Skip to main content
Log in

Clinical, angiographic and procedural characteristics of longitudinal stent deformation

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Recently, longitudinal stent deformation (LSD) has been reported increasingly. Even though the reported cases included almost all stent designs, most cases were seen in the Element™ stent design (Boston Scientific, Natick, MA, USA). It is considered that stent design, lesion and procedural characteristics play a role in the etiology of LSD. Yet, the effect of LSD on long-term clinical outcomes has not been studied well. Element stents implanted between January 2013 and April 2015 in our hospital were examined retrospectively. Patients were grouped into two according to the presence of LSD, and their clinical, lesion and procedural characteristics were studied. Twenty-four LSD’s were detected in 1812 Element stents deployed in 1314 patients (1.83 % of PCI cases and 1.32 % of all Element stents). LMCA lesions (16.7 % vs 1.6 %, p < 0.001), complex lesions (75 % vs 35.1 %, p < 0.001), bifurcation lesions (37.5 % vs 18.3 %, p = 0.017), ostial lesions (33.3 % vs 12.8 %, p = 0.003), using of extra-support guiding catheter (54.2 % vs 22.3 %, p < 0.001) and extra-support guidewire (37.5 % vs 16.2 %, p = 0.005) were found to be more frequent in cases with LSD than in cases without it. In addition, the number of stents, stent inflation pressure and the use of post-dilatation were significantly different between the two groups. Two patients had an adverse event during the follow-up period. LSD is a rarely encountered complication, and is more common in complex lesions such as ostial, bifurcation and LMCA lesions. The use of extra-support guiding catheter, extra-support guidewires and low stent inflation pressure increases the occurrence of LSD. Nevertheless, with increased awareness of LSD and proper treatment, unwanted long-term outcomes can be successfully prevented.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Serruys PW, Silber S, Garg S, van Geuns RJ, Richardt G, Buszman PE, Kelbaek H, van Boven AJ, Hofma SH, Linke A, Klauss V, Wijns W, Macaya C, Garot P, DiMario C, Manoharan G, Kornowski R, Ischinger T, Bartorelli A, Ronden J, Bressers M, Gobbens P, Negoita M, van Leeuwen F, Windecker S (2010) Comparison of zotarolimus-eluting and everolimus-eluting coronary stents. N Engl J Med 363:136–146

    Article  CAS  PubMed  Google Scholar 

  2. Stone GW, Midei M, Newman W, Sanz M, Hermiller JB, Williams J, Farhat N, Mahaffey KW, Cutlip DE, Fitzgerald PJ, Sood P, Su X, Lansky AJ, SPIRIT III Investigators (2008) Comparison of an everolimus-eluting stent and a paclitaxel-eluting stent in patients with coronary artery disease: a randomized trial. J Am Med Assoc 299:1903–1913

    Article  CAS  Google Scholar 

  3. Williams PD, Mamas MA, Morgan KP, El-Omar M, Clarke B, Bainbridge A, Fath-Ordoubadi F, Fraser DG (2012) Longitudinal stent deformation: a retrospective analysis of frequency and mechanisms. EuroIntervention 8(2):267–274

    Article  PubMed  Google Scholar 

  4. Mamas MA, Williams PD (2012) Longitudinal stent deformation: insights on mechanisms, treatments and outcomes from the Food and Drug Administration Manufacturer and User Facility Device Experience database. EuroIntervention 8(2):196–204

    Article  PubMed  Google Scholar 

  5. Ormiston JA, Webber B, Webster MWI (2011) Stent longitudinal integrity. Bench insights into a clinical problem. J Am Coll Cardiol Cardiovasc Interv 4:1310–1317

    Article  Google Scholar 

  6. Prabhu S, Schikorr T, Mahmoud T, Jacobs J, Potgieter A, Simonton C (2012) Engineering assessment of the longitudinal compression behavior of contemporary coronary stents. EuroIntervention 8:275–281

    Article  PubMed  Google Scholar 

  7. Shannon J, Latib A, Takagi K, Chieffo A, Figini F, Sacco F, Ferrarello S, Montorfano M (2013) Procedural trauma risks longitudinal shortening of the Promus Element™ stent platform. Catheter Cardiovasc Interv 81(5):810–817

    Article  PubMed  Google Scholar 

  8. Levine GN, Bates ER, Blankenship JC, Bailey SR, Bittl JA, Cercek B, Chambers CE, Ellis SG, Guyton RA, Hollenberg SM, Khot UN, Lange RA, Mauri L, Mehran R, Moussa ID, Mukherjee D, Nallamothu BK, Ting HH American College of Cardiology Foundation; American Heart Association Task Force on Practice Guidelines; Society for Cardiovascular Angiography and Interventions.(2011) 2011 ACCF/AHA/SCAI guideline for percutaneous coronary intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions. J Am Coll Cardiol 58(24):e44–e122

