Over-expansion capacity and stent design model: An update with contemporary DES platforms

Ng, Jaryl; Foin, Nicolas; Ang, Hui Ying; Fam, Jiang Ming; Sen, Sayan; Nijjer, Sukhjinder; Petraco, Ricardo; Mario, Carlo Di; Davies, Justin E.; Wong, Philip

doi:10.1016/j.ijcard.2016.06.097

Cited by 80 publications

(65 citation statements)

References 24 publications

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“…DES from different manufactures are available with different diameter ranges, but only a few manufacturers provide large diameter stents whose nominal range falls within the typical LM size (4.5-5 mm) ( Table 2). Bench-top tests have confirmed the ability of different DES platforms with a nominal size of 3-4 mm to maintain structural integrity when expanded to higher diameters 23,24 . However, major concerns exist regarding specific expansion limits, suboptimal plaque coverage (due to reduced metal-artery ratio) and the preservation of drug-elution kinetics.…”

Section: Left Main Stent Sizingmentioning

confidence: 87%

Percutaneous coronary intervention in left main coronary artery disease: the 13th consensus document from the European Bifurcation Club

Burzotta¹,

Lassen²,

Banning³

et al. 2018

EuroIntervention

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The 2017 European Bifurcation Club (EBC) meeting was held in Porto (Portugal) and allowed a multidisciplinary international faculty to review and discuss the latest data collected in the field of coronary bifurcation interventions. In particular, the topic of percutaneous coronary intervention (PCI) on left main coronary artery (LM) disease was highlighted as a contemporary priority. Herein, we summarise the key LM anatomy features, the diagnostic modalities and available data that are relevant for a patient's procedural management. Since the clinical outcomes of patients undergoing PCI on LM disease may depend on both PCI team organisation and PCI performance, the optimal catheterisation laboratory set-up and the rationales for device and technique selection are critically reviewed. The best lesion preparation modalities, the different DES implantation technique choices and the strategies to be considered during PCI on unprotected LM for optimal PCI results are reviewed step by step.

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Section: Left Main Stent Sizingmentioning

confidence: 87%

Percutaneous coronary intervention in left main coronary artery disease: the 13th consensus document from the European Bifurcation Club

Burzotta¹,

Lassen²,

Banning³

et al. 2018

EuroIntervention

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“…Larger distance between struts can reduce the scaffolding, increasing the risk of plaque prolapsing and potentially reducing drug delivery efficacy. 11 Self-apposing stent presents a consistent cell geometry also at 6.0 mm. diameter without any distortion of the strut.…”

Section: Discussionmentioning

confidence: 85%

“…Overdilation could cause significant deformation with large changes in terms of cell opening and strut distortion. Larger distance between struts can reduce the scaffolding, increasing the risk of plaque prolapsing and potentially reducing drug delivery efficacy . Self‐apposing stent presents a consistent cell geometry also at 6.0 mm.…”

Section: Discussionmentioning

confidence: 99%

Dutch multicenter experience using the STENTYS Xposition S self‐apposing stent in complex coronary lesions

Vlieger

Şimşek

Balland³

et al. 2019

Cathet Cardio Intervent

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Objectives The aim is to assess the experience in the Netherlands using the Xposition S self‐apposing stent in complex coronary lesions in clinical practice. Background Treatment of complex coronary lesions could be accompanied with stent sizing difficulties and complications, particularly due to vessel overdilation or stent underexpansion. The self‐apposing feature of the Xposition S stent (STENTYS, Paris, France) supports good strut apposition in complex anatomies and allows for an increase in diameter after implantation. Methods In this real‐world registry, data from patients treated with Xposition S in four Dutch clinical sites were prospectively collected and analyzed. Any patient suitable for implantation with Xposition S according to current recommendations was enrolled. Primary endpoint was major adverse cardiac events (MACE) at 1 year. Results Between 2015 and 2018, data from 251 patients were collected. Clinical presentation was an acute coronary syndrome in majority of the patients (76.9%). Main angiographic indications were lesions in aneurysmatic or ectatic vessels (32.3%), thrombus containing lesions (13.1%), and bifurcation/left main stenosis (10.4%). Most of the target lesions (TLs) were classified as AHA/ACC Type C (53.6%). Despite lesion complexity, device was successfully implanted at TL in 96.8%. MACE rate, reported on patients having completed 1‐year follow‐up (n = 203), was 6.6%, with low rate of definite/probable stent thrombosis (1.0%). Conclusions In clinical practice of several Dutch sites, STENTYS Xposition S showed good procedural results and low 1‐year clinical events rate, despite complex coronary anatomy.

