Optical coherence tomography-verified longer balloon inflation time may provide better stent apposition and optimal index parameters.

Abstract

Incomplete stent expansion and inadequate apposition predispose to stent thrombosis following percutaneous coronary intervention. Recent studies have shown that increasing the duration of balloon inflation during stent employment was beneficial. Thus, the balloon inflation time required for optimal stent expansion and apposition in patients receiving second-generation drug-eluting stents (DES) were determined using optical coherence tomography (OCT). Between April 2014 and March 2015, 38patients (28men, 10women; mean age 60.5 ± 11.4years) with stable angina pectoris due to single significant de novo coronary artery stenosis were prospectively enrolled. All patients were administered aspirin and clopidogrel and received weight-adjusted intravenous unfractionated heparin. Images of basal lesions were obtained using the C7XR LightLab Dragonfly OCT catheter. Expansion and apposition parameters improved with increasing duration of balloon inflation (30 s or 60 s) with nominal pressure (12 atm). Mean lesion length was 19.8 ± 7.6 mm. Mean stent diameter and length were 2.8 ± 0.36 mm and 24.9 ± 7.6 mm, respectively. With deployment of astent at nominal pressure with conventional duration, inadequate stent expansion and malapposition frequently occurred as detected by OCT; however, aballoon inflation duration of 60 s markedly improved stent expansion and apposition parameters without significant complications.