Premium
Underexpansion of sirolimus‐eluting stents: Incidence and relationship to delivery pressure
Author(s) -
Cheneau Edouard,
Satler Lowell F.,
Escolar Esteban,
Suddath William O.,
Kent Kenneth M.,
Weissman Neil J.,
Waksman Ron,
Pichard Augusto D.
Publication year - 2005
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.20350
Subject(s) - medicine , stent , balloon , lumen (anatomy) , intravascular ultrasound , sirolimus , radiology , cardiology
We aimed to assess the incidence of underexpansion and the relationship between delivery pressure and expansion with sirolimus‐eluting stents. Adequate stent expansion contributes to early and late improved outcomes. In 51 patients (53 lesions) with native coronary artery narrowing, balloon‐expandable sirolimus‐eluting stents (Cypher) were serially expanded with gradual balloon inflations [14 atm, 20 atm, and in case of minimal stent cross‐sectional area (CSA)/reference lumen CSA < 50% at 20 atm, postdilatation with 0.5 mm larger balloon]. Intravascular ultrasound (IVUS) imaging was performed before intervention and after each gradual balloon inflation. Stent expansion (minimal stent CSA/reference lumen CSA) was measured. Stent expansion was 72% ± 16% after 14 atm balloon inflation, 90% ± 18% after 20 atm balloon inflation ( P < 0.001 vs. 14 atm), and 90% ± 18% at the end of the procedure (including optional postdilatations with 0.5 mm larger balloon; P = NS vs. 20 atm). Stent expansion addressed by MUSIC criteria (all struts apposed, no tissue protrusion, and final lumen CSA > 80% of the reference or > 90% if minimal lumen CSA was < 9 mm 2 ) was adequate in 15% of the cases after 14 atm balloon inflation, in 60% after 20 atm balloon inflation ( P < 0.001 vs. 14 atm), and in 60% at the end of the procedure ( P = NS vs. 20 atm). Sirolimus‐eluting stent underexpansion is common when deployed at conventional pressures. Increasing balloon delivery pressure or assessing stent expansion with IVUS seems warranted in order to ensure adequate sirolimus‐eluting stent deployment. © 2005 Wiley‐Liss, Inc.