Cypher Stent Research Articles

TCTAP C-149 Multivessel Coronary Artery Disease with Aberrant RCA CTO Lesion by Retrograde Approach

### Patient Initials or Identifier Number 0617925 ### Relevant Clinical History and Physical Exam A 66 old male admitted to our hospital for congestive heart failure. He had a medical history of IHD, mid LAD was implanted Cypher stent. His coronary risk factors were diabetes, hypertension, and

A randomized multicenter trial comparing the XIENCE everolimus eluting stent with the CYPHER sirolimus eluting stent in the treatment of female patients with de novo coronary artery lesions: The SPIRIT WOMEN study

BackgroundThe comparative performance of different drug-eluting stents (DES) among female patients has not been assessed in a randomized manner.ObjectivesThe SPIRIT Women Clinical Evaluation trial compared the durable polymer everolimus-eluting XIENCE stent (DP-EES) with the durable polymer sirolimus-eluting Cypher stent (DP-SES) in women undergoing percutaneous coronary intervention (PCI).MethodsA total of 455 female patients with stable CAD were randomly assigned to receive DP-EES (n = 304) or DP-SES (n = 151). The powered angiographic outcome of the trial was in-stent late lumen loss (LLL) at 9 months after the index procedure. Secondary angiographic end points included in-segment LLL, in-stent and in-segment binary restenosis and percent diameter stenosis. The primary clinical outcome was a composite of all-cause death, myocardial infarction (MI) or target vessel revascularization (TVR).ResultsAt 9-month follow-up, in-stent LLL was 0.19±0.38 mm and 0.11±0.37 mm in patients assigned to DP-EES and DP-SES, respectively. The one-sided upper 95% CI of the difference in in-stent LLL between the groups of 0.08 mm was 0.15 and therefore within the pre-specified non-inferiority margin of 0.17 mm (p for non-inferiority = 0.013). However, the test for superiority showed a borderline significant difference in terms of LLL between DP-EES and DP-SES (p for superiority = 0.044). There were no significant differences in binary restenosis (2.0% vs. 0.72%, p = 0.44) and percent diameter stenosis (14.97±12.17 vs. 13.36±10.82, p = 0.19). The rate of definite stent thrombosis at 12 months was lower in patients treated with DP-EES (0% vs. 2.0%, p = 0.036).ConclusionsAmong women undergoing PCI, DP-EES was associated with a small but probably clinically relevant increase in in-stent LLL at 9 months as compared to DP-SES and with a lower risk of definite stent thrombosis at 12 months.Trial registrationClinicalTrials.gov NCT01182428.https://clinicaltrials.gov/

Safety and efficacy outcomes of 3rd generation DES in an all-comer population of patients undergoing PCI: 12-month and 24-month results of the e-Biomatrix French registry.

ObjectivesThe French Ebiomatrix registry aimed to confirm the results of the Leaders trial in an all‐comer population in France.BackgroundThe Leaders trial showed the Biolimus‐eluting‐sent (BES) to be equivalent to the Cypher stent in terms of safety and efficacy at 1 year and superior regarding stent thrombosis after 1 year.MethodsBES recipients were enrolled in 42 French centers with up to 24‐month clinical follow up.Results2365 patients were included. Mean age: 65.7 ±11.2 years, 76.1% males, 31.8% had diabetes, 36.5% ACS (28.7% non‐ST‐elevation MI and 7.8% with ST‐elevation MI). 1.7 ± 1.0 stents/patient were implanted and procedural success was 99.5%. 12‐month follow‐up was completed in 94.3% patients and 24 months in 91.4%. MACCE rates at 12 and 24 months were 5.8% and 9% (all cause‐death 1.5% and 2.2%; stent thrombosis definite/probable 0.4% and 0.6%), respectively. MACCE were not significantly higher in diabetic patients compared with non‐diabetics but cardiac death was higher (1.6% vs. 0.6%, P = 0.01 at 1 year and 1.9% vs. 0.6, P = 0.005 at 2 years) as was stent thrombosis (0.9% vs. 0.2%, P = 0.009 and 1.2 vs. 0.3% P = 0.008). Compared with non‐ACS patients, MACCE was significantly higher in the ACS subgroup (7.5% vs. 4.8%, P = 0.001 at 1 year and 10.3% vs.8.1%, P = 0.07 at 2 years).ConclusionIn this large real‐world registry, the BES with biodegradable polymer showed excellent acute and mid‐term outcomes with a 5.8% and 9% rate of MACCE at one and 2 years and a very low rate of stent thrombosis between 1 and 2 years (0.2%), thus demonstrating the replicability of the LEADERS trial in a registry population. © 2017 The Authors Catheterization and Cardiovascular Interventions Published by Wiley Periodicals, Inc.