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“…In the present study, excessive over‐expansion was observed in 74% of patients in the Control group . Over‐expanded DES are characterized by (a) important strut distortion (which may limit the anti‐proliferative effectiveness by damaging the drug coating) and (b) stent cell enlargement, which may impact the scaffolding properties . Carina reconstruction is also often suboptimal especially in the case of two‐stents techniques .…”

Section: Discussionmentioning

confidence: 99%

“…QCA analysis pre-and post-stenting are reported in Table 3 Over-expanded DES are characterized by (a) important strut distortion (which may limit the anti-proliferative effectiveness by damaging the drug coating) and (b) stent cell enlargement, which may impact the scaffolding properties. 5,26 Carina reconstruction is also often suboptimal especially in the case of two-stents techniques. 27,28 In contemporary practice, the single (MV) stent approach has become the default strategy.…”

Section: Angiographic and Ivus Analysismentioning

confidence: 99%

Sirolimus‐eluting BiOSS LIM dedicated bifurcation stent in the treatment of unprotected distal left main stenosis

Briguori

Visconti

Golino

et al. 2019

Cathet Cardio Intervent

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Background Proximal optimization technique (POT) has been proposed to adapt the conventional drug‐eluting stent (DES) with the fractal anatomy of the bifurcation. However, only few DES are labeled for post‐expansion beyond 5.0 mm. Furthermore, recrossing in the side branch (SB) through the main vessel (MV) stent cells may be challenging. Objectives To compare the sirolimus‐eluting, balloon‐expandable dedicated bifurcation stent BiOSS LIM DES versus the second generation DES in the treatment of distal unprotected left main coronary arteries (ULMCAs) lesions. Methods Forty‐two consecutive patients with distal ULMCA lesions were treated with the BiOSS LIM (BiOSS LIM group) in our center. A matched‐group of patients treated with second‐generation DES was selected from our database (Control group). The primary endpoint was the procedural complication rate, including (a) SB occlusion, defined as intraprocedural TIMI flow grade <3 immediately after MV stenting; and/or (b) trouble in SB access, defined as the need of ≥2 guidewires or a failure to recross in the SB trough the MV stent cells. The need of POT in the two groups was also analyzed. Results The primary endpoint occurred in four (9.5%) patients in the BiOSS LIM group and in 13 (31%) in the Control group (p = 0.028; OR = 4.25; 95% confidence interval: 1.25–14.43). POT was performed more often in the Control group (71% vs. 35%; p = 0.004). Conclusions Compared to conventional DES, the BiOSS LIM stent (1) facilitates SB recrossing and (2) fits well with the fractal anatomy of the left main bifurcation.

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Over-expansion capacity and stent design model: An update with contemporary DES platforms

Cited by 80 publications

References 24 publications

Percutaneous coronary intervention in left main coronary artery disease: the 13th consensus document from the European Bifurcation Club

Percutaneous coronary intervention in left main coronary artery disease: the 13th consensus document from the European Bifurcation Club

Dutch multicenter experience using the STENTYS Xposition S self‐apposing stent in complex coronary lesions

Sirolimus‐eluting BiOSS LIM dedicated bifurcation stent in the treatment of unprotected distal left main stenosis

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