Abstract
Stent struts protruding into ostial side branch called “jailed strut” at bifurcation lesions is a likely cause of thrombus formation. We aimed to investigate the influences of multiple kissing balloon inflation (KBI) for stent expansion, and stent platform design, respectively, on the reduction of incomplete stent apposition area (ISA area) caused by jailed struts at a side-branch ostium, using a three-dimensional elastic left main (LM) bifurcated coronary artery model. The referenced LM bifurcation angle data of 209 patients were stratified by tertiles focusing on the angle between the LM trunk (LMT) and left anterior descending artery (LAD). A bifurcation model was fabricated with angles of 129°, 122.2°, and 76.4° for LMT–LAD, LMT–left circumflex (LCx), and LAD–LCx, respectively, and with diameters of 5, 3.75, and 3.5 mm for LMT, LAD, and LCx, respectively; these diameters fulfill Murray’s law. A 75 % stenosis was included along the LMT. One-time and three-time KBIs were conducted using two-link Nobori and three-link Xience Xpedition (n = 6 each). The ISA area was quantified using micro-CT. Three-time KBI was effective in reducing the ISA area compared with one-time KBI for both the Nobori (p = 0.05) and Xience Xpedition (p = 0.07). The ISA area was smaller in the Nobori than in the Xience Xpedition, both in one-time and three-time KBI (one-time KBI: p = 0.003; three-time KBI: p = 0.001). Our findings of this study on reducing the ISA area by focusing on an interventional technique and stent design may help to improve coronary bifurcation intervention for a possibly better long-term clinical outcome.
Highlights
Drug eluting stents (DESs) have been shown to reduce the rate of restenosis considerably, and have widely expanded treatments for various types of severe lesions and indications of percutaneous coronary intervention (PCI) [1, 2]
We aimed to investigate the influences of multiple kissing balloon inflation (KBI) for stent expansion, and stent platform design, respectively, on the reduction of incomplete stent apposition area (ISA area) caused by jailed struts at a side-branch ostium, using a three-dimensional elastic left main (LM) bifurcated coronary artery model
The ISA area caused by jailed struts at the left circumflex (LCx) ostium was lower with the three-time KBI than the ISA area caused by jailed struts at the LCx ostium with the one-time KBI for the Nobori stent (Nobori: 1.00 ± 0.28 mm2 vs. 2.49 ± 1.44 mm2, p = 0.05; Xience: 4. 07 ± 1.04 mm2 vs. 5.21 ± 0.93 mm2, p = 0.07) (Fig. 5a, b)
Summary
Drug eluting stents (DESs) have been shown to reduce the rate of restenosis considerably, and have widely expanded treatments for various types of severe lesions and indications of percutaneous coronary intervention (PCI) [1, 2]. Coronary bifurcation lesions, which account for 15–20 % of all PCIs, still represent a challenging lesion subset for interventional cardiologists [3, 4]. Several studies have reported that a two-stent (complex stent) strategy does not offer any advantage over a single-stent (simple stent) strategy in bifurcation lesions [5, 6]. A recent intravascular ultrasound (IVUS) study indicated that the presence of incomplete stent apposition (ISA), Reduction in incomplete stent apposition area caused by jailed struts after single stenting
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