    Article  PubMed  Google Scholar 

  9. Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A (2014) 2014 ESC/EACTS guidelines on myocardial revascularization: the Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 35(37):2541–2619

    Article  PubMed  Google Scholar 

  10. Hanratty CG, Walsh SJ (2011) Longitudinal compression: a “new” complication with modern coronary stent platfroms—time to think beyond deliverability? EuroIntervention 7:872–877

    Article  PubMed  Google Scholar 

  11. Leibundgut G, Gick M, Toma A, Valina C, Löffelhardt N, Büttner HJ, Neumann FJ (2013) Longitudinal compression of the platinum-chromium everolimus-eluting stent during coronary implantation: predisposing mechanical properties, incidence, and predictors in a large patient cohort. Catheter Cardiovasc Interv 81(5):E206–E214

    Article  PubMed  Google Scholar 

  12. Seth A, Dhall A (2013) Longitudinal stent shortening: the long and short of it!! Catheter Cardiovasc Interv 81(5):818–819

    Article  PubMed  Google Scholar 

  13. Kirma C, Esen AM (eds) (2014) From diagnosis to treatment—percutaneous coronary interventions, 1st edn. Akademi yayınevi, Istabul

  14. Colombo A, Stankovic G (2007) Problem oriented approaches in interventional cardiology, 1st edn. Informa UK Ltd., Colchester, pp 9–19

  15. Sayar N (2014) Stenting. In Kirma C, Esen AM (eds) From diagnosis to treatment—percutaneous coronary interventions, 1st edn. Akademi yayınevi, Istabul, pp 174–186

  16. Arnous S, Shakhshir N, Wiper A, Ordoubadi FF, Williams P, Clarke B, Mahadavan V, El-Omar M, Mamas M, Fraser D (2015) Incidence and mechanisms of longitudinal stent deformation associated with biomatrix, resolute, element, and xience stents: angiographic and case-by-case review of 1,800 PCIs. Catheter Cardiovasc Interv 86(6):1002–1011

    Article  PubMed  Google Scholar 

  17. Menown IBA, Noad R, Garcia EJ, Meredith I (2010) The platinum chromium element stent platform: from alloy, to design, to clinical practice. Adv Ther 27:129–141

    Article  CAS  PubMed  Google Scholar 

  18. Abdel-Wahab M, Sulimov DS, Kassner G, Geist V, Toelg R, Richardt G (2012) Longitudinal deformation of contemporary coronary stents: an integrated analysis of clinical experience and observations from the bench. J Interv Cardiol 25(6):576–585

    Article  PubMed  Google Scholar 

  19. Stone GW, Teirstein PS, Meredith IT, Farah B, Dubois CL, Feldman RL, Dens J, Hagiwara N, Allocco DJ, Dawkins KD, PLATINUM Trial Investigators (2011) A prospective, randomized evaluation of a novel everolimus-eluting coronary stent: the PLATINUM (a Prospective, Randomized, Multicenter Trial to Assess an Everolimus-Eluting Coronary Stent System [PROMUS Element] for the treatment of up to two de novo coronary artery lesions) trial. J Am Coll Cardiol 57:1700–1708

    Article  CAS  PubMed  Google Scholar 

  20. Allocco DJ, Cannon LA, Britt A, Heil JE, Nersesov A, Wehrenberg S, Dawkins KD, Kereiakes DJ (2010) A prospective evaluation of the safety and efficacy of the TAXUS Element paclitaxel-eluting coronary stent system for the treatment of de novo coronary artery lesions: design and statistical methods of the PERSEUS clinical program. Trials 11:1

    Article  PubMed  PubMed Central  Google Scholar 

  21. Kereiakes DJ, Popma JJ, Cannon LA, Kandzari DE, Kimmelstiel CD, Meredith IT, Teirstein PS, Verheye S, Allocco DJ, Dawkins KD, Stone GW (2012) Longitudinal stent deformation: quantitative coronary angiographic analysis from the PERSEUS and PLATINUM randomised controlled clinical trials. EuroIntervention 8(2):187–195

    Article  PubMed  Google Scholar 

  22. Chung MS, Yang DH, Kim YH, Roh JH, Song J, Kang JW, Ahn JM, Park DW, Kang SJ, Lee SW, Lee CW, Park SW, Park SJ, Lim TH (2016) Stent fracture and longitudinal compression detected on coronary CT angiography in the first- and new-generation drug-eluting stents. Int J Cardiovasc Imaging 32(4):637–646

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to A. Guler.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guler, A., Guler, Y., Acar, E. et al. Clinical, angiographic and procedural characteristics of longitudinal stent deformation. Int J Cardiovasc Imaging 32, 1163–1170 (2016). https://doi.org/10.1007/s10554-016-0905-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-016-0905-1

Keywords

Navigation