Late acquired stent malapposition: why, when and how to handle?

Karalis, Ioannis; Ahmed, Tarek A H N; Jukema, J. Wouter

doi:10.1136/heartjnl-2011-301220

Cited by 25 publications

(11 citation statements)

References 21 publications

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“…The strut of the stent has a 100 mm Â 100 mm square cross section, which is modeled as an elastoplastic material with a Young's modulus of 270 GPa, a Poisson's ratio of 0.27, a yield strength of 300 MPa, and a tensile strength of 650 MPa, corresponding to 316L stainless steel (34). The stent indentation is an input variable that ranges from 0 to 50% of the stent strut size (35). The external boundary of the arterial wall is subjected to a spring foundation displacement condition, with a spring constant of 300 Pa, chosen to represent the radial elasticity of an artery (36).…”

Section: Simulations Of Stent Deploymentmentioning

confidence: 99%

Mechanical Criterion for the Rupture of a Cell Membrane under Compression

Gonzalez‐Rodriguez

Guillou

Cornat

et al. 2016

Biophysical Journal

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We investigate the mechanical conditions leading to the rupture of the plasma membrane of an endothelial cell subjected to a local, compressive force. Membrane rupture is induced by tilted microindentation, a technique used to perform mechanical measurements on adherent cells. In this technique, the applied force can be deduced from the measured horizontal displacement of a microindenter's tip, as imaged with an inverted microscope and without the need for optical sensors to measure the microindenter's deflection. We show that plasma membrane rupture of endothelial cells occurs at a well-defined value of the applied compressive stress. As a point of reference, we use numerical simulations to estimate the magnitude of the compressive stresses exerted on endothelial cells during the deployment of a stent.

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Section: Simulations Of Stent Deploymentmentioning

confidence: 99%

Mechanical Criterion for the Rupture of a Cell Membrane under Compression

Gonzalez‐Rodriguez

Guillou

Cornat

et al. 2016

Biophysical Journal

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“…1 In the era of drug-eluting stents (DESs), late-acquired stent malapposition is a wellrecognized problem in interventional cardiology because it may constitute a potent substrate for late stent thrombosis. [1][2][3] The incidence of late-acquired stent malapposition was reported to be as high as 25% in patients with acute myocardial infarction. 4 In addition, predictors of late-acquired stent malapposition include plaque or thrombus absorption or positive vascular remodeling.…”

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confidence: 99%

“…4 In addition, predictors of late-acquired stent malapposition include plaque or thrombus absorption or positive vascular remodeling. 1,5,6 Intravascular ultrasound (IVUS) imaging was used to detect stent malapposition in previous studies. IVUS may not completely detect stent malapposition because of limited axial resolution (100-200 μm) or stent-related artifacts.…”

mentioning

confidence: 99%

Incidences, Predictors, and Clinical Outcomes of Acute and Late Stent Malapposition Detected by Optical Coherence Tomography After Drug-Eluting Stent Implantation

Kim

et al. 2014

Circ: Cardiovascular Interventions

134

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5However, optical coherence tomography (OCT) with a higher resolution (12-18 μm) may detect stent malapposition with greater accuracy. There are limited data on detection of acute and late stent malapposition by OCT in small sample sizes. Therefore, we investigated the incidences, predictors, and clinical outcomes of acute and late stent malapposition detected by OCT in a large number of patients who received DESs. Editorial see p 6 Methods Study PopulationPatients who received implantation of DESs for de novo coronary lesions between January 2009 and December 2011 with poststent and follow-up OCT were identified from the OCT registry database of our institute. Exclusion criteria included the following (1) the DES was implanted for left main coronary disease, (2) there were overlapping DESs implanted in the lesion, (3) the clinical follow-up period after DES implantation was <1 year, (4) follow-up OCT was performed >1 year after DES implantation, and (5) the OCT image had poor quality.Background-We investigated the incidences, predictors, and clinical outcomes of acute and late stent malapposition detected by optical coherence tomography (OCT) after drug-eluting stent implantation. Methods and Results-We analyzed the OCT images from 351 patients with 356 lesions who received poststent and followup OCT examinations. Acute stent malapposition was observed in 62% of lesions. Approximately half of the acute stent malappositions were located within the edges of the stents. Severe diameter stenosis, calcified lesions, and long stents were independent predictors of acute stent malapposition. Follow-up OCT examinations were performed 175±60 days after drug-eluting stent implantation. Thirty-one percent of lesions with acute stent malapposition remained malapposed (late-persistent stent malapposition) and were typically (72%) located within the edges of the stent. The location within the stent edges and the volume of acute stent malapposition were independent predictors of late-persistent stent malapposition. Acute stent malapposition with a volume >2.56 mm 3 differentiated late-persistent stent malapposition from resolved acute stent malapposition. Late-acquired stent malapposition was detected in 15% of all lesions and was usually (61%) located within the stent body. Late-acquired stent malapposition was more frequently associated with plaque/thrombus prolapse on poststent OCT images (70% versus 42%; P<0.001). Clinical events, including cardiovascular death, nonfatal myocardial infarction, and stent thrombosis, did not occur in patients with late stent malapposition during the follow-up period of 28.6±10.3 months after drug-eluting stent implantation. Conclusions-Acute, late-persistent, and late-acquired stent malapposition had relatively high incidences but different predictors. The clinical outcome of stent malapposition was favorable. (Circ Cardiovasc Interv. 2014;7:88-96.)

