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
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Figure 1 Minimum lumen diameter (MLD) predicted by the manufacturer at the pressure used compared with intravascular ultrasound (IVUS) and quantitative coronary angiography (QCA) measurements within the stent. The MLD measured by either IVUS or QCA was significantly smaller than the manufacturer’s expected values.
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Figure 2 Minimum stent lumen cross-sectional area (CSA) predicted by the manufacturer and measured directly by intravascular ultrasound (IVUS). The measurement of minimum stent CSA by IVUS was significantly smaller than the manufacturer’s expected stent CSA.
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Figure 3 Relationship of stent lumen cross-sectional area (CSA) between manufacturer’s stated values and in vivo intravascular ultrasound (IVUS) measurements. The manufacturer’s expected areas were determined from a combination of two kinds of stents (Guidant/Tristar or AVE-Medtronic/S670), four stent sizes (2.5 mm, 3.0 mm, 3.5 mm or 4.0 mm) and two inflation pressures (14 or 16 atm).
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Figure 4 Stenting a left anterior descending coronary artery lesion. Upper left panel: Baseline angiogram shows a severe stenosis at the trifurcation of a diagonal and large septal branch. Upper right panel: After rotational atherectomy and cutting balloon dilation, a 3.5-mm Tristar stent was deployed at 16 atm. There is no residual stenosis, but the minimum stent diameter was 2.8 mm by quantitative coronary angiography. Lower panel: Intravascular ultrasound (IVUS) imaging just after stenting. Intravascular ultrasound revealed a major and minor diameter of 3.2 mm by 2.4 mm, which was 63% of the manufacturer’s expected stent diameter. The predicted stent area at 16 atm was 11.4 mm2. The actual minimum stent cross-sectional area measured by IVUS was 6.0 mm2, which was 53% of the manufacturer’s expected stent area. MLA = minimum lumen area; MLD = minimum lumen diameter.
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