Long-Term Outcomes of Stenting the Proximal Left Anterior Descending Artery in the PROTECT Trial

ObjectivesThis study sought to compare the outcomes of patients undergoing drug-eluting stent implantation according to lesion location within or outside the proximal left anterior descending (LAD) artery. BackgroundProximal LAD artery involvement is considered uniquely in revascularization guidelines. The impact of LAD lesion location on long-term outcomes after revascularization is poorly understood in context of current percutaneous coronary intervention and medical therapy. MethodsAmong 8,709 patients enrolled in PROTECT (Patient Related Outcomes with Endeavor Versus Cypher Stenting Trial), a multicenter percutaneous coronary intervention trial, we compared the outcomes of 2,534 patients (29.1%) (3,871 lesions [31.5%]) with stents implanted in the proximal LAD to 6,172 patients (70.9%) (8,419 lesions [68.5%]) with stents implanted outside the proximal LAD. ResultsAt the 4-year follow-up, death rates were the same (5.8% vs. 5.8%; p > 0.999), but more myocardial infarctions occurred in the proximal LAD group (6.2% vs. 4.9%; p = 0.015). The rate of clinically driven target vessel failure (TVF) (14.8% vs. 13.5%; p = 0.109), major adverse cardiac event(s) (MACE) (15.0% vs. 13.7%; hazard ratio: 1.1; 95% confidence interval: 0.97 to 1.31; p = 0.139), and stent thrombosis (2.1% vs. 2.0%; p = 0.800) were similar. Drug-eluting stent type had no interaction with MACE or TVF. In multivariate analysis, the proximal LAD was a predictor of myocardial infarction (p = 0.038) but not of TVF (p = 0.149) or MACE (p = 0.069). ConclusionsIn this study of contemporary percutaneous coronary intervention, proximal LAD location was associated with higher rates of myocardial infarction during the long-term follow-up, but there were no differences in stent thrombosis, death, TVF, or overall MACE. This finding may suggest that, in the drug-eluting stent era, proximal LAD no longer confers a different prognosis than other lesion sites. (Randomized Study Comparing Endeavor With Cypher Stents [PROTECT]; NCT00476957)

Development and Biological Evaluation of Inkjet Printed Drug Coatings on Intravascular Stent.

Inkjet-printing technology was used to apply biodegradable and biocompatible polymeric coatings of poly(d,l-lactide) with the antiproliferative drugs simvastatin (SMV) and paclitaxel (PCX) on coronary metal stents. A piezoelectric dispenser applied coating patterns of very fine droplets (300 pL) and inkjet printing was optimized to develop uniform, accurate and reproducible coatings of high yields on the stent strut. The drug loaded polymeric coatings were assed by scanning electron microscopy (SEM), atomic force microscopy (AFM), and transition thermal microscopy (TTM) where a phase separation was observed for SMV/PLA layers while PCX showed a uniform distribution within the polymer layers. Cytocompatibility studies of PLA coatings showed excellent cell adhesion with no decrease of cell viability and proliferation. In vivo stent implantation studies showed significant intrastent restenosis (ISR) for PCX/PLA and PLA plain coatings similar to marketed Presillion (bare metal) and Cypher (drug eluting) stents. The investigation of several cytokine levels after 7 days of stent deployment showed no inflammatory response and hence no in vivo cytotoxicity related to PLA coatings. Inkjet printing can be employed as a robust coating technology for the development of drug eluting stents compared to the current conventional approaches.