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“…Thrombus dissolution is one of the mechanisms of late-acquired stent malapposition, and acute coronary syndrome is reported to be a risk factor of stent malapposition. 28 This result might be caused by the aforementioned mechanism. Although Tokuda et al reported that PSS after second-generation DES implantation was associated with TLR, 17 the clinical effect of PSS on exclusively EES-implanted lesions is not fully elucidated.…”

Section: Resultsmentioning

confidence: 92%

Stent Fracture and Peri-Stent Contrast Staining After Everolimus-Eluting Stent Implantation　― 5-Year Outcomes ―

Miura

Tada

Kuwayama

et al. 2017

Circ J

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tion. Although PSS occurs at a low frequency, it has been reported as a risk factor for ST and TLR after first-generation DES implantation and a potential risk factor of adverse events after second-generation DES implantation. 15-17 We aimed to investigate the effect of SF and PSS on 5-year clinical outcomes after EES implantation. Methods Patient PopulationThis study was a retrospective single-center study. A total of 1,013 consecutive patients (1,716 lesions) undergoing EES (Xience V, Abbott Vascular, Santa Clara, CA, USA) implantation between January and December 2010 were enrolled. The exclusion criteria were repeat EES implantation and the combined use of EES and other types of stent. Finally, we analyzed 636 patients (1,081 lesions) exclusively treated using EES and undergoing follow-up angiography within 1 year (Figure 1). Clinical outcomes were compared between the groups of lesions with and without F irst-generation drug-eluting stents (DES) have resulted in a substantial reduction in in-stent restenosis and the need for subsequent target lesion revascularization (TLR) compared with bare-metal stents. 1,2 Everolimus-eluting stents (EES) are a second-generation DES, designed to improve safety, efficacy, and device performance with a newer antiproliferative drug, a durable polymer, improved stent design, and thinner struts. Compared with bare-metal stents and first-generation DES, EES have reduced adverse events as reported in randomized control trials and meta-analyses. 3-7 Recently, stent fracture (SF) after DES implantation has become a concern because of its association with adverse events such as in-stent restenosis (ISR), stent thrombosis (ST), and subsequent TLR. 8-10 Previous studies have reported that SF after sirolimus-eluting stent (SES) implantation is associated with ISR and higher cardiac event rates. 11-13 This association is reported even in patients treated with second-generation DES. 14 Peri-stent contrast staining (PSS) is contrast staining outside stent struts after stent implanta- Background: Stent fracture (SF) and peri-stent contrast staining (PSS) after sirolimus-eluting stent implantation are reported to be risk factors of adverse events. However, the effect of these after everolimus-eluting stent (EES) implantation on long-term outcomes remains unclear.

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Late acquired stent malapposition: why, when and how to handle?

Cited by 25 publications

References 21 publications

Mechanical Criterion for the Rupture of a Cell Membrane under Compression

Mechanical Criterion for the Rupture of a Cell Membrane under Compression

Incidences, Predictors, and Clinical Outcomes of Acute and Late Stent Malapposition Detected by Optical Coherence Tomography After Drug-Eluting Stent Implantation

Stent Fracture and Peri-Stent Contrast Staining After Everolimus-Eluting Stent Implantation　― 5-Year Outcomes ―

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Late acquired stent malapposition: why, when and how to handle?

Cited by 25 publications

References 21 publications

Mechanical Criterion for the Rupture of a Cell Membrane under Compression

Mechanical Criterion for the Rupture of a Cell Membrane under Compression

Incidences, Predictors, and Clinical Outcomes of Acute and Late Stent Malapposition Detected by Optical Coherence Tomography After Drug-Eluting Stent Implantation

Stent Fracture and Peri-Stent Contrast Staining After Everolimus-Eluting Stent Implantation ― 5-Year Outcomes ―

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Stent Fracture and Peri-Stent Contrast Staining After Everolimus-Eluting Stent Implantation　― 5-Year Outcomes ―