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Narimani S, Ayati A, Tayebi A, Jalai A, Amirsardari Z, Sahebjam M, Zoroufian A. Three-dimensional transesophageal echocardiography measurements of ASD sizing parameters in comparison to balloon sizing method in percutaneous ASD closure. Echocardiography 2024; 41:e15822. [PMID: 38853621 DOI: 10.1111/echo.15822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 04/06/2024] [Accepted: 04/15/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND Balloon sizing (BS) has been used for device size selection in percutaneous atrial septal defect (ASD) closure. Due to its limitations, alternative imaging techniques like three-dimensional transesophageal echocardiography (3D-TEE) are valuable for guiding ASD device size selection during ASD closure procedures. The purpose of this study was to compare ASD sizing using measurements obtained from 3D-TEE to those utilizing the standard balloon sizing method. METHODS We identified 53 patients with single secundum type ASD without PFO who underwent percutaneous closure at the Tehran Heart Center between 2019 and 2022. Balloon sizing was performed in all patients with the stop-flow technique, and the choice of device size was determined based on the sizing derived from BS. 3D-TEE imaging was performed before the intervention, and the ASD shape and quality of ASD rims were assessed. RESULTS Among the 53 patients who underwent single ASD device closure, multiple 3D TEE measurements significantly correlated with balloon sizing results. This included defect area, perimeter, and diameter obtained from 3D-TEE images multi-planar reconstruction. ASD perimeter detected by 3D TEE had the best correlation with BS results. When divided by the shape of ASD, there was no significant difference between our 3D-images data and BS in round or oval-shaped ASDs. CONCLUSION The 3D-TEE study is reliable for assessing ASD configurational characteristics in percutaneous device closure candidates. 3D-TEE has the potential to accurately determine the appropriate device size and reduce complications, costs, and procedural duration. Further research is needed to validate these findings and establish the role of 3D-TEE measurements in guiding the best treatment decisions for ASD closure.
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Affiliation(s)
- Sima Narimani
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Advanced Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Aryan Ayati
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirhossein Tayebi
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Jalai
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Amirsardari
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Sahebjam
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Advanced Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arezou Zoroufian
- Tehran Heart Center, Cardiovascular Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Advanced Echocardiography, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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Gajewski T, Szajek K, Stȩpak H, Łodygowski T, Oszkinis G. The influence of the nylon balloon stiffness on the efficiency of the intra-aortic balloon occlusion. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2019; 35:e3173. [PMID: 30447053 DOI: 10.1002/cnm.3173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 09/10/2018] [Accepted: 11/08/2018] [Indexed: 06/09/2023]
Abstract
In interventional procedures, the balloon inflation is used to occlude the artery and thus reduce bleeding. There is no practically accepted measure of the procedure efficiency. A finite element method model with state-of-the-art modelling techniques was built in order to predict the occlusion levels under the influence of different balloon inflation and its material stiffness. The geometries of a healthy human thoracic aorta and an occlusion balloon were idealized. The non-linear constitutive material of Gasser-Ogden-Holzapfel model was employed for the thoracic aorta; the balloon was model as the hyperelastic model. The realistic physiological blood pressure and the balloon inflation pressures were applied to simulate the different occlusion levels. The final outcome shows an important influence of the material stiffness on the balloon deformation and thus the occlusion efficiency.