Sustained Efficacy and Arterial Drug Retention by a Fast Drug Eluting Cross-Linked Fatty Acid Coronary Stent Coating.

The long held assumption that sustained drug elution from stent coatings over weeks to months is imperative for clinical efficacy has limited the choice for stent coating materials. We developed and evaluated an omega-3 fatty acid (O3FA) based stent coating that is 85% absorbed and elutes 97% of its Sirolimus analog (Corolimus) load within 8d of implantation. O3FA coated stents sustained drug levels in porcine coronary arteries similarly to those achieved by slow-eluting durable coated Cypher Select Plus Stents and with significantly lower levels of granuloma formation and luminal stenosis. Computational modeling confirmed that diffusion and binding constants of Corolimus and Sirolimus are identical and explained that the sustained retention of Corolimus was facilitated by binding to high affinity intracellular receptors (FKBP12). First in man outcomes were positive-unlike Cypher stents where late lumen loss drops over 6month, there was a stable effect without diminution in the presence of O3FA. These results speak to a new paradigm whereby the safety of drug eluting stents can be optimized through the use of resorbable biocompatible coating materials with resorption kinetics that coincide with the dissociation and tissue elimination of receptor-bound drug.

Balancing Long-Term Risks of Ischemic and Bleeding Complications After Percutaneous Coronary Intervention With Drug-Eluting Stents

Although trials comparing antiplatelet strategies after percutaneous coronary intervention report average risks of bleeding and ischemia in a population, there is limited information to guide choices based on individual patient risks, particularly beyond 1 year after treatment. Patient-level data from Patient Related Outcomes With Endeavor vs Cypher Stenting Trial (PROTECT), a broadly inclusive trial enrolling 8,709 subjects treated with drug-eluting stents (sirolimus vs zotarolimus-eluting stent), and PROTECT US, a single-arm study including 1,018 subjects treated with a zotarolimus-eluting stent, were combined. The risk ofischemic events, cardiovascular death/non-periprocedural myocardial infarction (MI)/definite or probable stent thrombosis, and bleeding events, Global Use of Strategies to Open Occluded Arteries moderate or severe bleed, were predicted using logistic regression. At median follow-up of 4.1years, major bleeding occurred in 260 subjects (2.8%) and ischemic events in 595 (6.3%). Multivariate predictors of bleeding were older age, smoking, diabetes mellitus, congestive heart failure, and chronic kidney disease (all p <0.05). Ischemic events shared all the same predictors with bleeding events and gender, body mass index, previous MI, previous coronary artery bypass graft surgery, ST-segment elevation MI on presentation, stent length, and sirolimus-eluting stent use (all p <0.05). Within individual subjects, bleeding and ischemic risks were strongly correlated; 97% of subjects had a greater risk of ischemic events than bleeding. In conclusion, individual patient risks of ischemia and bleeding are related to many common risk factors, yet the predicted risks of ischemic events are greater than those of major bleeding in the large majority of patients in long-term follow-up.

Outcomes following implantation of the Biolimus A9-eluting BioMatrix coronary stent: Primary analysis of the e-BioMatrix registry.

