CLINICAL STUDY
Optimizing stent expansion with new stent delivery systems
Yuzuru Takano, MD, PhDa,
Lawrence A. Yeatman, MD, FACCa,
James R. Higgins, MDa,
Jesse W. Currier, MD, FACCa,
Erick Ascencio, RTa,
Kristin A. Kopelson, NPa and
Jonathan M. Tobis, MD, FACC*,a
a University of California, Los Angeles Center for Health Sciences, Los Angeles, California, USA
Manuscript received April 10, 2001;
revised manuscript received July 20, 2001,
accepted August 15, 2001.
* Reprint requests and correspondence: Dr. Jonathan M. Tobis, 10833 Le Conte Avenue, Room BL-394 CHS, Los Angeles, California 90095-1717 USA jtobis{at}mednet.ucla.edu
OBJECTIVES
The purpose of this study was to assess whether the newer stent delivery systems provide a stented lumen cross-sectional area (CSA) that is equal to the delivery balloon nominal dimensions.
BACKGROUND
First generation stents were often not adequately expanded with their delivery system and frequently required higher pressure or a larger balloon after deployment. Newer stents were designed to optimize expansion with noncompliant, high-pressure balloons provided as the delivery systems.
METHODS
Intravascular ultrasound (IVUS) was used to evaluate 38 stents in 32 patients after deployment at 14 to 16 atm with their delivery balloon system. Minimum stent lumen CSA and stent minimum lumen diameter (MLD) were measured by IVUS imaging. The manufacturers expected stent diameter was defined as the balloon diameter measured by the company at the maximum pressure used. The manufacturers expected stent area was calculated based on the manufacturers expected stent diameter.
RESULTS
The MLD (2.5 ± 0.5 mm) and minimum stent CSA (6.0 ± 1.7 mm2) by IVUS were significantly smaller than the manufacturers expected stent diameter (3.5 ± 0.4 mm) and area (9.5 ± 1.9 mm2) (p < 0.0001, respectively). The mean MLD by IVUS was 72 ± 8% of the expected stent diameter, and the mean minimum stent CSA by IVUS was 62 ± 10% of the expected stent area.
CONCLUSIONS
Despite moderately high-pressure inflations, the mean minimum stent CSA actually achieved was, on average, only 62% of the manufacturers expected stent area. To optimize stent deployment, these IVUS observations should be considered during coronary artery stenting.
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Abbreviations and Acronyms
| | CSA | = cross-sectional area | | IVUS | = intravascular ultrasound | | MLD | = minimum lumen diameter | | QCA | = quantitative coronary angiography |
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