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Affiliation(s)
- Tomasz Gajewski
- Institute of Structural Engineering, Poznań University of Technology, Poznań, Poland
| | - Krzysztof Szajek
- Institute of Structural Engineering, Poznań University of Technology, Poznań, Poland
| | - Hubert Stȩpak
- Department of Vascular and Endovascular Surgery, Angiology, and Phlebology, Poznań University of Medical Sciences, Poznań, Poland
| | - Tomasz Łodygowski
- Institute of Structural Engineering, Poznań University of Technology, Poznań, Poland
| | - Grzegorz Oszkinis
- Department of General and Vascular Surgery, Poznań University of Medical Sciences, Poznań, Poland
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Svendsen MC, Akingba AG, Sinha AK, Chattin B, Turner A, Brass M, Bhatt DL, Kassab GS. Conductance sizing balloon for measurement of peripheral artery minimal stent area. J Vasc Surg 2013; 60:759-66. [PMID: 23992994 DOI: 10.1016/j.jvs.2013.06.095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 06/25/2013] [Accepted: 06/29/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Because stent underdeployment occurs frequently, accurate minimal stent area (MSA) measurement during postdilatation is necessary. This study investigated the accuracy and repeatability for MSA determination using a novel conductance balloon (CB) catheter for peripheral vessels. METHODS The CB catheter is a standard balloon catheter that measures electrical conductance (ratio of current/voltage drop) in real-time during inflation, which directly relates to the balloon cross-sectional area through Ohm's law. CB measurements were made in 4- to 10-mm phantoms on the bench, ex vivo in stents fully deployed in diseased human peripheral arteries, and in vivo in stents fully deployed in peripheral vessels in six swine. CB measurement accuracy and repeatability were calculated and compared with the known dimension (bench phantoms) or with intravascular ultrasound (IVUS) measurement after stent deployment (ex vivo and in vivo). RESULTS CB measurements were highly accurate (error: 1.8% bench, 5% ex vivo, and 5% in vivo) and repeatable (error: 0.9% bench, 1.8% ex vivo, and 1.3% in vivo), with virtually no bias (average difference in measurements: -0.05 mm bench CB vs known phantom diameters, -0.06 mm ex vivo CB vs IVUS, and -0.11 mm in vivo CB vs IVUS). CONCLUSIONS The CB sizing capability can be integrated within a standard balloon catheter (two-in-one function) to provide accurate, real-time assessment of MSA to ensure full stent apposition rather than the use of pressure as a surrogate for size.
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Affiliation(s)
- Mark C Svendsen
- Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, Ind
| | - A George Akingba
- Department of Surgery, Indiana University-Purdue University Indianapolis, Indianapolis, Ind
| | - Anjan K Sinha
- Department of Cardiology, Indiana University-Purdue University Indianapolis, Indianapolis, Ind
| | - Brooke Chattin
- Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, Ind
| | - Amelia Turner
- Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, Ind
| | - Margaret Brass
- Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, Ind
| | - Deepak L Bhatt
- VA, Boston Healthcare System, Brigham and Women's Hospital, and Harvard Medical School, Boston, Mass
| | - Ghassan S Kassab
- Department of Biomedical Engineering, Indiana University-Purdue University Indianapolis, Indianapolis, Ind; Department of Surgery, Indiana University-Purdue University Indianapolis, Indianapolis, Ind; Department of Cellular and Integrative Physiology, Indiana University-Purdue University Indianapolis, Indianapolis, Ind.
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Chacko Y, Haladyn JK, Smith DM, Lim R. Compliance charts to guide non-complex small artery stenting: validation by quantitative coronary angiography. HEART ASIA 2013; 5:76-9. [PMID: 27326085 DOI: 10.1136/heartasia-2013-010312] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Accepted: 05/05/2013] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine whether stent sizing derived from manufacturers' compliance charts provides a reasonable in vivo estimate of final minimum lumen diameter (MLD) when compared with quantitative coronary angiography (QCA). DESIGN Single-centre measurement comparison study. SETTING Tertiary referral university hospital. PATIENTS Fifty cases receiving a single stent for non-complex de novo stenosis were randomly selected from the percutaneous coronary intervention database of our high-volume centre. Restenosis, stent thrombosis, bifurcational disease, rotablation, left main or graft stenting, intravascular ultrasound or kissing balloon inflations were exclusion criteria. MAIN OUTCOME MEASURES Equality and limits of agreement (LOA) between compliance chart and QCA measurements of final MLD, especially focusing on patients with small stents<3 mm. The paired t test and Bland-Altman plots were used to compare measurements. RESULTS There was no significant difference between compliance chart-derived and QCA final MLD (n=50; mean -0.034 mm, SD 0.35, 95% CI -0.132 to +0.064; p=0.49), with reasonable Bland-Altman LOA between the two methods of assessing final MLD in the overall group (LOA -0.72 to +0.66 mm), as well as in the group of particular interest with Derived final MLD <3 mm (n=30; mean 0.019 mm, SD 0.27, 95% CI -0.082 to +0.119; p=0.71; LOA -0.52 to +0.56 mm). CONCLUSIONS Compliance charts provide an acceptable estimate of final MLD and are a reasonable guide to sizing during non-complex stenting, especially in small vessels <3 mm.
