Reduction in incomplete stent apposition area caused by jailed struts after single stenting at left main bifurcation lesions: micro-CT analysis using a three-dimensional elastic bifurcated coronary artery model

Abstract

Stent struts protruding into ostial side branch called “jailed strut” at bifurcation lesions is a likely cause of thrombus formation. We aimed to investigate the influences of multiple kissing balloon inflation (KBI) for stent expansion, and stent platform design, respectively, on the reduction of incomplete stent apposition area (ISA area) caused by jailed struts at a side-branch ostium, using a three-dimensional elastic left main (LM) bifurcated coronary artery model. The referenced LM bifurcation angle data of 209 patients were stratified by tertiles focusing on the angle between the LM trunk (LMT) and left anterior descending artery (LAD). A bifurcation model was fabricated with angles of 129°, 122.2°, and 76.4° for LMT–LAD, LMT–left circumflex (LCx), and LAD–LCx, respectively, and with diameters of 5, 3.75, and 3.5 mm for LMT, LAD, and LCx, respectively; these diameters fulfill Murray’s law. A 75 % stenosis was included along the LMT. One-time and three-time KBIs were conducted using two-link Nobori and three-link Xience Xpedition (n = 6 each). The ISA area was quantified using micro-CT. Three-time KBI was effective in reducing the ISA area compared with one-time KBI for both the Nobori (p = 0.05) and Xience Xpedition (p = 0.07). The ISA area was smaller in the Nobori than in the Xience Xpedition, both in one-time and three-time KBI (one-time KBI: p = 0.003; three-time KBI: p = 0.001). Our findings of this study on reducing the ISA area by focusing on an interventional technique and stent design may help to improve coronary bifurcation intervention for a possibly better long-term clinical outcome.

Finite element analysis of cutting balloon expansion in a calcified artery model of circular angle 180°: Effects of balloon-to-diameter ratio and number of blades facing calcification on potential calcification fracturing and perforation reduction

“…In a clinical setting, there are no measures to guide two blades facing the calcification. However, we have shown that three-time repetition of delivery-balloon inflation for stent deployment increased the luminal cross-sectional area [ 28 , 29 ]. Repeating the cutting balloon inflation by changing the rotation of the cutting balloon catheter may change the direction of the blades and may be able to adjust two blades toward the calcification.…”

Outcomes at 1 Year of Non-Left Main Trunk Bifurcation Lesions Treated With a 2-Stent Strategy Using Newer-Generation Everolimus-Eluting Stents

“…16 In fact, a previous bench test showed that the 2-link stent had a wider SB ostium and lower stent strut jail. 17 Furthermore, optical coherence tomography analysis showed that a lower number of links reduced the incidence of the link-connecting configuration. 18 For these reasons, a lower number of links may have improved the angiographic outcomes in the bifurcation lesions.…”

The impact of proximal cell rewiring compared with distal cell rewiring with single-stent deployment and subsequent kissing balloon inflation in the inadequate jailing of a Kaname stent on the side branch ostium

“…The second guidewire was recrossed through a target stent cell in front of the SBO under visual guidance, and SB dilation was performed with a 3.0 × 15 mm semi-compliant balloon 3 times, each time for 20 s, balloon inflation pressure was 6 atm according to the compliance chart. KBI was then performed 3 times [12] for 20 s each using two 3.0 × 15 mm semi-compliant balloons with minimal overlapping [13] and balloon inflation pressures of 6 atm. The balloon diameters for KBI were determined by Finet's formula: 0.678 × (3.0 mm + 3.0 mm) = 4.02 mm [14].…”