Clinical effects of routine postdilatation of drug‐eluting stents

Pasceri, Vincenzo; Pelliccia, Francesco; Pristipino, Christian; Roncella, Adriana; Irini, Diego; Varveri, Antonio; Bisciglia, Andrea; Speciale, Giulio

doi:10.1002/ccd.24999

Cited by 18 publications

(15 citation statements)

References 28 publications

(34 reference statements)

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“… 15) Additionally, the clinical efficacy of this strategy has not been well evaluated in patients with second-generation DESs, although recent studies evaluated this strategy mostly among patients with bare-metal stents and first-generation DESs. 7) 8) Frobert et al 8) reported that post-stent balloon dilation was not associated with a significantly lower risk of stent thrombosis, but it was associated with a higher rate of restenosis in an analysis of 93,697 stents (55,426 of bare-metal stents, 59%). Pasceri et al 7) compared clinical outcomes for DES-treated patients based on whether they received routine post-stent balloon dilatation (n=279) or selective post-stent balloon dilation after suboptimal results (n=262).…”

Section: Discussionmentioning

confidence: 99%

“… 7) 8) Frobert et al 8) reported that post-stent balloon dilation was not associated with a significantly lower risk of stent thrombosis, but it was associated with a higher rate of restenosis in an analysis of 93,697 stents (55,426 of bare-metal stents, 59%). Pasceri et al 7) compared clinical outcomes for DES-treated patients based on whether they received routine post-stent balloon dilatation (n=279) or selective post-stent balloon dilation after suboptimal results (n=262). The MACE incidence at 12 months was 19.5% in the selective post-stent balloon dilation group and 12.5% in the routine post-stent balloon dilation group (p=0.040).…”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the clinical efficacy of post-stent adjunct balloon dilation has not been well evaluated in patients treated with second-generation DES, although 2 recent studies evaluated its efficacy for patients treated with bare-metal stents and first-generation DESs. 7) 8) …”

Section: Introductionmentioning

confidence: 99%

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Effect of Adjunct Balloon Dilation after Long Everolimus-eluting Stent Deployment on Major Adverse Cardiac Events

et al. 2017

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Background and ObjectivesThe effectiveness of adjunct balloon dilation after drug-eluting stent (DES) deployment has not been sufficiently evaluated. We evaluated whether adjunct balloon dilation was associated with a reduction in major adverse cardiac events (MACEs) after long everolimus-eluting stents (EESs) implantation.Subjects and MethodsDrawing from 2 randomized trials, a total of 1,672 patients treated with long EES were analyzed. Of 1,672 patients, 1,061 patients (64%) received post-stent adjunct balloon dilation. MACE, defined as a composite of cardiac death, myocardial infarction, and target-lesion revascularization (TLR), was compared between patients who received post-stent adjunct balloon dilation and patients who did not in 595 propensity score-matched pairs.ResultsFor the matched population, MACE occurred in 29 patients (4.9%) who received adjunct balloon dilation and in 29 patients (4.9%) who did not (hazard ratio [HR], 1.01; 95% confidence interval [CI], 0.60–1.69; p=0.972). However, significant interactions were observed among the subgroups for clinical presentation and vessel size. Adjunct balloon dilation was more favored within the subset of patients with stable angina vs. the subset of patients with acute coronary syndrome (p for interaction=0.037), and within the subset of lesions with small vessel diameter (reference vessel diameter [RVD] <3 mm) vs. the subset of lesions with larger vessel diameter (RVD ≥3 mm; p for interaction=0.027).ConclusionAdjunct balloon dilation was not associated with MACE reduction at 1 year among patients requiring long EES implantation. However, post-stent adjunct balloon dilation may be necessary for patients requiring long EES implantation who present with stable angina or for lesions with small vessel diameters.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Effect of Adjunct Balloon Dilation after Long Everolimus-eluting Stent Deployment on Major Adverse Cardiac Events

et al. 2017

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“…Several studies have suggested potential benefits for PD in elective PCI or in non‐MI conditions . It has even been postulated that routine PD in all non‐MI patients, by comparison with selected groups, reduces MACE and the need for future TVR . On the other hand, it has been theorized that the inflation of coronary stents with high‐pressure balloons during this procedure may increase the risk of the distal embolization of thrombi and the no‐reflow phenomenon in the setting of acute MI and unstable thrombotic plaques.…”

Section: Discussionmentioning

confidence: 99%

Short‐term safety and long‐term benefits of stent postdilation after primary percutaneous coronary intervention: Results of a cohort study

Saadat

Saadatagah

Nargesi

et al. 2019

Cathet Cardio Intervent

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Aim Achieving the optimal apposition of coronary stents during percutaneous coronary intervention is not always feasible. The risks and benefits of stent postdilation in primary percutaneous coronary intervention (PPCI) in patients with ST‐elevation myocardial infarction (STEMI) have remained controversial. We sought to evaluate the immediate angiographic and long‐term outcomes in patients with and without stent postdilation. Methods A cohort of patients (n = 1,224) with STEMI, treated with PPCI (n = 500 postdilated; n = 724 controls), were studied. The flow grade, the myocardial blush grade, and the frame count were considered angiographic outcomes. The clinical outcomes were major adverse cardiovascular events (MACE)—comprising cardiac death, nonfatal MI, and repeat revascularization—and the device‐oriented composite endpoint (DOCE)—consisting of cardiac death, target lesion revascularization, and target vessel revascularization. Results The flow and myocardial blush grades were not different between the two groups, and the frame count was significantly lower in the postdilation group (15.7 ± 8.4 vs. 17 ± 10.4; p < .05). The patients were followed up for 348 ± 399 days. DOCE (2.2% vs. 5.8%) and cardiac mortality (1.2% vs. 3.2%) were lower in the postdilation group. In the fully adjusted propensity score‐matched analysis, postdilation was associated with decreased DOCE (HR = 0.40 [0.18–0.87], p = .021). Conclusions Selective postdilation improved some angiographic and clinical outcomes and could not be discouraged in PPCI on patients with STEMI.

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“…In this issue of the journal, Pasceri et al astutely present their single center experience with routine high‐pressure, noncompliant balloon inflation following DES placement . A strategy of universal postdilatation was instituted in 2009 with the exception of procedures guided by intravascular ultrasound and in patients with ST elevation myocardial infarction or vein graft intervention; where the risk of no reflow was a concern.…”

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confidence: 99%

Routine postdilation of drug‐eluting stents: Worth the gain

Srour

Abbott

2014

Cathet Cardio Intervent

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Clinical effects of routine postdilatation of drug‐eluting stents

Abstract: Our results suggest that a strategy of routine postdilatation with non compliant balloons may improve clinical outcomes of DES.

Cited by 18 publications

References 28 publications

Effect of Adjunct Balloon Dilation after Long Everolimus-eluting Stent Deployment on Major Adverse Cardiac Events

Effect of Adjunct Balloon Dilation after Long Everolimus-eluting Stent Deployment on Major Adverse Cardiac Events

Short‐term safety and long‐term benefits of stent postdilation after primary percutaneous coronary intervention: Results of a cohort study

Routine postdilation of drug‐eluting stents: Worth the gain

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