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Affiliation(s)
- Yohan Chacko
- Department of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - J Kimberly Haladyn
- Department of Medicine , The University of Queensland , Brisbane, Queensland , Australia
| | - Debbie M Smith
- Department of Cardiology , Princess Alexandra Hospital , Brisbane, Queensland , Australia
| | - Richard Lim
- Department of Medicine, The University of Queensland, Brisbane, Queensland, Australia; Department of Cardiology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
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He Y, Maehara A, Mintz GS, Bharaj H, Castellanos C, Kesanakurthy S, Wu X, Guo N, Choi SY, Leon MB, Stone GW, Mehran R, Rabbani LE, Moses JW. Intravascular ultrasound assessment of cobalt chromium versus stainless steel drug-eluting stent expansion. Am J Cardiol 2010; 105:1272-5. [PMID: 20403478 DOI: 10.1016/j.amjcard.2009.12.042] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2009] [Revised: 12/14/2009] [Accepted: 12/14/2009] [Indexed: 01/21/2023]
Abstract
It is not clear whether the thin struts and different alloy of a cobalt chromium stent will cause greater acute stent recoil compared to conventional stainless steel stents. We used postintervention intravascular ultrasound (IVUS) examinations to study 99 patients with 116 stented lesions: 61 Xience/Promus stents (cobalt chromium stent group) and 27 Taxus Liberté and 28 Cypher stents (stainless steel stent group). The IVUS images were obtained before and immediately after stent implantation with only the stent-delivery balloon. The ratio of the IVUS-measured to manufacturer-predicted stent diameter and area was the measure of acute stent recoil and expansion. The baseline patient characteristics, lesion morphology, and procedural details were comparable between the 2 groups. The ratio of the IVUS-measured to manufacturer-predicted stent diameter and area was 0.74 versus 0.73 (p = 0.57) and 0.63 versus 0.63 (p = 0.69), respectively, for the cobalt chromium and stainless steel stents. In conclusion, the acute performance of Xience/Promus was similar to that of previous stainless steel stents, and the thinner cobalt chromium metallic platform did not compromise the radial strength of the stent.
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Bertrand OF. Inflation time and drug-eluting stent: the longer, the better... Catheter Cardiovasc Interv 2009; 73:212-3. [PMID: 19156881 DOI: 10.1002/ccd.21957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Olivier F Bertrand
- Interventional Cardiology Laboratories, Laval Hospital, Quebec Heart-Lung Institute, Quebec, Canada.
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Is adjunctive balloon postdilatation necessary with drug-eluting stents? One center experience in Chinese patients. Chin Med J (Engl) 2008. [PMID: 18364137 DOI: 10.1097/00029330-200803020-00009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Romagnoli E, Sangiorgi GM, Cosgrave J, Guillet E, Colombo A. Drug-Eluting Stenting. JACC Cardiovasc Interv 2008; 1:22-31. [DOI: 10.1016/j.jcin.2007.10.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2007] [Revised: 10/16/2007] [Accepted: 10/25/2007] [Indexed: 02/02/2023]
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Aziz S, Morris JL, Perry RA, Stables RH. Stent expansion: a combination of delivery balloon underexpansion and acute stent recoil reduces predicted stent diameter irrespective of reference vessel size. Heart 2007; 93:1562-6. [PMID: 17483130 PMCID: PMC2095749 DOI: 10.1136/hrt.2006.107052] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND There is a strong inverse relationship between final vessel diameter and subsequent risk of treatment failure after coronary stent deployment. The aim of this study was to investigate the magnitude by which stent delivery balloon underexpansion and stent elastic recoil contributed to suboptimal final vessel geometry. METHODS A prospective angiographic study recruiting 499 lesions (385 patients) undergoing coronary stent implantation was performed. Quantitative coronary angiography (QCA) was used to measure the minimal lumen diameters of the delivery balloon during stent deployment (MLD1) and of the stented segment following balloon deflation (MLD2). The expected balloon diameter for the deployment pressure was determined from the manufacturer's reference chart. Delivery balloon deficit was measured by subtracting the MLD1 from the expected balloon size and stent recoil was calculated by subtracting MLD2 from MLD1. Delivery balloon deficit and stent recoil were examined as a function of reference vessel diameter (RVD) and balloon-vessel (BV) ratio. RESULTS The final stent MLD was a mean 27.2% (SD = 7.2) less than the predicted diameter. The mean delivery balloon deficit was 0.65 mm (SD = 0.27) and the mean stent recoil was 0.28 mm (SD = 0.17). Percentage delivery balloon deficit and stent recoil were independent of RVD. Delivery balloon deficit increased with higher BV ratios. Stent recoil was independent of BV ratio and the use of predilatation. CONCLUSION Failure to achieve predicted final stent diameter is a real problem with contribution from delivery balloon underexpansion and stent recoil. On average the final stent MLD is only 73% of the expected diameter, irrespective of vessel size.
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Affiliation(s)
- Shahid Aziz
- Department of Cardiology, Royal Blackburn Hospital, Haslingden Road, Blackburn, Lancashire BB2 3HH, UK.
