Impact of Stent Size Selection on Acute and Long-Term Outcomes After Drug-Eluting Stent Implantation in De Novo Coronary Lesions

Kitahara, Hideki; Okada, Kozo; Kimura, Takeshi; Yock, Paul G.; Lansky, Alexandra J.; Popma, Jeffrey J.; Yeung, Alan C.; Fitzgerald, Peter J.; Honda, Yasuhiro

doi:10.1161/circinterventions.116.004795

Cited by 51 publications

(39 citation statements)

References 33 publications

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“…Furthermore, clinical evidence suggests the existence of issues after stenting, such as restenosis, stent thrombosis, and arterial injuries. Kitahara et al studied the impact of stent oversizing, concluding that aggressive oversizing may not lead to vascular injuries at the stent edge, as arteries with siginificant stent oversizing reach better apposition without increasing the amount of dissection at the stent egde. However, Chamie et al concluded that the overstretching of the arterial wall due to an oversized stent was an important factor of dissection at stent edges.…”

Section: Discussionmentioning

confidence: 99%

A new finite‐element shell model for arterial growth and remodeling after stent implantation

Laubrie

Mousavi

Avril

2019

Numer Methods Biomed Eng

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The goal of this paper is to study computationally how blood vessels adapt when they are exposed to a mechanobiological insult, namely, a sudden change of their biomechanical conditions such as proteolytic injuries or implantation.Adaptation occurs through growth and remodeling (G&R), consisting of mass production or removal of structural proteins, such as collagen, until restoring the initial homeostatic biomechanical conditions. In some circumstances, the initial conditions can never be recovered, and arteries evolve towards unstable pathological conditions, such as aneurysms, which are responsible for significant morbidity and mortality. Therefore, computational predictions of G&R under different circumstances can be helpful in understanding fundamentally how arterial pathologies progress. For that, we have developed a low-cost open-source finite-element 2D axisymmetric shell model (FEM) of the arterial wall. The constitutive equations for static equilibrium used to model the stress-strain behavior and the G&R response are expressed within the homogenized constrained mixture theory. The originality is to integrate the layer-specific behavior of both arterial layers (media and adventitia) into the model. Considering different mechanobiological insults, our results show that the resulting arterial dilatation is strongly correlated with the media thickness. The adaptation to stent implantation is particularly interesting. For large stent oversizing ratios, the artery cannot recover from the mechanobiological insult and dilates forever, whereas dilatation stabilizes after a transient period for more moderate oversizing ratios. We also show that stent implantation induces a different response in an aneurysm or in a healthy artery, the latter yielding more unstable G&R. Finally, our G&R model can efficiently predict, with very low computational cost, fundamental aspects of arterial adaptation induced by clinical procedures. KEYWORDSarterial growth and remodeling, axisymmetric shell model, homogenized constrained mixture theory, layer-specific behavior, stent implantation Int J Numer Meth Biomed Engng. 2020;36:e3282.wileyonlinelibrary.com/journal/cnm

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Section: Discussionmentioning

confidence: 99%

A new finite‐element shell model for arterial growth and remodeling after stent implantation

Laubrie

Mousavi

Avril

2019

Numer Methods Biomed Eng

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“…been reduced by the full coverage of plaque using IVUS. 5,18) It is important to note that an increase in edge residual stenosis led to an increase in the chance of restenosis in this study. Full coverage of the lesions by a postprocedural stent is essential for good outcomes, even in this era of second-generation DESs.…”

Section: Discussionmentioning

confidence: 75%

“…6) Similarly, axial geographic miss, defined as a diameter mismatch between the stent and the native arteries, may also induce mechanical stress to the wall, resulting in edge restenosis with DES. 4,5) However, axial geographic miss had a minimal influence on the outcomes of first-generation DESs in the STTLR study (a multicenter prospective study of SES). 16) These mechanical stresses may be caused by thicker struts and might be associated with a risk of angiographic and clinical restenosis.…”

Section: Discussionmentioning

confidence: 99%

“…espite advances in interventional technologies, restenosis of the segments adjacent to the proximal and distal edges of first-generation drugeluting stents (DESs), such as the sirolimus-eluting stent (SES), has been reported. 1,2) The mechanism of edge restenosis has been indicated as a result of arterial injury to the adjacent area by the stent deployment balloon, 3) inappropriate coverage of the plaque as in longitudinal geographic miss, 4) balloon-artery size mismatches as in axial geographic miss, 4,5) and mechanical stresses, such as the stresses created by severe angulation at the edge of the stent as well as bulky struts 6) with a bare metal stent or first-generation DESs. Although second-generation DESs, the current first-line coronary stents, have thinner struts, no meticulous analysis of edge restenosis following their implantation has yet been conducted, except for a report on target lesion revascularization at edges.…”

