Abstract
Drug-eluting stent (DES) expansion characteristics after aggressive high-pressure post-dilation using a non-compliant (NC) balloon have not been fully investigated. We evaluated 58 patients with native coronary lesions treated with DESs [24 paclitaxel eluting stents (PES) and 34 sirolimus-eluting stents (SES)]. After post-dilation (12–14 atm) using a stent-mounted semi-compliant balloon to reduce stent edge injury, adjuvant high-pressure post-dilation using NC balloon was performed within the stents. Stent size, stent length, and NC balloon size were selected based on preinterventional intravascular ultrasound (IVUS) assessment. Stent underexpansion was defined according to criteria of the Multicenter Ultrasound Stenting in Coronaries (MUSIC) study as a minimal stent cross-sectional area <90% of the average reference lumen area. Resultant endpoint was to obtain optimal stent expansion. Serial changes of stent expansion and stent symmetry were calculated in each group. After stent-mounted semi-compliant balloon post-dilation, both stents could not achieve adequate percent stent expansion (PES 73 ± 18% vs. SES 67 ± 9%, p = 0.38). After high-pressure post-dilation using an NC balloon, percent stent expansion was 97 ± 14% in PES and 91 ± 13% in SES, respectively (p = 0.25). Axial stent symmetry indices also significantly improved in both groups. Although radial stent symmetry indices improved significantly in PES group, those in the SES group had no significant changes. Finally, frequency of stent underexpansion significantly reduced, 87–20% in PES and 92–15% in SES, respectively (p = 0.01) without any significant stent edge injury. DES expansion improved safely after adjuvant high-pressure post-dilation using an NC balloon under IVUS guidance.
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References
Morice MC, Serruys PW, Sousa JE, Fajadet J, Ban Hayashi E, Perin M, Colombo A, Schuler G, Barragan P, Guagliumi G, Molnar F, Falotico R (2002) A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization. N Engl J Med 346:1773–1780
Stone GW, Ellis SG, Cox DA, Hermiller J, O’Shaughnessy C, Mann JT, Turco M, Caputo R, Bergin P, Greenberg J, Popma JJ, Russell ME (2004) A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med 350:221–231
Cheneau E, Leborgne L, Mintz GS, Kotani J, Pichard AD, Satler LF, Canos D, Castagna M, Weissman NJ, Waksman R (2003) Predictors of subacute stent thrombosis: results of a systematic intravascular ultrasound study. Circulation 108:43–47
Cutlip DE, Chauhan MS, Baim DS, Ho KK, Popma JJ, Carrozza JP, Cohen DJ, Kuntz RE (2002) Clinical restenosis after coronary stenting: perspectives from multicenter clinical trials. J Am Coll Cardiol 40:2082–2089
Sonoda S, Morino Y, Ako J, Terashima M, Hassan AH, Bonneau HN, Leon MB, Moses JW, Yock PG, Honda Y, Kuntz RE, Fitzgerald PJ (2004) Impact of final stent dimensions on long-term results following sirolimus-eluting stent implantation: serial intravascular ultrasound analysis from the sirius trial. J Am Coll Cardiol 43:1959–1963
Fujii K, Carlier SG, Mintz GS, Yang YM, Moussa I, Weisz G, Dangas G, Mehran R, Lansky AJ, Kreps EM, Collins M, Stone GW, Moses JW, Leon MB (2005) Stent underexpansion and residual reference segment stenosis are related to stent thrombosis after sirolimus-eluting stent implantation: an intravascular ultrasound study. J Am Coll Cardiol 45:995–998
de Ribamar Costa J Jr, 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 (2007) Intravascular ultrasound assessment of drug-eluting stent expansion. Am Heart J 153:297–303
Ishio N, Kobayashi Y, Iwata Y, Kitahara H, Fukushima K, Asano T, Nakayama T, Kuroda N, Komuro I (2010) Ubiquitous atherosclerosis in coronary arteries without angiographically significant stenosis. Heart Vessels 25:35–40
