Abstract
BackgroundPercutaneous coronary interventions (PCI) of bifurcation stenoses are both complex and challenging. Stenting strategies share that the stents’ side cells must be carefully explored and appropriately prepared using balloons or stents. So far, stent manufacturers have not provided any information regarding side-branch expansion capacity of their stent platforms.AimsGiven that drug-eluting stent (DES) information regarding their mechanical capacity of side-branch expansion is not available, we aimed to evaluate contemporary DES (Orsiro, BIOTRONIK AG; Xience Sierra, Abbott Vascular; Resolute Integrity, Medtronic; Promus Premier Select, Boston Scientific; Supraflex Cruz, Sahajan and Medical Technologies) by their side-branch expansion behavior using in vitro bench testing.MethodsIn this in vitro study, we analyzed five commercially available DES (diameter 3.0 mm), measuring their side-branch expansion following inflation of different high-pressure non-compliant (NC) balloons (balloon diameter: 2.00–4.00 mm), thereby revealing the morphological characteristics of their side-branch expansion capacities.ResultsWe demonstrated that all tested contemporary DES platforms could withstand large single-cell deformations, up to 4.0 mm. As seen in our side-branch experiments, DES designs consisting of only two connectors between strut rings did not only result in huge cell areas, but also in larger cell diameters following side-branch expansion compared with DES designs using three or more connectors. Furthermore, the stent cell diameter attained was below the balloon diameter at normal pressure.ConclusionsWe recommend that the expansion capacity of side-branches should be considered in stent selection for bifurcation interventions.
Highlights
We demonstrated that all tested contemporary drug-eluting stent (DES) platforms could withstand large single-cell deforma‐ tions, up to 4.0 mm
As seen in our side-branch experiments, DES designs consisting of only two connectors between strut rings did result in huge cell areas, and in larger cell diameters following side-branch expansion compared with DES designs using three or more connectors
We recommend that the expansion capacity of side-branches should be considered in stent selection for bifurcation interventions
Summary
Percutaneous coronary interventions (PCI) of bifurcation stenoses are still complex and challenging procedures, because a bifurcation intervention is required in approximately 20% of PCIs [1]. Öner et al Eur J Med Res (2021) 26:121 share that the stents’ side cells must be carefully explored and appropriately prepared using either balloons or stents. Stent manufacturers have only specified their stents’ radial expansion capacity. The side-branch expansion capacity of the different stent models has not been assessed in other studies reported to date. We analyzed several stents, measuring their side-branch expansion following inflation of different high-pressure balloons, thereby revealing the morphological characteristics of their side-branch expansion capacities. Percutaneous coronary interventions (PCI) of bifurcation stenoses are both complex and challeng‐ ing. Stenting strategies share that the stents’ side cells must be carefully explored and appropriately prepared using balloons or stents. Stent manufacturers have not provided any information regarding side-branch expansion capacity of their stent platforms
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