To assess the safety and efficacy of Biolimus A9-eluting stents (BES, BioMatrix™ and BioMatrix Flex™) in routine clinical practice. The LEADERS randomized trial has documented equivalent efficacy and superior safety of the BES when compared to a first generation Sirolimus-eluting Cypher(TM) stent. 5,472 patients from 57 centers, treated with BES, were enrolled in an international multicenter registry and followed clinically up to 2 years. Mean patient age was 63.2 ± 11 years, 24% of patients had diabetes, and 49.8% presented with an acute coronary syndrome. 99.3% of patients were discharged on dual antiplatelet therapy (DAPT), 83.3% remained on DAPT at 1 year and 30.6% at 2 years. The incidence of the composite primary end point [major adverse cardiac events (MACE) at 12 months] was 4.5% [cardiac death 0.9%, myocardial infarction 1.7%, clinically indicated target vessel revascularization (ci-TVR) 2.8%]. MACE incidence was 6.8% at 24 months (cardiac death 1.5%, myocardial infarction 2.4%, ci-TVR 4.3%). At 12 months, 32 patients (0.6%) had suffered at least one definite or probable stent thrombosis (ST), and 91 patients (1.7%) a major bleed (MB). Nine patients with ST (27.3%) and 7 patients with a MB (7.7%) died during the first year after the index procedure. Between 12 and 24 months after implantation, there were 18 (0.4%) additional MB and 8 (0.2%) additional ST. This large international cohort documents a low 12 and 24 months MACE incidence and a very low ST incidence in an unselected patient population undergoing BES implantation. The results are in keeping with those of the randomized controlled LEADERS trial. Even though ST with this stent was a rare event, it was still associated with significant mortality. MB remains a problem, and warrants improved tailoring of DAPT in recipients of drug eluting stents.

Coronary Bifurcations: Still the Touchstone of Drug-eluting Stents and Bioresorbable Vascular Scaffolds?

Coronary bifurcation lesions that involve significant side branches represent a particularly challenging subset of target lesions for percutaneous coronary interventions. Besides the necessity for the interventional cardiologist to often perform technically demanding interventions with more procedural steps, clinical outcome following percutaneous coronary intervention has usually been somewhat inferior. For more than two decades, coronary bifurcation lesions represent a serious touchstone for both interventional cardiologists and various types of stents and vascular scaffolds. The use of first-generation drug-eluting stents (DES) has reduced the incidence of restenosis following percutaneous coronary intervention of bifurcation lesions as compared to bare metal stents. In a first, small-sized study by Colombo et al, a numerically lower rate of angiographic restenosis was seen in bifurcated lesions treated with a single DES in the main vessel. In the meantime, pooled data of the Nordic Bifurcation and the British Bifurcation Coronary studies, both using first-generation Cypher DES (Cordis; Waaren, New Jersey, United States), have clearly demonstrated at 9-month follow-up that clinical outcome is superior following a simple approach with provisional Tstenting of the side branch vs a complex approach. In addition, the Nordic Bifurcation study has shown that long-term outcome (up to 5 years) following bifurcation stenting with a simple approach was at least as good as the outcome of a complex approach. The aforementioned studies were performed with the first-generation Cypher stent that had a closed-cell design. The results of several in vitro studies and bench tests suggest that DES with different stent materials and designs may act differently in the setting of bifurcation stenting. Moreover, the coatings of various DES types show significant dissimilarities in mechanical properties, which may be relevant during kissing balloon inflations that apply a significant shear stress to the coatings of DES. Consequently, the assessment of clinical outcome

Stent fracture: Insights on mechanisms, treatments, and outcomes from the food and drug administration manufacturer and user facility device experience database

Stent fracture (SF) is an uncommon complication following percutaneous coronary intervention. Previous studies of SF have either been small single-center studies or have reported data mainly from first generation platforms. The FDA MAUDE database was used to identify cases of SF to gain mechanistic insight into procedural and anatomical factors predisposing to this complication, to define treatment and associated clinical outcomes in contemporary and first generation stent platforms. Using defined search terms, 376 unique reports of SF were identified in the FDA MAUDE database of which 336 (89.4%) occurred in first generation stent platforms with 96.1% occurring in the Cypher platform. The remaining 40 reports (10.6%) occurred with a similar distribution of cases across different contemporary platforms. Common vessel characteristics associated with SF included calcification, tortuosity, stent overlap, and significant angulation with the most common modality of presentation being in-stent restenosis or stent thrombosis. SF occurs most commonly in first generation Cypher stents with a similar distribution of cases across different contemporary platforms. Optimal treatment strategy remains unclear with the decision to treat and the modality of treatment utilized depending on the type and severity of SF.

