Longitudinal stent deformation: a retrospective analysis of frequency and mechanisms

Williams, Paul D.; Mamas, Mamas A.; Morgan, K.; El–Omar, Magdi; Clarke, Bernard; Bainbridge, Anthony; Fath‐Ordoubadi, Farzin; Fraser, Douglas G.

doi:10.4244/eijv8i2a41

Cited by 125 publications

(118 citation statements)

References 5 publications

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“…Furthermore, considerable attention has recently been focused on longitudinal stent deformation (LSD) in patients treated with new-generation thin-strut DES. Williams et al 27 reported 9 cases of LSD during a 4-year period, presenting 0.2% of cases and affecting 0.097% of stents deployed. There were several mechanisms for this complication, including compression by postdilation balloons, guide catheter extensions, and proximal embolic protection devices.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Clinical Impact of Stent Fracture After Everolimus-Eluting Stent Implantation

Kuramitsu

Iwabuchi

Haraguchi

et al. 2012

Circ: Cardiovascular Interventions

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Background-Stent fracture (SF) after drug-eluting stent implantation has recently become an important concern because of its potential association with in-stent restenosis and stent thrombosis. However, the incidence and clinical impact of SF after everolimus-eluting stent implantation remain unclear. Methods and Results-A total of 1035 patients with 1339 lesions undergoing everolimus-eluting stent implantation and follow-up angiography 6 to 9 months after index procedure were analyzed. SF was defined as complete or partial separation of the stent, as assessed by plain fluoroscopy or intravascular ultrasound during follow-up. We assessed the rates of SF and major adverse cardiac events, defined as cardiac death, myocardial infarction, stent thrombosis, and clinically driven target lesion revascularization within 9 months. SF was observed in 39 of 1339 lesions (2.9%) and in 39 of 1035 patients (3.8%). Ostial stent location and lesions with hinge motion, tortuosity, or calcification were independent predictors of SF. The rate of myocardial infarction and target lesion revascularization were significantly higher in the SF group than in the non-SF group (5.1% versus 0.4%; P=0.018 and 25.6% versus 2.0%; P<0.001, respectively). Stent thrombosis was more frequently observed in the SF group than in the non-SF group (5.1% versus 0.4%; P=0.018). Major adverse cardiac events within 9 months were significantly higher in the SF group than in the non-SF group (25.6% versus 2.3%; P<0.001). Conclusions-SF after everolimus-eluting stent implantation occurs in 2.9% of lesions and is associated with higher rate of major adverse cardiac events, driven by higher target lesion revascularization and stent thrombosis. (Circ Cardiovasc Interv. 2012;5:663-671.)

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Section: Discussionmentioning

confidence: 99%

Incidence and Clinical Impact of Stent Fracture After Everolimus-Eluting Stent Implantation

Kuramitsu

Iwabuchi

Haraguchi

et al. 2012

Circ: Cardiovascular Interventions

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“…This happens in following clinical scenarios during PCI: (1) crossing the deployed stent with non-compliant balloon for post dilatation, the most commonly reported cause for longitudinal compression, (2) guide catheter or its extensions coming in contact with the stent, either in case of stent in the ostial location or guide catheter deep seating, (3) IVUS catheter pull back for post stent deployment assessment, (4) withdrawal of the stent delivery system following stent deployment when the balloon gets stuck in the struts, (5) crossing the newly deployed stent with another stent for the treatment of a distal lesion, (6) wire entanglement. 2,3,6 These result in either nesting of stent rings into or over each or elongation longitudinally. This phenomenon occurs commonly at the proximal end of the stent and is accentuated by stent malapposition and wire bias toward the outer border of the stent.…”

Section: Discussionmentioning

confidence: 99%

“…With both stent compression and elongation, the vessel is no longer uniformly scaffolded which might compromise the drug delivery and predispose to restenosis. 2,3,6,7 In a clinical study, Micro-Driver deformation was associated with 38% incidence of major adverse cardiac events. 4 Stent deformation once recognized should be corrected by further balloon dilatation to overcome luminal obstruction and apposition of the stent to the vessel wall.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal deformation – Price we pay for better deliverability of coronary stent platforms

Janakiraman

Subban

Victor

et al. 2012

Indian Heart Journal

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IntroductionCoronary stents, especially drug eluting stents (DES), have revolutionized the practice of interventional cardiology. With the availability of newer stent designs with better deliverability and conformability, more complex coronary subsets are now effectively managed with percutaneous intervention rather than coronary artery bypass surgery. 1 However, these newer stents have issues previously unknown with older platforms. Longitudinal compression, one such issue with newer DES platforms, has caused concern among the interventionist. 2e5 We report a case of such deformation in a patient who underwent percutaneous intervention for a mid left anterior coronary artery (LAD) lesion. Case reportA 67 year old female, diabetic, hypertensive and hypothyroid was evaluated for exertional chest pain of CCS class III. Her exercise stress test was strongly positive for inducible ischemia and the coronary angiogram showed a 12 mm long concentric 80% type B stenosis in LAD starting just beyond the second septal branch (Fig. 1A).* Corresponding author. Tel.: þ91 44 26565953; fax: þ91 44 26565859. E-mail address: icvddoctors@mmm.org.in (E. Janakiraman).Available online at www.sciencedirect.com journal homepage: w ww.el sevier.com/locate /ihj i n d i a n h e a r t j o u r n a l 6 4 ( 2 0 1 2 ) 5 1 8 e5 2 0

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“…This improves deliverability and conformability, at the expense of reduction in strength. Recently longitudinal shortening has been reported, often associated with adjunctive devices after stent deployment [3][4][5].…”

Section: Case Reportmentioning

confidence: 99%

Deformacja wzdłużna stentu uwalniającego lek Synergy w trakcie wyjmowania balonu tnącego

2018

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Contemporary stent platforms have reduced strut thickness and fewer connectors. This improves deliverability and conformability, at the expense of reduction in strength. Recently longitudinal shortening has been reported, often associated with adjunctive devices after stent deployment.We present an unusual, impressive case of longitudinal shortening of a previously implanted Synergy stent (Boston Scientific, MA USA), within the proximal left anterior descending artery (LAD). The patient subsequently represented with restenosis of a further stent in the mid LAD. On withdrawal of a Flextome cutting balloon catheter (Boston Scientific), this device snared and dramatically shortened the Synergy. This was successfully treated with progressive dilatation using a series of enlarging balloons and subsequent implantation of another stent (Xience Xpedition, Abbott, CA USA).This case illustrates, that despite having additional connectors to enhance longitudinal strength, Synergy is not immune from compression. Furthermore, it is imperative, that stents are sized and post-dilated appropriately to ensure complete expansion.

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Longitudinal stent deformation: a retrospective analysis of frequency and mechanisms

Cited by 125 publications

References 5 publications

Incidence and Clinical Impact of Stent Fracture After Everolimus-Eluting Stent Implantation

Incidence and Clinical Impact of Stent Fracture After Everolimus-Eluting Stent Implantation

Longitudinal deformation – Price we pay for better deliverability of coronary stent platforms

Deformacja wzdłużna stentu uwalniającego lek Synergy w trakcie wyjmowania balonu tnącego

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