), stent overstretch and strut malapposition were quantified on 2D and 3D OCT. Results were compared to FKB with Promus PREMIER. Whatever the design, rePOT maintained vessel circularity compared to FKB: elliptical ratio, 1.02±0.01 to 1.04±0.01 vs. 1.26±0.02 (p<0.05). Global strut malapposition was much lower: 2.6±1.4% to 0.1±0.2% vs. 40.4±8.4% for FKB (p<0.05). However, only Promus PREMIER and XIENCE Xpedition achieved significantly less SBO: respectively, 5.6±3.5% and 10.0±5.3% vs. 23.5±5.7% for FKB (p<0.05). Platform design differences had little influence on the excellent results of rePOT versus FKB. RePOT optimised strut apposition without proximal elliptical deformation in the six main latest-generation DES. Thickness and design characteristics seemed relevant for optimising SBO.