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de Ribamar Costa J, Mintz GS, Carlier SG, Fujii K, Sano K, Kimura M, Tanaka K, Costa RA, Lui J, Na Y, Castellanos C, Biro S, Moussa I, Stone GW, Moses JW, Leon MB. Intravascular ultrasound assessment of drug-eluting stent expansion. Am Heart J 2007; 153:297-303. [PMID: 17239693 DOI: 10.1016/j.ahj.2006.08.026] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2006] [Accepted: 08/02/2006] [Indexed: 11/24/2022]
Abstract
BACKGROUND In the drug-eluting stent (DES) era, stent expansion remains an important predictor of restenosis and subacute thrombosis. Compliance charts are developed to predict final minimum stent diameter (MSD) and area (MSA). The objectives of the study were (1) to assess DES expansion by comparing intravascular ultrasound (IVUS)-measured MSD and MSA against the values predicted by compliance charts and (2) to compare each DES against its bare-metal stent (BMS) equivalent. METHODS We enrolled 200 patients with de novo coronary lesions treated with single, >2.5-mm Cypher (Cordis, Johnson & Johnson, Miami Lakes, FL) (sirolimus-eluting stent [SES], 133 patients) or Taxus (Boston Scientific, Natick, MA) (paclitaxel-eluting stent [PES], 67 patients) stent under IVUS guidance without another postdilation balloon. We used a comparison cohort of 65 equivalent BMS (Express 2 [Boston Scientific], 37 patients; Bx Velocity [Cordis, Johnson & Johnson], 28 patients) deployed under similar conditions. RESULTS The DES achieved only 75% +/- 10% of predicted MSD and 66% +/- 17% of predicted MSA; this was similar for SES and PES. Furthermore, 24% of SES and 28% of PES did not achieve a final MSA of 5 mm(2), a consistent predictor of DES failure. The SES achieved 75% +/- 10% of predicted MSA versus 75% +/- 9% for Bx Velocity (P = .9). The PES achieved 79.9% +/- 14% of predicted MSA versus 79% +/- 10% for Express 2 (P = .8). Lesion morphology, arc and length of calcium, stent diameter and length, and implantation pressures did not affect expansion. CONCLUSIONS Compliance charts fail to predict final MSD and MSA. A considerable percentage of DES does not achieve minimum standards of stent expansion. The SES and PES achieve similar expansion to their BMS platform, indicating that the polymer coating does not affect DES expansion in vivo. However, stent expansion cannot be predicted from preintervention IVUS lesion assessment.
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Affiliation(s)
- Jose de Ribamar Costa
- Cardiovascular Research Foundation and Columbia University Medical Center, New York, NY, USA
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Lozano I, López-Palop R, Pinar E, Pérez-Lorente F, Picó F, Valdés M. Comparación entre dimensiones teóricas y reales del stent intracoronario en lesiones no complejas. Rev Esp Cardiol 2006. [DOI: 10.1157/13089751] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Brodie BR. Adjunctive Balloon Postdilatation after Stent Deployment: Is It Still Necessary with Drug-Eluting Stents? J Interv Cardiol 2006; 19:43-50. [PMID: 16483339 DOI: 10.1111/j.1540-8183.2006.00103.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Deployment of bare metal stents (BMS) with current stent delivery systems is often associated with suboptimal stent expansion. Adjunctive postdilatation with noncompliant balloons has improved stent expansion with BMS and has been associated with less need for target vessel revascularization (TVR). Drug-eluting stents (DES) have proven highly effective in reducing restenosis and TVR and are now being used in the great majority of percutaneous coronary interventions. Because of the very low rates of TVR with DES, many operators have felt that postdilatation may no longer be necessary. In this review, we present data showing that stent expansion of DES (like BMS) using current stent delivery systems is frequently suboptimal. Furthermore, smaller mimimal stent area (MSA) and stent underexpansion following deployment of DES are strong predictors of stent thrombosis and TVR. Adjunctive postdilatation with noncompliant balloons can increase MSA and decrease the frequency of suboptimal stent deployment and potentially can reduce the frequency of stent thrombosis and TVR. Despite the lack of evidence from randomized clinical trials, we believe the observational data support the use of adjunctive balloon postdilatation following deployment of DES in the great majority of patients.
