Abstract
Background
Incomplete stent expansion and inadequate apposition predispose to stent thrombosis following percutaneous coronary intervention. Recent studies have shown that increasing the duration of balloon inflation during stent employment was beneficial. Thus, the balloon inflation time required for optimal stent expansion and apposition in patients receiving second-generation drug-eluting stents (DES) were determined using optical coherence tomography (OCT).
Patients and methods
Between April 2014 and March 2015, 38 patients (28 men, 10 women; mean age 60.5 ± 11.4 years) with stable angina pectoris due to single significant de novo coronary artery stenosis were prospectively enrolled. All patients were administered aspirin and clopidogrel and received weight-adjusted intravenous unfractionated heparin. Images of basal lesions were obtained using the C7XR LightLab Dragonfly OCT catheter.
Results
Expansion and apposition parameters improved with increasing duration of balloon inflation (30 s or 60 s) with nominal pressure (12 atm). Mean lesion length was 19.8 ± 7.6 mm. Mean stent diameter and length were 2.8 ± 0.36 mm and 24.9 ± 7.6 mm, respectively.
Conclusion
With deployment of a stent at nominal pressure with conventional duration, inadequate stent expansion and malapposition frequently occurred as detected by OCT; however, a balloon inflation duration of 60 s markedly improved stent expansion and apposition parameters without significant complications.
Zusammenfassung
Hintergrund
Die unvollständige Stentexpansion und unzureichende Apposition prädisponieren für eine Stentthrombose nach perkutaner Koronarintervention. In aktuellen Studien wirkte sich eine Verlängerung der Balloninsufflationszeit während der Stentimplantation positiv aus. Daher wurde mithilfe der optischen Kohärenztomographie (OCT) die Balloninsufflationszeit bestimmt, die für eine optimale Stentexpansion und -apposition bei Implantation von medikamentenfreisetzenden Stents („drug-eluting stents“ [DES]) der zweiten Generation erforderlich ist.
Patienten und Methoden
Von April 2014 bis März 2015 wurden 38 Patienten (28 Männer, 10 Frauen; Durchschnittsalter 60,5 ± 11,4 Jahre) mit stabiler Angina pectoris aufgrund einer einzelnen signifikanten De-novo-Koronarstenose prospektiv eingeschlossen. Alle Patienten erhielten Acetylsalicylsäure, Clopidogrel und gewichtsadaptiert unfraktioniertes Heparin intravenös. Bilder der grundlegenden Läsionen wurden mit dem C7XR-LightLab-Dragonfly-OCT-Katheter angefertigt.
Ergebnisse
Die Expansions- und Appositionsparameter verbesserten sich mit zunehmender Dauer der Balloninsufflation (30 s oder 60 s) bei Nenndruck (12 atm). Die mittlere Läsionslänge betrug 19,8 ± 7,6 mm. Der mittlere Stentdurchmesser lag bei 2,8 ± 0,36 mm, die mittlere Länge bei 24,9 ± 7,6 mm.
Schlussfolgerung
Wie die OCT-Aufnahmen zeigten, kam es häufig zu einer unzureichenden Stentexpansion und Stentmalapposition, wenn ein Stent bei Nenndruck mit gängiger Dauer implantiert wurde. Eine Balloninsufflationszeit von 60 s verbesserte dagegen deutlich die Stentexpansions- und Stentappositionsparameter ohne erhebliche Komplikationen.
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O. Tasar, A.K. Karabay, C.Y. Karabay, S. Kalkan, G. Cinier, I.H. Tanboga, A.I. Izgi and C. Kırma declare that they have no competing interests.
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Tasar, O., Karabay, A.K., Karabay, C.Y. et al. Optical coherence tomography-verified longer balloon inflation time may provide better stent apposition and optimal index parameters. Herz 45, 369–374 (2020). https://doi.org/10.1007/s00059-018-4738-7
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DOI: https://doi.org/10.1007/s00059-018-4738-7
Keywords
- Percutaneous coronary interventions
- Coronary artery stenosis
- Myocardial ischemia
- Thrombosis
- Myocardial infarction