First three-dimensional optical frequency domain imaging evaluation of a bioabsorbable vascular scaffold implantation in an instent-restenosis 6 years after CYPHER stenting

A 60-year-old male patient with a past history of acute ST-segment elevation myocardial infarction in 2007 and primary percutaneous coronary intervention of the right coronary artery (RCA) was referred to the Andreas Gruentzig Catheterization Laboratories for elective evaluation due to angina symptoms and a positive stress perfusion magnetic resonance imaging (MRI) with an infero-septal ischaemic burden and furthermore a reduced left …

Late Development Localized Aneurysmal Ectasia of Stented Coronary Segments after Sirolimus-Eluting Stent Placement, a Case Series

This case series reviews 3 patients who presented with aneurysmal ectasia, suggestive of pseudoaneurysms, at the site of coronary Cypher drug-eluting stents (DES) with Sirolimus as the eluting agent. We examine risk factors and possible etiologies of DES and Sirolimus related aneurysmal formation, specifically focusing on inhibited vessel healing, increased vascular wall apoptosis, as well as inflammatory and hypersensitivity reactions. We also examine various treatment options, including stenting the lesion with a Jomed covered stent. The clinical value of this report is to foster awareness of aneurysms and pseudoaneurysms as possible complications at stented coronary arteries. The patients described include a 56 year-old male with a Left Anterior Descending (LAD) aneurysmal formation 2 years after a Cypher stent placement, 54 year-old male with multiple areas of LAD ectasia at both Cypher stent sites 1 year after placement, and a 47 year-old female with LAD ectasia at the Cypher stent site 10 months after the intervention.

Computational Modelling and Analysis of Latest Commercially Available Coronary Stents During Deployment

Coronary artery disease (CAD), especially atherosclerosis is the major contributor of untimely and abrupt death of the maximum population of the world. Balloon angioplasty has become a popular choice of cardiac intervention owing to its minimal invasive quality for the treatment of stenosis. Of the various available commercial coronary stents in the market we have taken six commercial stents for our experimental study namely: PS stent, CYPHER stent (Cordis, J & J), S670 stent, Driver stent (Medtronic, USA), Taxus Express stent, Element stent (Boston Scientific, USA). Geometry modeling, meshing and computational simulation is done to mimic real life biological conditions (with assumptions). Of the total 192 simulation results, Element stent design has come up to be the better stent design among others and cobalt alloys specially cobalt alloy MP35N (ASTM F562) has shown the best performance by developing least von mises stress, in terms of material perspective.

In vivo evaluation of axial integrity of coronary stents using intravascular ultrasound: Insights on longitudinal stent deformation

To evaluate the axial integrity of different coronary stents using intravascular ultrasound (IVUS). Longitudinal stent deformation was recently reported. Consecutive patients who underwent IVUS analysis after drug-eluting stent (DES) implantation for de novo coronary lesions were evaluated. Stent length was compared with label length for calculation of absolute change and relative difference (absolute change divided by label length). A total of 233 DES utilizing five different platforms were included. The median absolute change in stent length was 0.90 mm (interquartile range [IQR] 0.48-1.39) and the relative difference was 5.24% (IQR 2.55-8.29). There was no significant difference among the groups in median absolute or relative change: Cypher 0.89 mm/3.89%, Taxus 0.88 mm/5.39%, Endeavor 1.16 mm/6.77%, Xience V 0.86 mm/5.80%, and PROMUS Element 0.79 mm/5.34% (P = 0.085, P = 0.072, respectively). Multivariate logistic regression revealed that the Cypher stent was independently correlated with a lower change in length, whereas stent label length and deployment pressure were correlated with higher absolute change. The axial integrity of DES platforms examined in vivo was high, with only mild changes in stent length after implantation. While there are differences between first- and second-generation DES, axial integrity among second-generation DES was similar.