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Affiliation(s)
- Bruce R Brodie
- Moses Cone Heart and Vascular Center, LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina 27401, USA
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de Ribamar Costa J, Mintz GS, Carlier SG, Costa RA, Fujii K, Sano K, Kimura M, Lui J, Weisz G, Moussa I, Dangas G, Mehran R, Lansky AJ, Kreps EM, Collins M, Stone GW, Moses JW, Leon MB. Intravascular ultrasonic assessment of stent diameters derived from manufacturer's compliance charts. Am J Cardiol 2005; 96:74-8. [PMID: 15979438 DOI: 10.1016/j.amjcard.2005.02.049] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2005] [Revised: 02/18/2005] [Accepted: 02/18/2005] [Indexed: 11/16/2022]
Abstract
We used intravascular ultrasound (IVUS) to assess the accuracy of manufacturers' stent balloon compliance charts. Many interventional cardiologists rely on manufacturers' compliance charts to select stent size and optimize stent diameters according to inflation pressures during percutaneous procedures. We randomly selected 212 patients who had de novo coronary lesions that had been treated with a single, bare metal, > or =3.0-mm stent (Bx velocity, NIR, TETRA/PENTA, S660/S670/S7) under IVUS guidance. Cases of stent overlap and postdilatation with another balloon were excluded. Predicted stent diameters were derived from each manufacturer's compliance charts, and stent size and final maximal deployment pressures were derived from each physician's report. IVUS-measured minimum stent diameters (range 1.4 to 4.0 mm, mean 2.79 +/- 0.48) were smaller than predicted diameters (range 3.1 to 4.57 mm, mean 3.79 +/- 0.44). The ratio of IVUS to predicted diameters ranged from 44% to 97% (mean 74 +/- 10%). This finding was common to all 3 stent sizes: 74 +/- 12% for 3.0 mm, 73 +/- 9% for 3.5 mm, and 74 +/- 9% for 4.0-mm stents (p = 0.9). This finding was also common to all 4 stent manufacturers, 72 +/- 8% for Boston Scientific, 76 +/- 11% for Guidant, 73 +/- 9% for Cordis, and 74 +/- 11% for Medtronic (p = 0.13), and to different stent lengths. Only 3.8% of the stents achieved 90% of the predicted minimum stent diameters, and only 24.6% achieved 80% of the predicted minimum stent diameters. In conclusion, in human coronary arteries, minimal stent diameter measured by IVUS is significantly smaller than that predicted by in vitro compliance charts. These differences are independent of stent manufacturer, length, diameter, and deployment pressure.
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Brodie BR, Cooper C, Jones M, Fitzgerald P, Cummins F. Is adjunctive balloon postdilatation necessary after coronary stent deployment? Final results from the POSTIT trial. Catheter Cardiovasc Interv 2003; 59:184-92. [PMID: 12772236 DOI: 10.1002/ccd.10474] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Early-generation balloon-expandable stents required postdilatation with noncompliant balloons at high pressure to optimize stent deployment. The need for adjunctive balloon postdilatation with modern stent delivery systems is unknown. Patients undergoing elective stenting were randomized to Boston Scientific NIR, Guidant Tri-Star/Tetra, and Medtronic AVE S670 stents. The primary endpoint was optimum stent deployment defined as a minimal stent diameter (MSD) >/= 90% of the average reference lumen diameter assessed by intravascular ultrasound (IVUS) performed immediately following stent deployment. If, by operator assessment, the primary endpoint was not achieved with the stent delivery system, adjunctive postdilatation with noncompliant balloons was performed. Of 256 patients with IVUS studies adequate for core laboratory analysis, only 29% achieved optimum stent deployment with the stent delivery system. None of the baseline clinical or angiographic variables predicted optimum stent deployment. Of the procedural variables, the type of stent and nominal stent size were not predictors, but higher deployment pressures were associated with a higher frequency of optimum stent deployment (< 12 atm 14% vs. >/= 12 atm 36%; P = 0.007). The inability to achieve optimum stent deployment was not due to undersizing the stent delivery balloon, but rather to an inability of the stent delivery balloon to expand fully the stent to nominal size. In patients who underwent postdilatation, the frequency of achieving optimum stent deployment increased from 21% to 42%, minimal stent area increased from 6.6 +/- 2.2 to 7.8 +/- 2.3 mm(2), and MSD increased from 2.6 +/- 0.5 to 2.8 +/- 0.4 mm. These data stress the continued need for adjunctive balloon postdilatation with modern stent delivery systems. Cathet Cardiovasc Intervent 2003;59:184-192.
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Affiliation(s)
- Bruce R Brodie
- LeBauer Cardiovascular Research Foundation, Greensboro, North Carolina 27403, USA.
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