Percutaneous coronary intervention-induced variations in systemic parameters of inflammation: relationship with the mode of stenting

Abstract

The inflammatory response after stent implantation depends on the mode of stenting. We therefore hypothesize that the inflammatory response after stenting might be related to the histological composition of the atherosclerotic plaques involved.

Comparison of the Systemic Levels of Inflammatory Markers after Percutaneous Coronary Intervention with Bare Metal versus Sirolimus‐Eluting Stents

“…Procedural causes for an enhanced systemic inflammatory response following PCI include the stent deployment pressure and the rate of lesion balloon predilatation. 13 In our study, stent deployment pressures were comparable between study groups (mean deployment pressures of 15.1 atm in the SES vs. 15.0 atm in the BMS group, P = NS), as were the rates of predilatation with a balloon prior to stent deployment (23.8% in the BMS group vs. 25% in the SES group, P = NS). None of the patients in our study had postdilatation performed after stent placement.…”

“…There are, however, pathophysiological data that may partially explain the observed trend for higher systemic concentrations of proinflammatory cytokines in the DES cohort. Procedural causes for an enhanced systemic inflammatory response following PCI include the stent deployment pressure and the rate of lesion balloon predilatation 13 . In our study, stent deployment pressures were comparable between study groups (mean deployment pressures of 15.1 atm in the SES vs. 15.0 atm in the BMS group, P = NS), as were the rates of predilatation with a balloon prior to stent deployment (23.8% in the BMS group vs. 25% in the SES group, P = NS).…”

Effect of Stent Inflation Pressure and Post-Dilatation on the Outcome of Coronary Artery Intervention. A Report of More than 90 000 Stent Implantations

“…It complicates matters even more for the operator that manufacturer stent balloon compliance charts grossly overestimate the final stent dimensions, as these measurements are typically made in water without the vessel constraint that limits balloon expansion [17]. Very high stent inflation pressures may cause stent edge dissection, coronary rupture, media and intima rupture leading to an increased inflammatory response and higher restenosis rate [18] [19] – factors that may help to explain our findings in the ≥22 atm pressure group. Our study identified a possible optimal stent inflation pressure of 20–21 atm during PCI, which was associated with a lower risk of stent thrombosis and restenosis – a finding that fits well with the studies cited above.…”

Expert Opinion: Optimising Stent Deployment in Contemporary Practice: The Role of Intracoronary Imaging and Non-compliant Balloons

“…When the stent is deployed at high pressures with the semi-compliant stent balloon, it may cause stent edge dissection, coronary perforation and intimal injury leading to an increased inflammatory response and higher restenosis rate. 18 Hence, using an NC balloon for high-pressure post-dilatation stent optimisation is not just physiologically appropriate but technically safer than going up to higher pressures with a compliant balloon.…”