Influence of late vascular inflammation after using first generation DES on subsequent major adverse cardiac event among patients who underwent percutaneous coronary intervention

Background: It is suggested that vascular inflammation after using drug eluting stent (DES) may associate to occurrence of subsequent stent related adverse event. However, its relationship has not been cleared, so we assessed that relationship by measurement of C-reactive protein (CRP) at 8 months after PCI in addition to pre-procedural CRP as marker of vascular inflammation. Methods: The paired CRP (pre-procedure and 8months after PCI) was available in 812 patients who underwent PCI with either using Cypher (492 patients) or TAXUS stent (320patients). Elevated CRP was defined as over 0.2mg/dl. We investigated relationship between those CRPs and occurrence of major adverse cardiac event (MACE) which comprises from all cause death, non-fatal myocardial infarction, and initially unplanned any other revascularization, and target lesion revascularization (TLR). Results: Elevated CRP was seen in 43.2% at pre-procedure, however, it was decreased to 26.8% at late phase after DES implantation. Elevated CRP at both those two times or only late onsets was seen in 16.8%, 10.0% respectively. According to the level of late phase CRP, occurrence of MACE was frequently seen in patients with elevated late phase CRP than non-elevated late phase CRP (median: 1106 days, 43.2% vs. 16.1%, P<0.0001). By multivariate analysis, late phase CRP (HR: 3.07, 95% CI: 2.31-4.07, P<0.0001),statin therapy (HR: 0.68, 95% CI: 0.50-0.93, P<0.015), and CKD (HR: 1.70, 95% CIL 1.27-2.26, P=0.0003) was independent predictor of occurrence of MACE among them. Conclusion: Late phase CRP may be useful to estimate late vascular inflammation as determinant factor of long-term outcomes among patients who underwent DES implantation. CKD might relate with that inflammation.Statin therapy is recommended for all patients.

Numerical fatigue life assessment of cardiovascular stents: A two-scale plasticity-damage model

Cardiovascular disease has become a major global health care problem in the last decades. To tackle this problem, the use of cardiovascular stents has been considered a promising and effective approach. Numerical simulations to evaluate the in vivo behavior of stents are becoming more and more important to assess potential failures. As the material failure of a stent device has been often associated with fatigue issues, numerical approaches for fatigue life assessment of stents have gained special interest in the engineering community. Numerical fatigue life predictions can be used to modify the design and prevent failure without making and testing numerous physical devices, thus preventing from undesired fatigue failures. We present a numerical fatigue life model for the analysis of cardiovascular balloon-expandable stainless steel stents that can hopefully provide useful information either to be used for product improvement or for clinicians to make life-saving decisions. This model incorporates a two-scale continuum damage mechanics model and the so-called Soderberg fatigue failure criterion. We provide numerical results for both Palmaz-Schatz and Cypher stent designs and demonstrate that a good agreement is found between the numerical and the available experimental results.