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confidence: 99%

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Impact of Residual Stenosis on the Angiographic Edge Restenosis of a Second-Generation Drug-Eluting Stent

et al. 2019

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Edge restenosis has gained attention as a main cause of restenosis after first-generation drug-eluting stent (DES) implantation. The aim of this study was to assess the incidence of edge restenosis and identify the predictors of edge restenosis after second-generation DES implantation. Data were obtained from several postmarketing surveillance (PMS) studies on a cobalt-chromium everolimus-eluting stent (CoCr-EES; Xience V/ PROMUS, Xience Prime, Xience Prime SV, and Xience Expedition SV), a second-generation DES, in Japan. Angiographic analysis was conducted at the baseline and after eight months on the following subsegments: instent region, proximal edge, and distal edge. Restenosis was defined as !50% diameter stenosis (DS) at followup. We used multivariate logistic regression (with lesions as a random effect) to compare the instances of restenosis between the proximal and the distal edges. Univariate and multivariate analyses of the risk factors for restenosis were performed for each subsegment. We analyzed 1,966 lesions in 1,687 patients. The restenosis rates at the in-stent region, proximal edge, and distal edge were 4.4%, 3.0%, and 1.1%, respectively. The risk of restenosis at the distal edge was significantly lower than that at the proximal edge, when adjusted for 13 variables. The predictors of restenosis were postprocedural % diameter stenosis (%DS), postprocedural reference diameter, !45°bending, stent overlap at the proximal edge, and postprocedural %DS at the distal edge. Our analysis of eight-month angiographic outcomes from CoCr-EES PMS demonstrated that postprocedural %DS is a major predictor of edge restenosis. Edge restenosis is more likely attributable to postprocedural angiographic results than to the patient's background.

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“…In this context, the minimum stent area reflecting stent expansion postimplantation is an important independent predictor of ISR and ST 15. Theoretically, three measures can be considered to achieve the largest minimum stent area or SEI possible: (1) adequate lesion preparation, (2) optimal stent/scaffold sizing and (3) appropriate postdilatation once the stent/scaffold is implanted 3 20–22…”

Section: Discussionmentioning

confidence: 99%

Performing percutaneous coronary interventions with predilatation using non-compliant balloons at high-pressure versus conventional semi-compliant balloons: insights from two randomised studies using optical coherence tomography

et al. 2020

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IntroductionStent underexpansion is a predictor of in-stent-restenosis and stent thrombosis. Semi-compliant balloons (SCBs) are generally used for lesion preparation. It remains unknown whether routine predilatation using non-compliant balloons (NCBs) improves stent expansion in ordinary coronary lesions.MethodsThe PREdilatation by high-pressure NC balloon catheter for better vessel preparation and Optimal lesion preparation with non-compliant balloons for the implantation of bioresorbable vascular scaffolds studies randomised patients presenting with stable coronary artery disease or non-ST-elevation myocardial infarction requiring stent implantation to lesion preparation using NCBs versus SCBs. Stent expansion index (SEI-minimal luminal area/mean luminal area on optical coherence tomography) and periprocedural complications were compared.ResultsWe enrolled 104 patients: 53 patients (54 lesions) vs 51 patients (56 lesions) to the NCB and SCB groups, respectively. Predilatation pressure was higher in the NCB group (24±7 atmospheres (atm) vs 14±3 atm, p<0.0001). Postdilatation using NCBs was performed in 41 (76%) lesions vs 46 (82%) lesions pretreated with NCBs versus SCBs (p=0.57). Similar pressures were used for postdilatation with NCB in both groups (23±8 atm vs 23±9 atm, p=0.65). SEI after stent implantation was 0.88±0.13 in the NCB vs 0.85±0.14 in the SCB group (p=0.18). After postdilatation, SEI increased to 0.94±0.13 in the NCB group vs 0.88±0.13 in the SCB group (p=0.02). No relevant complications occurred.ConclusionsIn simple coronary lesions, predilatation/postdilatation with NCBs at high pressures appears to result in better scaffold and stent expansion. Using SCBs only for predilatation might lead to inadequate stent expansion and postdilatation with NCBs might only partially correct this. Predilatation and postdilatation using NCBs at high pressure is safe.Trial registration numberClinicalTrials.gov no. NCT03518645.

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Impact of Stent Size Selection on Acute and Long-Term Outcomes After Drug-Eluting Stent Implantation in De Novo Coronary Lesions

Cited by 51 publications

References 33 publications

A new finite‐element shell model for arterial growth and remodeling after stent implantation

A new finite‐element shell model for arterial growth and remodeling after stent implantation

Impact of Residual Stenosis on the Angiographic Edge Restenosis of a Second-Generation Drug-Eluting Stent

Performing percutaneous coronary interventions with predilatation using non-compliant balloons at high-pressure versus conventional semi-compliant balloons: insights from two randomised studies using optical coherence tomography

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