Major stent deformation / pseudofracture of 7 Crown Endeavor / Micro Driver stent platform: incidence and causative factors

Pitney, Mark; Pitney, Kate; Jepson, Nigel; Friedman, D. B.; Nguyendang, T.; Matthews, J.; Giles, R.; Taylor, David

doi:10.4244/eijv7i2a41

Cited by 40 publications

(29 citation statements)

References 9 publications

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“…1,[3][4][5]11 Although the mechanism and patterns of distortion observed in this study were different from those in our first-generation test, in general, the relative susceptibility of different stents to distortion was similar to that in the previous study.…”

Section: Discussionmentioning

confidence: 36%

“…5,7 Ex vivo attempts to develop a comparative test using noncompliant balloons were unsatisfactory because of poor reproducibility. 1 Our new test apparatus used a 3-mm nominal diameter stent deployed, so that its distal portion was fixed and the proximal portion malapposed in tubing of 3.5-mm diameter. The 5-mm malapposition length we used is similar to malapposition reported clinically.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4][5][6] Although it can occasionally involve the distal end or the body of a stent, it is much more likely to occur at the proximal end, especially if struts are malapposed. [5][6][7] Forward pressure on an angioplasty balloon or guide catheter, particularly when not coaxial with the stent, applies a force to a localized point on the proximal circumference of the stent rather than pressure over a broad front.…”

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confidence: 99%

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Stent Longitudinal Strength Assessed Using Point Compression

Ormiston

Webber

Ubod

et al. 2014

Circ: Cardiovascular Interventions

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Background-Stent longitudinal distortion, while infrequent, can lead to adverse clinical events. Our first bench comparison of susceptibility of different stent designs to distortion applied force to the entire circumference of the proximal stent hoop. The test increased understanding of stent design and led to recommendations for design change in some. Our second-generation test more closely mimics clinical scenarios by applying force to a point on the proximal hoop of a malapposed stent. Methods and Results-Each 3-mm-diameter stent was secured in a test apparatus so that its proximal 5 mm was malapposed in a 3.5-mm tube. An instron applied force to the proximal hoop of each of 5 examples of each of 6 stent designs using a narrow rod so that force applied and distance compressed could be measured. Hoops on the side of the force were pushed together, became malapposed, and obstructed the lumen. In addition, the proximal stent hoop tilted causing malapposition, the contralateral side of the stent from the applied force causing lumen obstruction. Conclusions-This second-generation, more clinically relevant test showed the Biomatrix Flex was the most resistant to deformation and the Element the most easily deformed. The addition of more connectors between the proximal hoops in the Promus Premier design has reduced the potential for distortion when compared with the Element, so that distortion was similar to the Vision, Multi-Link 8, and Integrity designs. The test also provided insight into the way in which stents are likely to distort in clinical practice. (Circ Cardiovasc Interv. 2014;7:62-69.)

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Section: Discussionmentioning

confidence: 36%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Stent Longitudinal Strength Assessed Using Point Compression

Ormiston

Webber

Ubod

et al. 2014

Circ: Cardiovascular Interventions

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“…2,3 In response to reports about this phenomenon, manufacturers reinforced the proximal struts with additional connectors that have effectively eliminated edge deformation proximally.…”

Section: Discussionmentioning

confidence: 99%

Longitudinal Deformation of Distal Edge in a New-Generation Stent Caused by Guidewire Entrapment

Taleb¹,

Parikh²,

Kakouros³

2018

Texas Heart Institute Journal

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Longitudinal stent deformation, described in some older stent geometries, prompted design L ongitudinal stent deformation-the distortion or shortening of a stent's length after successful deployment-has caused certain stent designs to fail.1 The initial reports of this problem led to mechanical reinforcement of the proximal ends of newer-generation stents. However, distal stent edges have not been reinforced. We report a case of longitudinal deformation at the distal edge of a newer-generation stent, caused by entrapment of a guidewire. To our knowledge, this is the first such case reported, and it highlights the potential weakness of nonreinforced platforms at the distal ends of these stents. Case ReportIn February 2016, a 68-year-old man presented with non-ST-segment-elevation myocardial infarction. Coronary angiograms showed subtotal occlusion of the mid right coronary artery (RCA), the distal left anterior descending coronary artery (LAD), and the first obtuse marginal artery. There was also severe proximal LAD stenosis. The patient was a poor candidate for surgical revascularization because of suboptimal distal targets and conduits, so we proceeded with multivessel percutaneous coronary intervention.Using a 6F catheter from a right radial artery approach, we crossed the subtotal RCA occlusion with an Asahi Fielder XT Coronary Guide Wire (Abbott Vascular) and successfully treated the lesion with a 2.25 × 32-mm Promus Premier everolimuseluting stent (Boston Scientific Corporation). We used a 6F JCL RAD 4.0 guiding catheter (Medtronic, Inc.) to intubate the left coronary system and then advanced an Asahi Prowater Guide Wire (Abbott Vascular) to the distal LAD.We treated the LAD lesions with 2 Promus Premier stents: 2.25 × 32-mm distally and 2.75 × 12-mm proximally. Both stents were postdilated at high pressure with use of noncompliant balloons.The results of angiographic evaluation were satisfactory (Fig. 1A). As we withdrew the Prowater guidewire, it caught the distal edge of the proximal LAD stent. Gentle traction enabled removal of the wire; however, angiography revealed longitudinal deformation of the proximal LAD stent at its distal edge (Fig. 1B). With substantial difficulty, we used a new Prowater guidewire to cross the deformed stent. Despite multiple attempts, including crossing of the stent with another wire, we could not pass balloons, a Finecross ® MG Coronary Micro-Guide Catheter (Terumo Interventional Systems), or a Tornus support catheter (Asahi Intecc) through the deformed stent.

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“…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. In case of geographic miss, a further stent should be deployed.…”

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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Major stent deformation / pseudofracture of 7 Crown Endeavor / Micro Driver stent platform: incidence and causative factors

Cited by 40 publications

References 9 publications

Stent Longitudinal Strength Assessed Using Point Compression

Stent Longitudinal Strength Assessed Using Point Compression

Longitudinal Deformation of Distal Edge in a New-Generation Stent Caused by Guidewire Entrapment

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

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