Initial experience with intratherapeutics intrastent doublestrut LD stents in patients with congenital heart defects

Abstract

Limitations of the currently available balloon-expandable stainless steel (BE-SS) stents for use in patients with congenital heart defects (CHD) include inflexibility, significant shortening with expansion, sharp ends, and limited sizes. These limitations increase risk and greatly effect success of stent placement in these patients. The recently approved IntraStent DoubleStrut LD (IS-LD) stents are BE-SS stents designed to address such limitations. We report our initial experience with IS-LD stents in patients with CHD. Using standard techniques, 36 stents were implanted in 22 patients whose median age was 11 years (range, 1.4-35 years) and weight was 33 kg (range, 9-96.8 kg). Lesions stented included aortic coarctation (4), branch pulmonary arteries (19), inferior or superior vena cava (11), Mustard baffle (1), and Fontan baffle (1). All attempts at stent placement were successful. Hemodynamic assessment and angiography was performed pre- and poststent placement in all patients. Intravascular ultrasound was performed in four patients. Stenosis diameter increased from 5.7 +/- 0.6 mm (mean +/- SD) to 11.6 +/- 0.5 mm (P < 0.001). Stents did not shorten significantly with dilation (median percent shortening, 3.8%; P > 0.1). Complications included stent recoil (2), stent migration (1), and stent distortion (1). IS-LD stents are a safe and effective treatment for the majority of vascular stenoses in patients with CHD. Stent recoil at large diameters may limit its usefulness in selected lesions. Follow-up studies are required to determine the long-term performance of IS-LD stents.

The role of stents in the treatment of congenital heart disease: Current status and future perspectives

“…These characteristics have been documented for the IntraStent™ DoubleStrut™ (EV3 Inc.). [67] This is laser cut out of a 316 L stainless steel tube. The parallel struts and the unique cell geometry allow flexibility around tight curves and minimize stent shortening (especially when serial dilation is performed).…”

“…[8] Therefore, in some lesions in which high radial strength is required, these stents may recoil. [6] Thus, if higher radial strength beyond 15 mm diameter is an issue, Intrastent™ Mega™ LD and Maxi™LD stents (EV3) have almost replaced the DoubleStrut stent. In these stents, the configuration of the cells is similar to that of the DoubleStrut stents, but the single struts are cut from a tubing of an initially thicker material, which makes each strut thicker and stronger than the double struts.…”

Pitfalls of stenting coarctation of an angulated right circumflex aortic arch in Goldenhar syndrome

“…Use of premounted stents and open cell design stents like IntraStent DoubleStrut LD stents also seem to be helpful in proper stent deployment in these settings. [5]…”

The role of the new Valeo stent for treating pulmonary artery stenoses in children with complex cardiac malformations

“…Key features of stents that the interventionalist looks at include whether the stent is an open or closed design, the material the stent is made of, whether the stent is premounted or mounted, if the stent is a balloon-expandable stent (BES) or a self-expandable stent, the size of the stent, and the sheath required to introduce the stent and catheter. In addition, the choice of stent will depend on the child’s age and the condition being treated [3,6–8]. …”