Chronic total occlusion induced by very late thrombosis in Cypher stent: a case report

Chronic total occlusion induced by very late thrombosis in Cypher stent: a case report

HEART's Original [臨床研究] 当院におけるCypherステント(シロリムス溶出性ステント)の急性期および慢性期成績:Bxステントとの比較検討

HEART's Original [臨床研究] 当院におけるCypherステント(シロリムス溶出性ステント)の急性期および慢性期成績:Bxステントとの比較検討

Provisional side branch‐stenting for coronary bifurcation lesions

To determine whether recent technical modifications have improved clinical outcomes for patients undergoing contemporary bifurcation lesion percutaneous coronary intervention (PCI). Provisional side branch (SB)-stenting has become the preferred strategy for bifurcation PCI. Newer generation drug-eluting stents (DESs), the proximal optimization technique (POT), and the use of noncompliant (NC) balloons for final kissing inflation (FKI) have the potential to optimize outcomes. We compared baseline characteristics, procedural and clinical outcomes in 300 consecutive patient pairs treated in 2005 and 2009. The primary outcome measure was the cumulative incidence of major adverse cardiac events (MACE) at 2-years. Compared to 2005, patients undergoing PCI in 2009 were at higher risk: prior myocardial infarction (18% vs. 8%, P = 0.0004), left ventricular function (EF 54 ± 13% vs. 61 ± 12%, P < 0.0001). Cypher (53 vs. 3%, P < 0.001) and Taxus (47 vs. 11%, P < 0.0001) stents were used more frequently in 2005, and Xience V in 2009 (0 vs. 47%, P < 0.0001). In 2009, the POT was performed in 36% and NC balloons used for FKI in 81%. SB stenting was required less frequently in 2009 (9% vs. 22%, P < 0.001). Two-year MACE was significantly lower in 2009 than 2005 (5.7 vs. 11.3%, P = 0.02), a difference driven by fewer cardiac deaths (2.0 vs. 5.0%, P = 0.05). MACE was independently associated with left main bifurcation treatment [hazard ratio (HR) 1.85:95%, CI 1.04-3.29; P = 0.036], side-branch stenting (HR 2.31:95% CI 1.27-4.20; P = 0.006), and PCI in 2005 (HR 1.86:95% CI 1.03-3.37; P = 0.004). Together, contemporary techniques and newer generation DES appear to improve outcomes and are both recommended for widespread uptake in patients undergoing provisional SB stenting for coronary bifurcation lesions.

Maximal expansion capacity with current DES platforms: a critical factor for stent selection in the treatment of left main bifurcations?

Left main stenting is increasingly performed and often involves deployment of a single stent across vessels with marked disparity in diameters. Knowing stent expansion capacity is critical to ensure adequate strut apposition after post-dilatation of the stent has been performed. Coronary stents are usually manufactured in only two or three different model designs with each design having a different maximal expansion capacity. Information about the different workhorse designs and their maximal achievable diameter is not commonly provided by manufacturers but, in the absence of this critically important information, stents implanted in segments with major changes in vessel diameter have the potential to become grossly overstretched and to remain incompletely apposed. We examined the differences in workhorse designs of six commercially available drug-eluting stents (DES): the PROMUS Element, Taxus Liberté, XIENCE Prime, Resolute Integrity, BioMatrix Flex and Cypher Select stents. Using micro-computed tomography, we tested oversizing capabilities above nominal pressures for the different workhorse designs of the six DES using 4.0, 5.0 and 6.0 mm post-dilatation balloons inflated to 14 atmospheres. MLD could be increased significantly in all stents, only restricted by workhorse design limitations. Minimal inner lumen diameter (MLD) achieved after two successive 6.0 mm post-dilatations of the largest design (4.0 mm stent) was 5.7 mm for the Element, 5.6 mm for the XIENCE Prime, 6.0 mm for the Taxus, 5.4 mm for the Resolute Integrity, 5.9 mm for the BioMatrix and 5.8 mm for the Cypher stent. Significant deformations were observed during stent oversizing with large changes in terms of cell opening and crowns expansion. These are affected by design structure and reveal important differences among all stents tested. Such extensive deformations may alter the functional ability of an individual stent to scaffold a lesion and prevent restenosis. Stent selection based on stent model design may be critical, particularly for treatment of large artery and left main bifurcations where overexpansion is normally required to optimise results and ensure full expansion of the stent.