Chechi T, Vecchio S, Vittori G, Giuliani G, Lilli A, Spaziani G, Consoli L, Baldereschi G, Biondi-Zoccai GG, Sheiban I, Margheri M (2008) ST-segment elevation myocardial infarction due to early and late stent thrombosis a new group of high-risk patients. J Am Coll Cardiol 51:2396–2402
Brodie BR (2006) Adjunctive balloon postdilatation after stent deployment: is it still necessary with drug-eluting stents? J Interv Cardiol 19:43–50
Roy P, Steinberg DH, Sushinsky SJ, Okabe T, Pinto Slottow TL, Kaneshige K, Xue Z, Satler LF, Kent KM, Suddath WO, Pichard AD, Weissman NJ, Lindsay J, Waksman R (2008) The potential clinical utility of intravascular ultrasound guidance in patients undergoing percutaneous coronary intervention with drug-eluting stents. Eur Heart J 29:1851–1857
Javaid A, Chu WW, Cheneau E, Clavijo LC, Satler LF, Kent KM, Weissman NJ, Pichard AD, Waksman R (2006) Comparison of paclitaxel-eluting stent and sirolimus-eluting stent expansion at incremental delivery pressures. Cardiovasc Revasc Med 7:208–211
Takebayashi H, Mintz GS, Carlier SG, Kobayashi Y, Fujii K, Yasuda T, Costa RA, Moussa I, Dangas GD, Mehran R, Lansky AJ, Kreps E, Collins MB, Colombo A, Stone GW, Leon MB, Moses JW (2004) Nonuniform strut distribution correlates with more neointimal hyperplasia after sirolimus-eluting stent implantation. Circulation 110:3430–3434
de Jaegere P, Mudra H, Figulla H, Almagor Y, Doucet S, Penn I, Colombo A, Hamm C, Bartorelli A, Rothman M, Nobuyoshi M, Yamaguchi T, Voudris V, DiMario C, Makovski S, Hausmann D, Rowe S, Rabinovich S, Sunamura M, van Es GA (1998) Intravascular ultrasound-guided optimized stent deployment. Immediate and 6 months clinical and angiographic results from the Multicenter Ultrasound Stenting in Coronaries Study (MUSIC Study). Eur Heart J 19:1214–1223
Hur SH, Kitamura K, Morino Y, Honda Y, Jones M, Korr KS, Reen B 3rd, Cooper CJ, Niess GS, Christie L, Corey W, Messenger J, Yock PG, Cummins F, Fitzgerald PJ (2001) Efficacy of postdeployment balloon dilatation for current generation stents as assessed by intravascular ultrasound. Am J Cardiol 88:1114–1119
Kim JS, Moon JY, Ko YG, Choi D, Jang Y, Kang WC, Ahn T, Kim BK, Oh SJ, Jeon DW, Yang JY (2008) Intravascular ultrasound evaluation of optimal drug-eluting stent expansion after poststent balloon dilation using a noncompliant balloon versus a semicompliant balloon (from the Poststent Optimal Stent Expansion Trial [POET]). Am J Cardiol 102:304–310
Asano T, Kobayashi Y, Fukushima K, Iwata Y, Kitahara H, Ishio N, Nakayama T, Kuroda N, Komuro I (2009) Effect of balloon inflation time on expansion of sirolimus-eluting stent. Heart Vessels 24:335–339
Kawasaki T, Koga H, Serikawa T, Orita Y, Ikeda S, Mito T, Gotou Y, Shintani Y, Tanaka A, Tanaka H, Fukuyama T, Koga N (2009) Impact of a prolonged delivery inflation time for optimal drug-eluting stent expansion. Catheter Cardiovasc Interv 73:205–211
Otake H, Shite J, Ako J, Shinke T, Tanino Y, Ogasawara D, Sawada T, Miyoshi N, Kato H, Koo BK, Honda Y, Fitzgerald PJ, Hirata K (2009) Local determinants of thrombus formation following sirolimus-eluting stent implantation assessed by optical coherence tomography. JACC Cardiovasc Interv 2:459–466
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Muraoka, Y., Sonoda, S., Tsuda, Y. et al. Effect of intravascular ultrasound-guided adjuvant high-pressure non-compliant balloon post-dilation after drug-eluting stent implantation. Heart Vessels 26, 565–571 (2011). https://doi.org/10.1007/s00380-010-0094-0
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DOI: https://doi.org/10.1007/s00380-010-0094-0